PCO / PCOS

Polycystic ovaries (PCO) is a very common condition in our community. Depending on the exact definition we may choose to use, as many as 15% or even 20% of the population will show these typical features on ultrasound examination. It is hardly a rare condition.  It is also a very bad term.  The word cyst immediately tends to raise concerns in a woman’s mind. “Cysts” tends to imply structures which require surgical removal, and even raise fears and concerns about the possibility of cancer or other gynaecological diseases.  When a woman learns that she has 25 “cysts” in one ovary, and 15 in the other, it is hardly surprising that she becomes deeply concerned.

These are not “cysts” in the sense that you would know them, however.  They are the normal tiny “follicles”, the tiny fluid filled sacs in which the eggs grow, and measure only 4 to 8 mm. in diameter.  They do not have to be surgically removed and, even if we did, a whole new group would immediately re-form. It is perfectly normal for all women of reproductive age to have these follicles in her ovaries.  Indeed, we would be extremely concerned if we did not see them on an ultrasound examination.  The word “poly” simply means “lots of”. A woman with PCO simply has many more of these follicles in her ovary than would normally be seen on an ultrasound examination. Perhaps we should have called it Polyfollicular Ovaries. I am sure that it would have caused much less concern and anguish.

About half of the women who have these changes on their ultrasound scan will have a group of clinical and hormone features which put them into a medical category known as polycystic ovarian syndrome (PCOS). You must have PCO to have PCOS, but only half of the woman with PCO have PCOS.

What are those hormonal features?

• A tendency towards having a real problem with weight (though many women with PCOS have normal weight).
• A tendency to very irregular menstrual periods and non-ovulation cycles.
• A slight increase in the production of male hormones called androgens. It is important to remember that all women produce male hormone. It is perfectly normal to do so.  With PCOS, however, the level of male hormone tends to be increased.  Women with PCOS will tend to have a problem with abnormal hair growth patterns and poor skin.

A woman does not have to have all three of these hormonal features for a diagnosis of PCOS to be made.

PCOS and Fertility Problems

It is very sad that so many young women are left with the impression that a diagnosis PCOS means that they are going to be unable to have a family. This is not so. PCOS will not prevent you from having a family but it may mean that you will need assistance to get you ovulating normally. It may also slightly increase your risk of miscarriage.  Many women with PCOS will not routinely ovulate and may require medication to achieve this. This is what we call ovulation induction.  Ovulation induction, for most women, is easy to do. If you are overweight, you may be able to achieve this naturally, simply with weight loss.

PCOS and Long-term Health

There are some long-term health issues associated with PCOS.  Women with PCOS are many times more likely to develop diabetes later in their lives. They may also have an increased risk of hypertension and heart disease. The most important long-term health issue for any woman who has been diagnosed with PCOS is to ensure that her weight is kept under control and that she regularly monitors her blood sugar levels.

Women with PCOS also have a very slight increased risk of cancer in the lining of the womb. Any history of abnormal or unusual vaginal bleeding should be reported to your doctor.

Polycystic ovaries