Polycystic ovarian syndrome is the most common endocrine disorder and affects an estimated 12-21% of women. Australian research suggests up to 70% of women with PCOS have not yet been diagnosed. The importance of this lies in the need to protect the long-term health of women with PCOS.
The exact causes of polycystic ovarian syndrome are not known, but are thought to be a combination of genetic and environmental factors. PCOS presents as a collection of symptoms – irregular or absent menstrual periods, infertility or reduced fertility, hirsutism (excess hair growth on the face, chest and abdomen), alopecia (scalp hair loss), acne, acanthosis nigricans (darkening of skin in body folds), obesity and increased risk of miscarriage.
Many women with PCOS will seek medical help for one or more of these symptoms, without knowing what condition they are associated with, or that they are in fact related to the same condition. As each symptom is often treated in isolation, the dots do not get connected, the real underlying cause is not discovered and PCOS is not diagnosed.
Symptoms usually arise in puberty, but are often masked by taking the convenient and very commonly used contraceptive pill. It is only years later when women are having problems falling pregnant and seek help with conception that they find out they have – and probably have had for a long time, polycystic ovarian syndrome. It is partly to do with this that PCOS has previously been seen as a fertility condition and the emphasis logically ends up being on assisting the body with falling pregnant and delivering a healthy baby.
The really important message that gets side lined whilst focus is on being able to start a family, is that PCOS has long term health risks associated with it. Between 50-80% of women with PCOS have insulin resistance, meaning their bodies produce increasing amounts of insulin in an attempt to control blood glucose. Insulin resistance predisposes them to gestational diabetes, type 2 diabetes and metabolic syndrome. Women with PCOS also tend to be overweight or obese and even those within a healthy weight range hold more fat around their middles, compared to women who do not have PCOS. Furthermore, polycystic ovarian syndrome appears to cause high triglycerides, higher total cholesterol, higher LDLs (bad cholesterol )and lower HDLs (good cholesterol). This significantly increases the risk of cardiovascular disease.
Whilst diagnosis and management may focus on aesthetics in puberty – not being the plump girl of the class, during the years of teenage angst, and fertility during the procreation years – becoming a mother. It is essential to remember that diagnosis of PCOS needs to lead to long-term management of the condition in order to prevent, or delay chronic disease and safeguard health and wellbeing in the future.