It may be one of the most common conditions affecting women, but diagnosis can be difficult. At least two symptoms must be usually present before further tests are ordered to confirm polycystic ovary syndrome, or PCOS, as it is commonly known. Irregular periods, raised male hormones, excessive body hair, acne and infertility are some of the signs of the endocrine disorder. “Girls usually come to us with irregular periods, sometimes with excessive hair growth and acne. But we try not to diagnose the condition when patients are children, because it’s common to have some amount of irregularity when they have their periods in the first few years,” said Dr Hemashree Rajesh, Senior Consultant, Department of Obstetrics and Gynaecology, Singapore General Hospital (SGH). Irregular periods can be due to other causes such as thyroid or adrenal disorders, and excessive secretion of prolactin, the milk protein. “So before we diagnose a patient with polycystic ovaries, we have to make sure that they do not have any of these,” she added.

As the name suggests, women with the condition have many tiny cysts in their ovaries. So patients may have to undergo ultrasound tests that use sound waves and a computer to generate images of blood vessels, tissues and organs to assess the size of the ovaries and check whether cysts are growing there. The test can also look at the thickness of the lining of the uterus.

Because many women with ovaries that look polycystic on ultrasound have regular periods, yet do not have PCOS, doctors look for additional symptoms, such as raised hormone levels, severe acne or excessive hair growth before coming up with a diagnosis. A patient’s blood can be drawn to test for abnormal levels of the male androgen and other hormones, blood glucose, cholesterol and triglyceride. Elevated levels of male hormones can lead to excess facial and body hair, as well as severe acne.

What causes PCOS? “We think there could be a genetic component, but there are also many associated lifestyle factors. PCOS does not cause patients to put on weight, but those who put on weight tend to exhibit more symptoms of polycystic ovaries; if they then lose weight, there is some reversal. It’s predominantly genetic, and worsened by lifestyle factors,” said Dr Rajesh, who noted that South Asian women tend to be at higher risk of PCOS. It is not just obese patients who develop polycystic ovaries. Patients who have so-called thin polycystic ovaries do not show significant weight gain.

Patients with PCOS may be more prone to conditions such as infertility and, later in life, complications like heart disease, diabetes, depression and sleep apnoea.

Women who ovulate regularly experience elevated levels of oestrogen in the first half of the menstrual cycle, and progesterone in the second half of the menstrual cycle. When their periods are irregular, their bodies tend to make too much of male sex hormones like testosterone. Hormonal imbalance makes women more prone to issues like cancer of the lining of the womb. Being unable to ovulate regularly also means they will not be able to conceive, and they will be prescribed medications to help with ovulation. Indeed, said Dr Rajesh, PCOS is a major cause of infertility.

Nevertheless, PCOS is a common and treatable condition, and early detection and lifestyle modifications can help symptoms. “We try to tailor the treatment to the symptoms. Women with hormone imbalances seeking to conceive may be prescribed ovulation induction agents. Those with excessive hair growth may be put on contraceptive pills to minimise their male hormones,” said Dr Rajesh.

Dr Rajesh has seen patients as young as in their 20s with cancer of the uterus who need to be on long-term treatment due to polycystic ovaries. “We hope that, by highlighting the symptoms to look out for, patients can seek professional medical help early and not wait for the end stage,” she said.

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