PCOS 1

Hi, Everyone. Welcome to today’s video. Today we’re going to be chatting about polycystic ovarian syndrome, otherwise known as PCOS. We’re going to chat about how we diagnose it, what are the health implications and the different ways we might help you fall pregnant. So, let’s start off just by clearing the air and a lot of panic about the word cyst, in the name, polycystic ovarian syndrome. You do not have an ovary full of cysts, cysts often come along with a lot of scary thoughts like surgery or health implications or cancers, this is not what we’re talking about.
We’re talking about an ovary that is still jam packed full of those little follicles. Remember a follicle is that little egg factory that when it receives the right signals will then grow and eventually release the egg and ovulate. So, your ovary is full of these little potential eggs that have been sitting there that haven’t received the stimulus to grow in that cycle. Now, sometimes these little follicles that are sitting there in the ovary they might have bypassed the time of which they can actually receive a signal and grow. There might be on their way sort of dying out; this doesn’t mean that you have a lot of eggs that are dying out. What it means is you’re not actually stimulating the little follicles to grow and release every month.

So, when it comes to identifying who’s at risk of having polycystic ovarian syndrome, we use something called the Rotterdam criteria. So, these are three different criteria for symptoms or results you might find on investigation. We put these together and if you meet two out of the three criteria, we would consider you for the diagnosis of polycystic ovarian syndrome. So, when we are talking about a normal cycle, this will obviously mean you need to keep track of your cycle. There are a variety of apps that are available on the App store on Google play, or you can even just jot these down in your diary.

If you’re going to do that, the way you work out what a normal cycle is, is 21 to 35 days. This goes for late teenage years, twenties, thirties, early forties, where that is a relatively regular cycle between 21 and 35 days. We would also expect you to have at least eight periods in a year. And any one cycle that lasts more than 90 days is concerning. Obviously, it doesn’t really count that this is related to pregnancy, but if you have had one cycle lasting more than 90 days or three months between periods, that’s something you should bring up to your gynecologist.

So, for any moms watching this and worried about their early teenage daughters, the very first year from the start of your menstrual cycles is allowed to be completely crazy and [inaudible 02:29] you’re allowed to have a very regular cycle. Between one and three years after the start of your menstrual periods then at that point you should have some form of regularity between 21 and 45 days. They’re allowed to be a little more crazy because your body is still trying to mature and get used to having cycles. But if they start falling longer than 45 days or shorter than 21 days, then that’s still a concern.

The second criteria we look at are signs that either clinically or on our blood tests, you have excess androgen levels. So too much of those androgen hormones; every woman needs to have androgens. And you might know the most common form of androgen, which is testosterone. So, every woman needs to have these androgens, we just don’t want you to have too many of these androgens circulating. So, we look at two different things, as I said, clinically, and biochemically so on a blood test. Some of the things that might make us concerned that they’re elevated androgen levels might be excess male pattern hair growth, such as mustache, chin hair, might have hair on nipples, little garden path, excess hair on the back. Another thing we might look for is severe acne. Obviously, this can get a little bit confusing in your teenage years, where you might be more prone to suffering from acne, but this is an ongoing problem. It might be a sign that there are excess androgens circulating.

We will also then check for your blood test levels for the different androgens. And if those do come back raised, we will look for other causes that can elevate your androgen levels. So, there are a few other things other than polycystic ovaries that can cause your androgen levels to be quite high. And we would do a few tests to look for these because obviously treatment might differ a little bit between those conditions and polycystic ovaries. The third criteria is what the ovaries look like on ultrasound. So, we will look for those little cystic structures, those little egg factories on the ovary, and we will count them on both ovaries. And we’ve got a specific level that has been increasing over the years as our ultrasound technology gets better. But we will count those little follicles, and if they meet a certain number, then we will say the ovary has a polycystic ovary appearance. We call it a morphology that’s the fancy word for it. So just because your ovary looks polycystic, it doesn’t mean you have polycystic ovarian syndrome.

So, what your doctor will do next is have a look at those three criteria and see if you fulfill two out of the three criteria. Remember that when it comes to your androgen levels, we need to have made sure that it’s not better explained by another condition. So, in other words, high testosterone not being caused by another problem. If you still meeting two out of those three criteria, then we will consider you for the diagnosis of polycystic ovarian syndrome. Next let’s have a look at what are some of the other health implications of having polycystic ovaries.
So, one of the things that your doctor is going to keep an eye on are signs of metabolic syndrome. So, we keep an eye on your weight, your waist to hip ratio, because this can be a sign of metabolic syndrome. We’re going to keep an eye on what your insulin levels are like and your fasting sugar levels. We also going to keep an eye on your cholesterol and your blood pressure. You are at risk of metabolic syndrome and this doesn’t mean that you are going to be getting heart attacks and strokes and be obese with high cholesterol and sugar problems the minute you’re diagnosed with polycystic ovaries. This is a lifetime risk we’re talking about. So it’s very important once you have been given this diagnosis to try and focus on improving all of those things, your diet, your exercise, losing some weight and making sure that your doctor does keep an eye on your cholesterol and your blood pressure whenever you go for your annual checkups.

Another condition that has been associated with polycystic ovarian syndrome is something called obstructive sleep apnea. Now, the ways you might know that you might have this is if your family members or your partner complain about excessive snoring. If you wake up in the morning, feeling exhausted and you go throughout the day, feeling incredibly tired, you might have obstructive sleep apnea. Now your gynecologist might not be the best person to deal with this problem for you, but they can refer you to a sleep clinic and try and assist you with this problem. It’s just important to bring these issues up to your gynecologist so we can get you to the right treatment.

Periods can be unpleasant and quite disruptive. So, some patients will say, Oh, well, I quite like not having a period more than once every three or four months, and might be a bit irritated that the doctor wants to give them medication to give them a regular period. One of the reasons we don’t want you going for very long period of time without having a bleed is because that lining within the uterus can actually build up and over time, I’m talking about years and years and years of not having a frequent period, you might be putting yourself at risk of getting cancer in that lining. Now, this is very different from when we take away your periods medically with something such as Mirena, we’re not putting you at any risk of cancer of the lining of the womb. And in fact, we might be reducing your risk of cancer. Same as with the contraceptive pill, can reduce your risk of cancer of the lining of the womb. Some other medical treatments can do this too.

So, your doctor might prescribe a tablet called Provera, which is a form of progesterone to make sure you are cycling every month. They might put you on a contraceptive pill or if for periods are real hassle, they might consider Mirena, which is a contraceptive device that takes away the period. But the main reason for this is avoiding the risk of you getting cancer of the lining of the womb.

Now, this is not a case of you have polycystic ovaries you will get cancer one day. This is a case of us managing your cycles to prevent you being at risk of getting cancer later on. Some of the other important things you can do is keep your weight down, keep your blood pressure well controlled. Keep your cholesterol down, keep the sugar controlled to make sure that you don’t develop diabetes from your lifestyle.

Before we carry on. I just want to highlight one important thing. This is a syndrome, so if you are diagnosed with polycystic ovarian syndrome, this does not mean that you are going to become overweight, have hair growing everywhere, have problems with acne. This syndrome can actually present in different ways. So, we have some patients who don’t struggle with the period, or don’t struggle with excess hair or acne, or don’t struggle with their weight. So, it can affect different women differently and we talk about these different phenotypes of polycystic ovarian syndrome. But what is quite important to chat about is how this can affect your quality of life, because there are quite a few different things going on here that might affect your self-esteem, your body image relationship. So, we need to have a quick chat about all of those things.

Let’s just check quickly before we wrap up about how polycystic ovarian syndrome can affect the rest of your life. So obviously if you are struggling with things such as trying to lose some weight or severe acne, or hair on the body that you don’t like, this might impact your body image, it might impact your diet and might put you at risk of eating disorders. So, it’s very important to bring up these issues to us so we can put you in touch with the right people to try and help. Some of the other things that your gynecologist or your fertility specialist can help you with, are excess body hair. We got different ways that we can treat this, acne as well as trying to fall pregnant. That’s obviously where your fertility specialist will get more involved. It is important that you bring up all of these aspects as it can affect your relationship if you’re trying to fall pregnant, or if your body image is suffering. You need to bring these things up to your doctor so we can put you in touch with the right people so that your quality of life can improve.

Thanks for tuning into today’s video and our next video on polycystic ovarian syndrome, we’re going to cover some of the other treatment modalities we might use. So, what we can do for struggling with acne or excess hair or an irregular period, we also give you a bit of advice on some of the guidelines for losing weight and how best to go about this. We’re not registered dieticians obviously and you should always consult a dietitian for weight loss programs. So, we can give you a few hints that you can start off with at home.

In our third video, we’re going to cover fertility and our fertility options for you. Stay tuned the next two videos they’ll follow shortly, and they will also be uploaded on YouTube and as well as our Instagram highlights reels. You can always refer back to these when you need to.