Kitabı oku: «The Ultimate PCOS Handbook», sayfa 2

CHAPTER 1 WHAT EXACTLY IS PCOS?

Polycystic ovary syndrome (PCOS) is a metabolic disorder that disrupts your hormones, typically giving you higher-than-normal levels of certain sex hormones and insulin, which can trigger symptoms such as irregular (or no) periods, acne, excess hair and weight gain. You may also have a number of cysts on your ovaries – these show up as dark blobs on an ultrasound scan. These are in fact empty egg follicles in a state of ‘suspended animation’, waiting for the right balance of sex hormones to come along and activate them. About one in 10 women in the UK, US and Australia develops the condition.¹

Most women with PCOS start to notice symptoms in their late teens or twenties. There’s a range of symptoms,² but you’re likely to have one or more of the following:

 absent, infrequent or irregular periods due to the imbalance of hormones

 subfertility, as you need to ovulate to become pregnant and some women with PCOS don’t ovulate regularly or at all

 acne which lasts longer than the normal teenage years – this happens if you produce too much testosterone

 obesity or weight gain

 insulin resistance: a higher-than-normal amount of insulin in your body, which creates an imbalance with other hormones and puts you at increased risk of Type 2 diabetes (by up to 40 per cent by age 40)

 excess hair (hirsutism) – if you produce too much testosterone – which can develop in places such as the face, chest and tummy

 alopecia (thinning hair) particularly at the top of your head and on your temples if you produce too much testosterone

 Long-term health risks.³ Women with PCOS tend to have a higher-than-normal risk of developing diabetes and a high cholesterol level later in life. It also increases your risk of having a stroke and developing uterine cancer.

HOW TO GET A DIAGNOSIS

If you suspect that you’ve got PCOS, you’ll need to see your doctor. If your GP also suspects that you have PCOS, they may refer you to a hospital specialist in endocrinology (medicine relating to hormones) or a gynaecologist (a specialist in women’s reproductive systems and hormones).

There are ways⁴ to confirm if you have PCOS:

1 Talking to your GP: your doctor will look out for typical symptoms such as menstrual disturbance, hyperinsulinaemia or insulin resistance (we’ll discuss this in more detail later on), hair and skin problems, and obesity. These aren’t foolproof indications, however, as you can have other symptoms, too. For instance, though many women with PCOS have irregular or absent periods, and many have menstrual cycle lengths greater than 35 days, you can still have PCOS even if your cycles are regular. And only around 40–60 per cent of women with PCOS are obese,⁵ so you may not be overweight. There’s also a distinct group of thin PCOS patients who may have even more firmly entrenched hormonal and fertility problems than their obese counterparts. And not all patients are excessively hairy but may have other problems such as acne. So your doctor can do medical tests, too.

2 Laboratory testing: Blood tests measure the levels of certain hormones so that a diagnosis of PCOS can be made. There’s considerable disagreement in the medical community about which tests to use, but generally the following are tested: FSH (follicle-stimulating hormone), LH (luteinizing hormone), total testosterone, sex hormone-binding globulin, prolactin, thyroid-stimulating hormone, fasting insulin and glucose levels. These are best obtained in the first 2–3 days after the onset of a period. A blood lipid profile should be part of every evaluation, as should a glucose tolerance test and a test to measure insulin levels.

3 Ultrasound scan:Transvaginal ultrasound⁶ is a way for your pelvis and ovaries to be ‘mapped’ to see if your ovaries look as if they are affected by PCOS. A hand-held probe is inserted directly into the vagina to scan the pelvic structures, while ultrasound pictures are viewed on a monitor. The test can be performed to evaluate women with infertility problems, abnormal bleeding, sources of unexplained pain and to diagnose PCOS by looking for slight enlargement of the ovaries and the empty follicles that show up as black ‘blobs’ on the scan (see diagram on page 9).

HOW DOES PCOS AFFECT MY OVARIES?

You have two ovaries, small organs inside your body where the egg cells are produced and stored. At puberty the number of fully-formed cells is around 300,000 – and when your body’s reproductive system is activated by puberty’s cascade of sex hormones, pumped into your bloodstream by the ovaries and adrenal glands, then each month about 20 of these egg cells, each encased in a sac called a follicle, begin to mature. One follicle eventually becomes dominant while the others shrink away. The egg within the dominant follicle continues ripening to maturity, then exits the ovary and enters the adjacent fallopian tube either to be fertilized or, if conception doesn’t happen, expelled from the body during menstruation.

But this normal cycle relies on a complex web of hormones being present at the right time, in the right amounts, for ovulation to happen. Having PCOS often interferes with this, affecting your ovaries’ abilities to nurture, mature and release an egg each month.

The best way to get to grips with how your ovaries are affected by PCOS is to compare a ‘normal’ menstrual cycle with a typical PCOS cycle.