Polycystic ovary syndrome (PCOS) is a term to describe multiple cysts/follicles on the ovaries. In women that don't ovulate, it accounts for around 50% of cases. A day two/three blood test is often taken to check if there are high levels of oestrogens and prolactin. The symptoms of PCOS usually start from puberty and include:
- A LH/FSH ratio greater than 2
- An excessive amount of follicles on the ovaries
- Decreased sex hormone binding globulin (SHBG) levels
- Greater levels of oestrone than oestradiol
- High levels of prolactin
- Increased androstenedione
- Increased distribution of body hair
- Increased testosterone
- Insulin resistance
- Irregular menstrual cycles
Long-term exposure of oestrogens to the endometrium can lead to over-enlargement of the lining, as oestrogens maintain and build the endometrial lining. Excessive oestrogen can also lead to possible cancer. Some women may also develop type II diabetes. If women with PCOS become pregnant, there is an increased risk of having a spontaneous miscarriage. In Chinese medicine this increased risk of spontaneous miscarriage is due to obstruction of qi and blood to the uterus caused by damp and blood stasis. Treatment using acupuncture and Chinese herbs can reduce this risk.
Treatment for PCOS in both western and Chinese medicine is to reduce weight. This is achieved through a good diet and regular exercise, in both medical paradigms. Metformin is usually prescribed to reduce insulin levels although recent large research studies have failed to show any benefit. Clomifene is also prescribed to try and induce ovulation. If this fails, laser surgery (laparoscopic ovarian drilling) or heat therapy is sometimes used. In women who are not trying to conceive, oral contraceptives are prescribed to reduce LH levels and therefore testosterone. Unfortunately, long-term use of oral contraceptives can cause infertility. It is therefore ideal to lose weight before any medication is prescribed.