Investigations for PCOS
The diagnosis of PCOS can be suspected based on symptoms and signs. To confirm the diagnosis the following investigations will be undertaken:
- ultrasound scan of the pelvis to look at the ovaries (and the womb)
- blood test to measure the levels of different relevant hormones including testosterone
- Blood glucose test and serum lipids (in some selected cases)
Treatment of PCOS
Treatment has to be tailored according to the main symptoms at presentation
Weight loss and Diet If overweight or obese, weight loss must be the starting point as it helps to reduce the insulin levels and improve the overall hormone imbalance. Ideally the body mass index (BMI) should be 20-25. Symptoms will improve significantly and may even disappear with weight loss.
The most appropriate diet for women with PCOS is one that promotes more stable levels of blood sugar and lower levels of insulin. A low glycaemic index diet which will not cause a rapid rise in blood sugar is better for women with PCOS.
Carbohydrates should be spaced throughout the day to avoid peaks in blood sugar and insulin production. Importantly, carbohydrates should be combined with proteins and/or fat rather than be eaten alone. Drugs may be used to aid weight loss. These act by reducing gastro-intestinal absorption of fats (Orlistat). In severe cases of obesity, the gastric bypass and other similar approaches should be considered.
Hormone preparations for irregular periods
The combined oral contraceptive pill (COC) is given to regulate the menstrual cycle and to reduce the risk of endometrial cancer (cancer of the lining of the womb). The COC pill causes elevated circulating levels of sex hormone binding globulin (SHBG) in the blood which binds the androgens, resulting in improvements in the symptoms of acne and unwanted excessive hair. Dianette is a hormone preparation containing the anti-androgen cyproterone acetate (CPA) and can be used for treatment of acne and/or excessive facial or body hair growth. CPA may take 6-12 months to improve symptoms. In some severe cases, additional CPA can be added on day 5-15 of the menstrual cycle.
Metformin is a type of drug known as insulin-sensitising agent which increases the sensitivity of the tissues to insulin, reduces insulin levels in the blood stream and indirectly reduces excess androgen levels. It may therefore restore ovulation and regular menstruation in some cases. Metformin should only be prescribed to women with a BMI less than 30, who is known to have insulin resistance. Side effects include abdominal cramps, nausea and other gastrointestinal side effects.
The diuretic drug Spironolactone has anti-androgen properties. It is useful in women unable to take the COC or Metformin but it should not be taken if trying to conceive. Side effects may include gastro-intestinal disturbance and frequent periods. Finesteride is a powerful anti-androgen usually used to treat male-pattern baldness and overgrowth of the prostate in men. Although the manufacturer does not license it for use in PCOS, it is used in specialist clinics. It is particularly useful in resistant cases with good results and has few side effects. Finesteride should not be taken if trying to conceive.
Eflornithine HCl Cream (Vaniqa®) is an effective non-hormonal approach to helping women with increased facial hair. It slows hair growth by inhibiting the enzyme ornithine decarboxylase (ODC). When this enzyme is blocked metabolic activity in the hair follicle decreases and hair growth is slowed down. Vaniqa® does not remove hair therefore it needs to be used in combination with a removal method. The studies so far have looked at facial and neck hair only, so Vaniqa® is not indicated for body use.
Cosmetic treatment can be used in addition to or as an alternative to medical drug treatments for excessive hair growth. Alternatives include plucking, shaving, waxing, electrolysis and laser treatments. All improve symptoms.