This article has been fact-checked by Dr Chong Kian Tai, urologist at Surgi-TEN Specialists, Farrer Park Hospital, Singapore.
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Polycystic ovarian syndrome (PCOS) is a chronic condition affecting 6-13% of reproductive-aged women worldwide, and up to 70% of women are undiagnosed. It is the leading cause of anovulation, which is when the ovary does not release an egg, and infertility. PCOS tends to run in families, and its manifestations vary by ethnicity. In a study of Asian American women, the risk of PCOS was higher in South Asian women compared to Chinese and Filipino women, and South Asian women had more hirsutism and an earlier onset than East Asian women. Between 1991 and 2021, the incidence of PCOS increased the most in Southeast Asia, East Asia, and Oceania.
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The exact cause of PCOS is not known. However, the result of this condition is excess androgens, or male hormones, and hyperinsulinemia, or high insulin levels, leading to the signs and symptoms of PCOS. These include:
- Irregular periods
- Hirsutism, which is excess hair on the face, chest, abdomen, and upper thighs, affects 7 out of 10 women with PCOS
- Obesity affects 4 out of 5 women with PCOS , where weight gain tends to be around the abdomen
- Acanthosis nigricans, or patches of darkened and thickened skin
- Cysts in the ovaries
- Female-pattern hair loss
- Acne
PCOS is diagnosed when 2 out of the following circumstances occur: irregular periods, elevated androgen levels known as hyperandrogenism, or multiple ovarian cysts are seen on ultrasound imaging.
PCOS can have numerous long-term effects on the body beyond reproductive system issues. This condition is associated with several risks and adverse health outcomes, including:
- Anovulation and infertility
- Increased risk of unfavourable pregnancy outcomes such as miscarriage, preeclampsia, preterm delivery, and gestational diabetes
- Higher risk of hypertension, type 2 diabetes, metabolic syndrome, non-alcoholic fatty liver disease, obstructive sleep apnea, and cardiovascular disease
- Increased risk of endometrial hyperplasia, or excess thickening of the uterine lining, which can increase the risk of endometrial cancer. The risk of endometrial cancer is 2-6 times higher in women with PCOS than in the general population
- Higher risk of mood disorders like depression and anxiety
PCOS cannot be cured, but treatments are available. The type of treatment selected depends on an individual’s symptoms and whether pregnancy is desired. Weight loss, between 5% and 10% of body weight, may normalise the menstrual cycle, improve cholesterol levels and insulin levels, and reduce acne and hirsutism. Excess hair growth can be managed with hair removal techniques.
The combined hormonal birth control (CHC) pill can be used to normalise the menstrual cycle, reduce hirsutism and acne, and reduce the risk of endometrial cancer if pregnancy is not desired. If estrogen cannot be used, progesterone-only medications can be used to induce regular bleeding to avoid long periods of time, or greater than 90 days, without a menstrual bleed, thereby providing endometrial protection.
Metformin, an insulin-sensitising medication, can help the body respond better to insulin, promote slight weight loss, normalise the menstrual cycle, improve ovulation, and reduce androgen levels.
Finally, anti-androgen medications, such as spironolactone and finasteride, may be used for hirsutism and used in combination with CHC. These medications are unsafe in pregnancy and must be used alongside effective contraception.
PCOS is a common chronic condition affecting women and can have potential adverse long-term effects on multiple body systems. Fortunately, it can be effectively managed through lifestyle adaptations and the use of medications.
