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PCOS is a common hormonal condition that affects up to 10% of women. It is typically associated with irregular periods along with signs and symptoms of androgen excess (typically increased hormones such as testosterone), which can cause acne or unwanted hair growth. PCOS may also be associated with difficulties losing weight and an increased risk of ‘metabolic disease’. Metabolic disorders refer to issues with the body’s metabolism and include conditions such as diabetes, hyperlipidaemia and fatty liver disease.

About 70% of women with PCOS may have issues with ovulation, whereby an egg is not release every month. This can have an impact of fertility, but this should be termed ‘subfertility’ rather than infertility. This is because anovulation (absence of ovulation) can be effectively treated with medications in many cases, including drugs like metformin, letrozole and clomiphene. Some patients with PCOS do go on to require assisted conception with treatment such as IVF, but this is only if other more conservative treatments have not been effective.

PCOS is a lifelong disorder without cure, however we can effectively manage the symptoms and health complications of the condition through regular clinical consultations and with certain medications. We prescribe a variety of medications in specialist endocrinology or gynaecology clinics which can control some of the health consequences of PCOS. These include medications to help with weight loss, to treat absence of ovulation (see above), to regulate menstrual cycles or to treat symptoms of androgen excess such as acne or hirsutism (unwanted hair growth).

Yes. There is a lot of published evidence that a diagnosis of PCOS is associated with an increased risk of mental health problems/conditions including anxiety, depression and low self esteem. This has also been found in large population studies which report mental health diagnoses in thousands of women with and without PCOS. It is unclear at this point whether the hormonal disturbances in PCOS directly impact on mental health or whether symptoms such as low mood, low self-esteem or increased anxiety are driven by PCOS-related issues such as weight, skin issues or general well being.

Combined oral contraceptive pills (COCPs) contain both synthetic or artificial forms of oestrogen and progesterone. They work as contraceptives by blocking ovulation. Other benefits for patient with PCOS include regulation of the menstrual cycle, easing of menstrual or ovulation pain, and a reduction in the severity of acne and hirsutism (unwanted hair growth). For these reasons they are often a very effective treatment option for PCOS. However COCPs can increase the risk of blood clots (venous thromboembolism) by about 3-5-fold compared to women who do not take the pill, although the overall risk remains very low. They are also associated with an increased risk of high blood pressure (hypertension). These risks are higher in patients with increased weight, in those who smoke and in older patients. For this reason we do not in general prescribe the COCP for women with PCOS with a BMI above about 35kg/m2, in those who smoke or in those more than 35 years of age. We also generally avoid these pills in patients with a background of migraine, particularly migraine with aura, as there is an increased risk of stroke. For other patients with PCOS, COCPs are usually very safe, effective and well tolerated.

Progesterone only pills such as desogestrel, which work in a different way to COCPs, are safe in older patients including those with increased weight, and the risk of blood clots is not increased with this group of medications.

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