Polycystic Ovarian Syndrome (PCOS)

What is Polycystic Ovarian Syndrome?

Polycystic ovarian syndrome or ‘Polycystic Ovaries’ is by far, the commonest endocrine disorder to affect women. Estimates range from 5 – 10% of all women being affected to some degree. Some estimate put the prevalence significantly higher than that. What is not in dispute is that at least 1 in 20 women are affected by this condition. It affects women of all races roughly equally.

Endocrine disorders

It is important to understand what we mean by endocrine disorders to really understand Polycystic Ovarian Syndrome. These are disorders where there is an abnormality of production of certain natural hormones and chemicals. The abnormality could be either in increased or reduced production. Examples would include an underactive thyroid where there is reduced thyroxine hormone production or Type 1 diabetes where the production of insulin hormone is severely reduced. There are several endocrine disorders, some not as common or well known. Let’s go back to Polycystic Ovarian Syndrome.

Causes of polycystic ovaries

It is wrong to talk about causes when it comes to ‘polycystic ovaries’. It is a condition that one inherently has. Unlike the examples of endocrine disorders mentioned above, polycystic ovarian syndrome is not acquired. It does not suddenly develop at some point in life. It is a condition that an individual always has and, crucially, will always have. Because it is a condition that is reproductive hormone related, it starts manifesting itself in the mid to late teens.

The name ‘Polycystic Ovarian Syndrome’ (PCOS)

In clinical practice, one always encounters this inevitable question once the diagnosis has been made: “Why don’t you just remove the cysts?” It is an understandable question but completely misguided as far as the nature of the condition is concerned.

When an ultrasound scan is performed to look at the ovaries in a woman with this condition, the ovaries are typically found to have multiple very small cysts all around the periphery. This finding has been dubbed ‘the necklace sign’ due to the small cysts being evenly spaced all around the periphery. The cysts are a manifestation and not a cause of the condition. Removing them is neither feasible nor beneficial.

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The ‘necklace sign’. The dark rings around the periphery of the ovary as seen in this scan picture are the tell-tale ultrasound feature of Polycystic Ovarian Syndrome.