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| CANTERBURY HEALTH LABORATORIES |
What is polycystic ovary syndrome?
How can this condition be detected?
What treatment is available?
Hirsutism
Infertility
What are the side-effects of these drugs?
The name sounds worrying, but it doesn't need to be. It is a very common condition affecting as many as 25% of "normal" women in some series. So at one end of the scale there are people with no obvious abnormality, and at the other extreme, people with excessive facial or body hair, infrequent periods and in fertility.
The cause of the condition is not completely understood, but a number of factors seem to be involved. The main problem is a regulatory one - the ovaries are being driven too hard by the pituitary gland, a little gland behind the eyes which regulates the ovaries. As a result, the ovaries make not only female hormone, but also other hormones which encourage hair growth and interfere with periods. The ovaries themselves tend to be slightly enlarged, and contain small fluid-filled cysts. These are a little larger than the follicles or eggs, which are normally found in the ovary, but are usually only a few millimetres in diameter. There is a tendency for people with this condition to be overweight, and this aggravates the regulatory abnormality, and can sometimes lead to a tendency to diabetes and blood fat problems.
If you have problems with hair growth (hirsutism), menstrual irregularity or infertility, your doctor will suggest some tests. These will probably include blood tests to look for excessive levels of androgens (hair-encouraging hormones) and pituitary gland hormones, and also an ultrasound examination of the ovaries. These tests may not be conclusive, but will exclude other important conditions. If infertility is a problem, then a laparoscopy may be carried out. This involves a short general anaesthetic, and a one centimetre cut in the navel which allows a laparoscope to be passed. Through this instrument the ovaries may be directly inspected, also the tubes and any other abnormalities in the pelvis.
Treatments for the excessive hair growth and the infertility are available, but at the moment the two types of treatment are incompatible. It is therefore very important that you should decide which treatment should take priority.
If this is mild, cosmetic methods may be all that are required. These included plucking, bleaching, waxing, depilatory creams which dissolve the hair, or shaving. Many people are worried that shaving will make the hair grow more rapidly, but there is no evidence for this. The disadvantage of these methods is that they are temporary, although they are relatively inexpensive. Electrolysis has a more permanent effect, but takes time (the hair follicles are destroyed one by one), and is therefore more expensive. If the hair growth is more extensive, then medical treatment may be considered. Although different types of treatment are available, the most common used drugs are the antiandrogens (spironolactone or cyproterone acetate). These are not curative, but reduce the rate of hair growth and the coarseness of the hair. They may take three to six months to work, and the effect gradually wears off once the drug is stopped. However many people find that it is very reassuring that the hair growth can be controlled.
This is not necessarily a problem, but if present can be treated with drugs that stimulate ovulation (formation of the egg). Clomiphene is used most commonly, and is given in a dose of one tablet on day two after the start of menstruation to day six. If you are not having periods, the tablets can be started at any time, and may result in a period approximately a month later. If necessary the dose can be increased further depending on the response. Ovulation can be checked by a rise in body temperature, or a change in vaginal mucus (it becomes more "tacky") or by a blood or urine test taken between days 22-24 of the cycle. Should treatment with clomiphene fail, then more powerful ovulation stimulation with gonadotrophins is available. This type of treatment requires more careful monitoring, and your doctor will give you further details.
Hirsutism
Spironolactone may make the periods less regular, but this can be overcome by taking it with a contraceptive pill that contains cyproterone acetate. Cyprotone acetate is given with an oestrogen to prevent contraception. It is important not to conceive when taking these drugs, as they may interfere with the development of a male baby. For this reason, no attempt is made to treat hirsutism by medical means if you are wanting to start a family.
Infertility
Clomiphene is a mild ovulation stimulant and there is only a slightly increased risk of having twins. It may cause transient flushing attacks or blurred vision. Occasionally it may cause enlargement of a cyst in the ovary, and so if you notice any lower abdominal pain, you should let your doctor know. Gonadotrophins are more likely to cause multiple pregnancy, and hence the reason for careful monitoring.