AILESBURY MEDICAL: Polycystic ovary syndrome (PCOS) explained by Dr. Patrick Treacy

PR Log (Press Release) – Jun 21, 2009 – ML You mention Metformin, Is this an approved drug?

PJT Metformin is approved by the Irish Medicines Board as a treatment for diabetes and it is not registered as a treatment for PCOS. Even though, many doctors who keep abreast of peer journal international research will prescribe it to patients with PCOS. With this medication in my experience, PCOS patients lose weight, drop their blood pressure, and also excess body hair (all caused by high testosterone).  However, we have been there before with many other unlicensed medicines, including some antibiotics in infants, codeine in under twos, the newer safer topical steroids in the under twos, even small amounts of Zantac in refluxing infants etc etc. And it is not just in infants, cosmetic doctors encounter this situation daily in adults with the restricted use of botulinum toxin and phosphatidyl choline.

ML Tell us more about the PCOS syndrome?

PJT Polycystic Ovaries develop when the ovaries are stimulated to produce excessive amounts of male hormones (androgens), particularly testosterone, either through the release of excessive luteinizing hormone (LH) by the pituitary gland or through high levels of insulin in the blood (hyperinsulinemia) in women whose ovaries are sensitive to this stimulus. The syndrome acquired its most widely used name due to the common sign on ultrasound examination of multiple (poly) ovarian cysts. These "cysts" are actually immature follicles, not cysts ("polyfollicular ovary syndrome" would have been a better name). A majority of patients with PCOS have insulin resistance. Their elevated insulin levels contribute to or cause the abnormalities seen in the hypothalamic-pituitary-ovarian axis that lead to PCOS.

ML How is PCOS diagnosed?

PJT  In 2003 a consensus workshop in Rotterdam indicated PCOS to be present if 2 out of 3 criteria are met: (1) minimal ovulation, (2) excess androgen activity, (3) polycystic ovaries (by gynaecologic ultrasound), and other endocrine disorders are excluded.

LB What are the symptoms of PCOS?  

PJT     There are many symptoms including irregular, few, or absent menstrual periods. This may result in infertility, generally resulting from lack of ovulation. Excessive and increased body hair, typically in a male pattern affecting face, chest and legs is very common and let’s not forget hair loss appearing as thinning hair on the top of the head
There are also skin problems including acne, oily skin, seborrhoea. We see quite a number of patients with obesity and depression.

ML What are the risks of not properly treating patients with PCOS?  

PJT  Women with PCOS are at risk for the following:

•   Cancer of the uterine lining is possible, due to lack of progesterone resulting in prolonged stimulation of uterine cells by oestrogen. It is however unclear if this risk is directly due to the syndrome or from the associated obesity.
•   Type II diabetes
•   High blood pressure
•   Disorders of lipid metabolism — cholesterol and triglycerides
•   Cardiovascular disease
•   Strokes
•   Weight gain
•   Miscarriage