Irregular periods, acne and unwanted facial or body hair are common, and are often put down to stress or weight. In many women they have a hormone cause that can be treated. The most common cause is polycystic ovary syndrome (PCOS), which affects roughly 1 in 10 women of reproductive age.
Common symptoms
- Periods that come less often than every 35 days, more often than every 21 days, or fewer than 8 times a year
- Excess hair on the face, chin, chest, abdomen or back (hirsutism)
- Persistent acne, oily skin, or thinning hair on the scalp
- Weight gain, especially around the waist, and difficulty losing weight
- Dark velvety skin on the neck or in the armpits
- Difficulty conceiving
How PCOS is diagnosed
PCOS is usually diagnosed when two of these three are present, after other causes have been ruled out:
- Irregular or absent ovulation, shown by irregular periods
- Signs of high male hormones (androgens), either on examination or in blood tests
- Polycystic ovaries on ultrasound. This is not used in teenagers within 8 years of their first period, because many healthy teenage ovaries look this way.
Other causes that must be ruled out
- Thyroid problems
- High prolactin
- Non-classic congenital adrenal hyperplasia
- Cushing's syndrome
- Pregnancy
See a doctor soon if excess hair or acne appears quickly over a few months, or comes with a deepening voice, increased muscle bulk or enlargement of the clitoris. These can be signs of a hormone-producing tumour.
Tests
- Testosterone and other androgens
- Thyroid function (TSH) and prolactin
- 17-hydroxyprogesterone, to check for congenital adrenal hyperplasia
- Glucose tolerance or HbA1c, and a lipid profile
- A pelvic ultrasound when appropriate
Treatment
- Lifestyle changes: even 5% weight loss can restore regular periods in many women.
- To regulate periods and protect the womb lining: hormonal pills or cyclical progesterone.
- For excess hair and acne: anti-androgen medicines, used with reliable contraception, alongside laser or other hair removal.
- For insulin resistance and metabolic risk: metformin or other medicines where appropriate.
- When planning pregnancy: ovulation treatment, coordinated with your gynaecologist.
Women with PCOS have a higher risk of diabetes, so sugar and cholesterol should be checked regularly, even in young women.
Consulting Dr. Prasadh Rao L
Dr. Prasadh Rao L (MBBS, MD (General Medicine), DM (Endocrinology)) is an Assistant Professor of Endocrinology at Madras Medical College, where these conditions are seen and managed regularly. Treatment is planned individually, because the right choice depends on the cause, your age, other health conditions and your plans, such as pregnancy. Consultations are available at Dr. PD's Diabetes and Endocrine Speciality Clinic, Maduravoyal (Mon – Sat, 7:30 – 9:30 PM), at Dr. RK Podiatric Institute, Kolathur (4:00 – 6:30 PM), and by appointment at partner hospitals and clinics. See all locations or read the doctor’s profile.
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Written by Dr. Prasadh Rao L, MBBS, MD (General Medicine), DM (Endocrinology). Assistant Professor of Endocrinology, Madras Medical College. Tamil Nadu Medical Council Reg. No. 96520.
This article is for general information. It is not a diagnosis or a treatment plan. Please don't start, stop or change any medicine without speaking to your doctor.