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Live Chat to Prof. Stephen Franks about Polycystic Ovary Syndrome
Thursday 20 February 2003, 3.30-4.30pm

Barbara Myers The Check Up live web chat about Polycystic Ovary Syndrome has now finished. Thanks to everyone who sent in questions for our guest Professor Stephen Franks, Professor of Reproductive Endocrinology, Imperial College London.

We had a great response - there just wasn't time to answer them all. Read the full transcript below.

From Susan Davies: What are the typical symptoms of Polycystic Ovary Syndrome?

Prof. Stephen Franks: Lack or irregular periods; unwanted body hair; acne. But not everyone with polycystic ovaries has all these symptoms and some have none.

From Sheila: I think I may have PCOS what should I do next? I have previously tried to conceive and was told that I would need IVF treatment as I had more male than female hormones. I am currently not in a realtionship but have suffered depression and have been overweight for most of my life, I seem to gain weight very easily. I have been tested for diabetes but it came back negative but I do have an excess thirst. I am 37 and have acne and facial hair

Prof. Stephen Franks: This could well be PCOS. Get your doctor to check it out. It need not affect your fertility and by improving the symptoms you may well feel better and be able to get on with your life.

From Tineke: Is the depression assosiated with the syndrome due to the hormone imbalance or a result of the side effects of the disorder. My 20 year old daughter is not diagnosed but has so many of the symptoms that I suspect she has. Only about 3 periods ever, recently developed acne, weight problems, depression. She is at University and is extremely unhappy. GP has advised her to take "The Pill". She doesn't want that because she says she will put on even more weight. Also if no diagnosis is made, why indeed should she start taking the pill? I wish she was at home so that we could visit the doctor here together. She is so depressed!

Prof. Stephen Franks: Polycystic syndrome doesn't cause depression, but of course the symptoms may be very distressing and depressing particularly for a girl at that age. We often suggest psychological support as well as medical treatment in this situation. The Pill is probably sensible treatment and there is no evidence that it will increase her chance of gaining weight.

From Carol: I've got got polycystic ovaries, and am therefore at risk of reduced fertility. I'm 36, (ie knocking on a bit) and am not planning on having children, but I might. I wonder given these circumstances if taking the pill would have any further detrimental effect on my fertility (obviously once I came off a couple of years)?

Prof. Stephen Franks: No, the Pill will have no adverse effect on your chance of fertility. But at 36 it's probably time to think about stopping the Pill if you want to get pregnant!

From Stephanie: Despite a recent scan for polycystic ovaries coming back normal I still bear the trademark hirsuitism and weight problems. At 50 I am now most concerned as to whether my first real experience is just menopausal or if the original scan was wrong - what should my next question to my GP be? I have had facial hair since my twenties and been overweight since my thirties despite having a more than normally physical job. I have twice been prescribed dianette despite being a long time celibate and have been told to shave as the only way of controlling hair growth

Prof. Stephen Franks: Ultra sound scans of the ovaries are not 100% reliable at diagnosing polycystic ovaries, especially if you're approaching or have passed the menopause.

Fortunately in most women unwanted hair improves after the menopause, but in a few it may not improve significantly or even get worse. It is perfectly possible to use either Dianette or the active ingredient of Dianette (cyproterone acetate) on its own or as part of an HRT preparation. This can be very effective in reducing unwanted hair. Losing weight is also likely to help your symptoms.

From Angela Ellingsen: I have PCOS and have dealt with this condition for the past 16 years. During the first 15 years doctors treated me with steroids and other drugs because they did not recognize the root cause of my condition. They were so-called experts, but they just told me to resort to drastic medical alternatives. Dieting was futile. I finally found a modern-thinking woman doctor who put me on glucophage, and I have manged to lose 180 pounds so far. Can you discuss why most endocrinologists in the US are so ignorant in the proper treatment of PCOS when glucophage has been prescribed in the UK for the past 25 years?

Prof. Stephen Franks: Metformin (glucophage) for treatment of women with PCOS was actually reported in the US about five years ago and has been used both in the USA and the UK since. It has been used for many years for treatment of diabetes but only recently for treatment of PCOS.

From David Mann: My 12 years old daughter recently had an ovarian cyst: it eventually ruptured, requiring an emergency laparoscopy. During the op. the surgeon had a good look round, and decided that she had POS - I saw the notes. But at a later checkup the Consultant did not mention this and the Radiologist who performed a lengthy ultrasound scan said she could not see signs of POS. Nevertheless, the Consultant has prescribed 'the pill' for my daughter. Has it gone? Is POS a temporary thing in very young women? (Her periods started 8 months ago) Will it come back? Is this becoming more common? Should we insist on further checks?

Prof. Stephen Franks: Single big cysts may occur in girls during puberty. These usually cause no problems but rarely they may rupture and require treatment. There is no evidence that this is linked to polycystic ovaries.

Polycystic ovaries are very hard to diagnose in girls of 12 and we are very careful about making this diagnosis. In girls of this age, the ovaries usually contain several small cysts - this is a normal feature of the developing ovary.

However, the pill may be useful in teenagers if they're having a lot of problems with irregular and heavy periods. I suggest you clarify this with your specialist.

From Jane: Do PCOS cysts always remain benign? Does their presence increase the chance of developing complications? Do they ever need to be removed?

Prof. Stephen Franks: Yes, they are always benign. It is important to know that "cysts" in the ovaries are normal. Both normal and polycystic ovaries contain small cysts inside which are the eggs. In women with regular cycles (whether or not they have polycystic ovaries) one of these cysts grows each month and the egg is released in the middle of the cycle. In women with PCOS who have no periods, or infrequent periods, the cysts seem to get "stuck" before the egg can mature. We think this is because of the imbalance of hormones. Only very big cysts cause problems and may occasionally need to be removed, but large cysts are no more common in women with polycystic ovaries than in those without polycystic ovaries.

From Margaret: My 19 year old daughter was diagnosed with Diabetes in the summer of 2001 - 2 days before going to University. Post puberty, she seemed to show the classic signs of polycystic ovaries - skin problems, weight gain, PMS, painful periods etc. After much nagging from me (what are mothers for, after all?) she had tests for polycystic ovaries which were negative.

Listening to your programme trailers has made me think again that her symptoms seem so accurate for the condition - do you think it might be worth more tests being carried out to see if she really does have the condition - or something similar?

Prof. Stephen Franks:Although it is possible that the PCOS has been a factor in her developing diabetes, it's very unusual for this to be the case in young women and there probably other more important factors involved.

I do not think an earlier or more positive diagnosis would have made a difference to her developing diabetes.

She really only needs more tests if she has disturbing symptoms and the focus should be on her diabetes. Sometimes the ultra sound scan is quite difficult to perform and it isn't always possible to get a good view of the ovaries to confirm that they are polycystic. So one negative scan does not exclude PCOS.

From Sara: What is the likelihood of the condition of PCO and chances of fertility improving over time?

Prof. Stephen Franks: Symptoms often get better with time provided you don't gain too much weight. In a recent study from Holland looking at women with PCOS in their late 30s and early 40s, it was found that they had more regular periods than when they were younger.

Unfortunately, fertility does not improve with age but it is not uncommon for women who have had problems conceiving (and have needed hormone treatment) to have a further pregnancy without any medical help.

From Rachael Griffin: What is the best course of diet for someone with PCOS who wants to lose weight?

Prof. Stephen Franks: It's very important to lose weight. A modest reduction in weight of between one and one and a half stone can make a huge difference to symptoms, eg periods may become more regular and, in time, hair growth may be reduced. There is no particular diet which better than any other. It is simply a matter of reducing calories and probably spacing out your meals more regularly. Some people swear by certain types of diet, eg the Atkins Diet, but there is no scientific evidence that this is better than any other low calorie diet. The most important thing is that the diet is palatable. Regular exercise is an enormous aid to losing weight.

From M Smith: What tests do the doctors do to see if you have polysystic ovary syndrome?

Prof. Stephen Franks: A simple blood test and an ultra sound of the ovaries and womb.

From Janeth Cardenas: I am 34 years old and after taking clomid I got pregnant. I was diagnosed with PCO, however my weight has always been normal and I don't have any facial hair. I don't use any contraceptives. I do get quite tired and irritable and my sex drive is very low. Is this due to the PCOS? Is there any alternative medicine for women with PCOS? Finally, is it true that the lack of periods can cause cervix cancer? Please help me.

Prof. Stephen Franks: First of all, irritability and low sex drive are probably no more common in women with PCOS than those without. A low sex drive can be a side effect of some types of treatment for unwanted hair (eg Dianette) but even this is uncommon. There is no link between PCOS and cervical cancer. Infrequent periods may lead to a build up to the lining of the womb, which is a risk factor for cancer of the womb, but this risk can be easily reduced by progesterone-containing hormonal treatment - which you're very likely to receive from your doctor if you're not having periods.

That's all the questions we have time for today. As a final reminder, Professor Franks says that if you are unfortunate enough to be suffering from the distressing symptoms of PCOS, and you are overweight, then one of the best things you can do to help yourself, to feel better about yourself, is to lose weight. It's not easy, but even a modest weight loss will improve your symptoms and your long-term health.

If you have experience of PCOS, you may like to share your thoughts on the Science Message Board.


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