Q My 23-year-old girlfriend suffers from irregular periods and serious pelvic pain. She is slim and blood tests show normal hormone levels. Yet, a year ago, her ultrasound was highly suggestive of polycystic ovaries. Her periods have regulated somewhat since going on the Pill (Yasmin) a few months ago on her doctor's recommendation. But how might polycystic ovaries affect her chances of getting pregnant? - Konstantinos Kapelas, West Wickham
A Polycystic ovarian syndrome, or PCOS, is more a collection of symptoms than a single illness. The symptoms, which include amenhorrhoea (no periods), dysmenorrhoea (irregular or painful menstruation), dyspareunia (pain during sex), hirsuitism, acne and infertility, are so diverse that physicians often find diagnosis difficult.
For a diagnosis of PCOS to have any credibility, it must include at least two of the following: anovulation (no ovulation); blood tests showing altered hormone levels [often, lutenising hormone (LH), oestrogen, testosterone and androgen are high, whereas follicle-stimulating hormone (FSH), sex-hormone-binding globulin (SHBG) and progesterone are low]; an ultrasound examination confirming 10 or more cysts on the ovary.
If left untreated, PCOS - which affects as much as 4-10 per cent of women of reproductive age - can lead to type 2 diabetes, cardiovascular disease and hyperoestrogen-related cancers.
PCOS can also make it difficult, but not impossible, to conceive. But taking the birth-control pill (a common 'cure' recommended by doctors) will most certainly prevent pregnancy; and you may wish to reconsider the use of Yasmin, a new-generation low-dose combination Pill (it contains both oestrogen and progestin; see Drug Alert, p 7). The progestin used in Yasmin has a diuretic effect. Indeed, in the US, it is being trumpeted in women's magazines as a combined weight loss and birth-control pill. Nevertheless, the truth is, it prevents water-retention bloat, but has no effect on body fat.
The diuretic effect means that it can increase potassium in some women. For this reason, Yasmin shouldn't be used by those who have impaired kidney, liver or adrenal function - and women who have PCOS often have poor adrenal function.
Although PCOS can play havoc with menstruation, the latest thinking is that the condition is linked not to reproductive hormones, but to those that regulate glucose metabolism. So, there may be benefit from approaching the problem from a different angle:
* Find your ideal weight. Up to half the women with PCOS are obese, but this is not the only factor. A very low body weight releases adrenaline to compensate for the body's not getting enough energy. This stimulates more insulin release, making symptoms worse.
* Try a low-glycaemic-index (GI) diet - one that includes wholefoods that do not cause blood-sugar levels to spike. More fibre helps reduce insulin secretion (Proc Soc Exp Biol Med, 1985; 180: 422-31) and removes excess oestrogen from the body. A higher-protein diet may also help.
* De-stress, as stress also stimulates adrenaline production. Chronic stress causes prolactin levels to rise which, in turn, alters levels of FSH and LH.
* Regular exercise is an important way to maintain insulin control.
* Take supplements. Women with PCOS may be deficient in D-chiro-inositol, an insulin sensitiser. In one study, 1200 mg/day restored ovulation in 86 per cent of women with PCOS (N Engl J Med, 1999; 340: 1314-20). Taking 200 mcg of chromium picolinate can also improve glucose tolerance and circulating insulin levels (Am J Clin Nutr, 1991; 54: 909-16), and fish oils can increase insulin sensitivity (Diabetes, 1991; 40: 280-9) albeit in laboratory rats.
* Try herbs. Stinging nettle (Urtica dioica) as a tea or supplement can help to balance hormones, at least in the lab (Planta Med, 1997; 63: 529-32). The most useful herb may be Vitex agnus-castus (chastetree berry), which regulates LH production. In a double-blind study of 96 women with infertility, 1.8 mL of Vitex extract for three months resulted in more than half of them becoming pregnant or resuming normal menstruation (Forsch Komplement"armed, 1998; 5: 272-8).
* Acupuncture can restore ovulation and balance hormone levels (J Tradit Chin Med, 1993; 13: 115-9).