Polycystic Ovary Syndrome

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Symptoms | Complications | Diagnosis

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PCOS Team in Dedicated Women’s Health Suite

OB/GYNs experienced specifically in diagnosis and management of PCOS

Specialists in Fertility and Adolescent Gynaecology

Providing the right care, expertise & approach for key PCOS patients groups

Advanced and Accredited Diagnostic Capability

From colposcopy to transvaginal ultrasound, with the latest equipment

What is Polycystic Ovary Syndrome?

Polycystic ovary syndrome (PCOS) is a common condition that affects the function of the ovaries in women of reproductive age. PCOS is thought to affect up to 20% of women worldwide, though some estimates suggest that up to 75% of women with PCOS are unaware that they have the condition. The incidence of PCOS in the Cayman Islands are likely to be similar, given our multicultural population.

The exact causes of PCOS are poorly understood, but is thought to develop when the ovaries produce higher levels of the male sex hormone, testosterone , possibly associated with insulin resistance too. Women typically produce small amounts of testosterone but, in individuals with PCOS, the ovaries may produce higher-than-average levels of the hormone. There is also a genetic component, and you are more likely to have it if other women in your family have it.

PCOS leads to a variety of issues relating to the ovaries and ovulation. Women with PCOS typically have an irregular menstrual cycle, with periods often delayed or skipped altogether. Another common feature of PCOS is the development of multiple tiny ovarian cysts; small, fluid-filled sacs that grow inside the ovaries, something we diagnose relatively commonly here at our Women’s Health Suite at Grand Pavilion, Grand Cayman.

Symptoms of Polycystic Ovary Syndrome

PCOS causes a variety of symptoms relating to the imbalance of hormones. Those symptoms often appear during puberty, though many only realise they have the condition when they experience weight gain or difficulty getting pregnant. It is one of the things we look for when helping our Cayman Ladies with fertility issues. The most common symptoms of PCOS are:

Irregular periods
PCOS affects the hormones responsible for triggering ovulation in women, and can prevent the release of eggs from the ovaries. This results in infrequent or missed periods. A long and irregular menstrual cycle is a key indicator of PCOS.
Heavy periods
PCOS can lead to a longer menstrual cycle, which means your uterine wall has more time to build up between periods. When the uterine wall does eventually break down, it will be thicker than usual and may result in a heavier menstrual flow.
Weight gain
Obesity is closely linked to the development of PCOS, and up to 85% of women with the condition are overweight or obese.
Acne
Increased testosterone levels can cause the skin to produce more oils than usual, which can lead to outbreaks of acne in people with PCOS. Acne is most likely to appear on the face, back, and chest.
Excess hair growth
Excess hair growth (AKA hirsutism) is a very common feature of PCOS. 70-80% of women with the condition experience abnormal hair growth on the face and body, including the back, stomach, and chest.
Unusual darkening of the skin
PCOS can cause patches of skin in the creases of the body to darken. This commonly affects areas like the neck, groin, and under the breasts.
Headaches
The hormonal imbalance caused by PCOS can cause headaches in some women.
Male pattern baldness
Increased levels of androgen can lead to male pattern baldness in women with PCOS. This is characterized by the thinning of hair on the scalp.

Complications of Polycystic Ovary Syndrome

PCOS is mainly associated with the menstrual cycle and ovarian function, but it can impact many other organ systems in the body. Over time, PCOS can lead to a variety of more serious medical complications, and thus it is important to identify and treat it. Complications can include:

Infertility
PCOS can interfere with the release of eggs from the ovaries, and may prevent ovulation. If ovulation doesn’t taken place, neither can fertilization. Fortunately, infertility caused by PCOS can be successfully treated in most women and this is something we do as part of our fertility services.
Metabolic Syndrome
Metabolic syndrome is an umbrella term for a cluster of conditions that affect the function of the metabolic system. This can lead to high cholesterol, high blood sugar, and high blood pressure levels, the combination of which can lead to much more serious health issues.
Cardiovascular Disease
The high cholesterol, blood sugar, and blood pressure levels associated with PCOS increase the risk of cardiovascular diseases like heart disease and stroke.
Sleep Apnea
Women with PCOS are often overweight, which can increase the risk of sleep apnea. Sleep apnea is a condition that causes repeated pauses in breathing during sleep, and may severely disrupt rest.
Depression and Anxiety
Women with PCOS are also prone to depression and anxiety. This may be related to the hormonal imbalances caused by PCOS, but is often caused by other symptoms of the condition (such as infertility, hair loss, excess hair growth, and acne).
Endometrial Cancer
PCOS increases the risk of endometrial cancer, which is a cancer of the uterine lining, and hence the importance of identifying PCOS so that it can be addressed and monitored appropriately.
Diabetes
PCOS is heavily associated with obesity and insulin resistance, both of which increase the risk of type II diabetes.

Diagnosis of Polycystic Ovary Syndrome

We are very experienced at diagnosing PCOS. Our PCOS team, led by Dr Lisa Joels, OBGYN with a special interest in fertility and adolescent gynaecology (and thus PCOS), will look at a range of symptoms, including things like:

Irregular menstruation
Typical scan appearance of the ovaries
High androgen levels

Based on your symptoms and history, we may perform a series of diagnostic tests to confirm that you have PCOS. These are likely to include blood tests, a pelvic exam, and ultrasound, all of which are done in the privacy and calm of our dedicated Women’s Health Suite.

What can you expect from our PCOS-experienced OBGYNs?

Blood Tests
If we suspect that you may have PCOS, we will perform a blood test to check your female hormones and testosterone levels. A blood test may also be used to measure blood glucose and cholesterol levels.

Pelvic Examination
We provide a comprehensive and careful pelvic examination, allowing a manual and visual examination of the reproductive organs. During the examination, we will check for abnormal growths in the vagina, ovaries, and uterus. We are very fortunate to have an OBGYN who is formally accredited in Colposcopy by The British Society for Colposcopy and Cervical Pathology (Dr Madhavi Manoharan).

Ultrasound
An ultrasound examination for PCOS involves the insertion of a device called a transvaginal ultrasound into the vagina of the patient. We will use the device to determine the thickness of the uterine lining, and to examine the ovaries. We are again fortunate to be formally accredited and trained in transvaginal ultrasound.

Treatment of Polycystic Ovary Syndrome

Although there is no outright cure for PCOS, symptoms can be reduced using a variety of treatment methods. Our approach is to focus on the management of problematic symptoms, such as infertility, obesity, acne, and excess hair growth, and we are the only practice in Cayman Islands to combine PCOS-focused OBGYNs with a dermatology team experienced in the treatment of both skin and hair problems.

We would discuss all treatment options with you, including lifestyle changes that can help too, and coordinate the care necessary between different specialists.

Polycystic ovary syndrome care… as it should be.

Dr Lisa Joels

Obstetrician & Gynaecologist
MB ChB, MD, FRCOG, FHEA
Tel: +1 (345) 745 7450 (clinic)
Email: [email protected]

Dr Joels has 36 years’ experience in obstetrics and gynaecology including 19 years as a Consultant working in Swansea (2001-11) and subsequently at the Royal Devon & Exeter NHS Foundations Trust in the UK (2011-20). She was lead clinician for prestigious Fertility Exeter and is passionate about women-centred care.

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Dr Madhavi Manoharan

Obstetrician & Gynaecologist
MBBS, MD, MRCOG
Tel: +1 (345) 745 7450 (clinic)
Email: [email protected]

Dr Manoharan has 23 years’ experience in obstetrics and gynaecology, including more than a decade at tertiary level, 7 years as consultant at the prestigious Royal Free London NHS Foundation Trust and a number of years as Assistant Professor at the world-renowned Weil Cornell Medicine, located in their Qatar campus, part of Cornell University.