Women often visit my office with concerns about menstruation. Polycystic ovary syndrome (PCOS) is a fairly common cause of menstrual irregularities and it affects almost seven per cent of women.

A woman has PCOS if she does not ovulate regularly and has excess of the male hormones, androgens, with no other cause. The cause is not known, but genetics seem to play a significant role.

As The Gleaner Health section's weight-management series continues, this becomes a particularly important condition, because even though a non-obese woman can have the condition, as I mentioned in my last article, PCOS and obesity are closely linked.

At least half the women with PCOS in the United States are overweight and obese. In fact, a risk factor for developing PCOS is weight gain around the time of a young woman's first menses.

Acne or hair growth

A woman with PCOS may have irregular bleeding, difficulty achieving pregnancy and acne or hair growth in a male-like pattern (hirsuitism). The bleeding problems tend to start when she starts having periods. The menses are irregular because women with PCOS do not ovulate (make and release an egg) in a regular monthly pattern. As a result, there is an imbalance of the hormones oestrogen and progesterone. The oestrogen causes the lining of the womb to build up and thicken. Without the stabilising influence of progesterone, which increases after ovulation, the lining can shed in an unpredictable manner, leading to sometimes very heavy, prolonged bleeding.

Difficult to lose weight

A woman with PCOS might report weight gain and difficulty losing weight. Unfortunately, her weight often worsens the symptoms of PCOS. For example, an obese woman with PCOS who is unable to get pregnant might need higher doses of fertility drugs, or in some cases, she might not ovulate, even on the medication.

PCOS can lead to other health problems, as women get older. These include insulin resistance and diabetes mellitus. The chance of an obese woman with PCOS developing diabetes may be more than five times higher than her risk if she were normal weight.

Women with PCOS are also more likely to develop other conditions, such as high cholesterol and hypertension, that can increase their risk of heart disease. They are also more likely to accumulate more fat around their bellies as opposed to their hips. This is called central obesity, which in itself is another risk factor for heart disease. This might occur whether her weight is normal or overweight. If a woman has PCOS and is overweight, she should be encouraged to lose weight, since even a relatively small amount of weight loss can make a significant improvement in her symptoms, including her fertility.

Contraceptive pills help

Birth-control pills can be used to regularise her menstruation, improve her acne and hirsuitism. Excess hair can be removed temporarily by shaving, or permanently, by electrolysis or laser therapy. Medications used for diabetes are not only helpful if she has developed diabetes, but may also help her to ovulate and have normal periods. She may sometimes need fertility drugs to achieve pregnancy. She should be warned that her pregnancy might have higher risks since the condition is associated with an increased risk of certain problems, including gestational diabetes, pre-eclampsia (hypertension and protein in a woman's urine) and pre-term infant birth.

Any woman with menstrual problems should consult with her doctor for the appropriate diagnosis, and treatment because, if she has PCOS, these symptoms may only be the tip of the iceberg.

Dr Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.