Dr Richard Murphy

PCOS

PCOS can influence your fertility as a woman. If you are diagnosed with this metabolic condition, it is important to see a gynaecologist to manage your treatment. This will involve not just your fertility journey but also the associated lifelong risks of vascular disease.

Obstetrics and gynaecology consultations at my private practice in Subiaco.
Fertility consultations at Fertility Specialists of Western Australia in Applecross
Delivering at the Labour Ward of SJOG Subiaco Hospital

Perth Gynaecologist

What is PCOS?

If your GP has referred you to a gynaecologist, you may have heard the term PCOS for the first time. PCOS or Polycystic Ovarian Syndrome is a metabolic condition associated with increased levels of androgens, such as testosterone and abnormalities of ovulation. The conversation often starts with a focus on your periods being irregular (or even absent). But when you have PCOS, we also have to look at the lifelong increased risks of vascular disease (heart disease and stroke).

PCOS symptoms

So what to look out for, if you believe you may have PCOS? The typical symptoms are:

  • irregular periods,
  • absent periods,
  • difficulties conceiving,
  • acne,
  • unwanted or excessive hair growth.


In older women or very severe cases ‘male-pattern hair loss’ can be one of the symptoms. This is very rare in young women.

Another aspect of PCOS in cases with irregular ovulation, is the chance of changes in your endometrium (the lining of the uterus). That then creates an increased risk of endometrial cancer, but the good news is that simple treatments can prevent this.

If PCOS causes an alteration in your body image, it can cause emotional distress and as your gynaecologist, I am here to listen and to address your concerns as we plan the most effective treatment.

“The “classical” PCOS patient is overweight, hairy, pimply and has irregular or absent periods. We now know that this is just one extreme variation of how PCOS can present. Assessing your symptoms and getting a clear diagnosis requires the specialised work of an experienced gynaecologist.”

Dr Richard Murphy, Perth Gynaecologist

You might be in a situation where different doctors have told you different things. Some may have told you that you have PCOS, others may have told you that you don’t. When you then receive a diagnosis, it can be reassuring because it creates clarity, or it can be distressing if you feel you now have a ‘disease’. While women with PCOS can struggle to conceive, good treatments are available to help safely and it is reassuring to remember that on average, women with PCOS have as many babies as women without PCOS(*).

“It is possible to have a milder form of PCOS with a regular period and no clinical signs of raised androgens. In that case the diagnosis of PCOS is made on blood test results and the ultrasound appearance of your ovaries.”

Dr Richard MurphyPerth Gynaecologist
PCOS Perth
There are a wide range of ways in which the syndrome can present, and we call them phenotypes. The core problem underlying PCOS is a high level of androgens and the changes associated with PCOS are associated with other factors that can increase the risk of vascular disease, so even with “asymptomatic” PCOS, a review of your general health is beneficial.

What causes PCOS?

When you hear that you may have a condition, you want clear answers. And at my practice, it is my intention to aim for the highest level of clarity. However, sometimes the answers are not simple. There is not one single cause of PCOS.

It tends to run through families in a pattern similar to autosomal dominant genetic conditions, where there is a 50% chance the offspring of an affected person will develop the disease. There is however no single gene associated with PCOS. Carrying extra weight will often exacerbate the symptoms of PCOS.

So it is key to look at your personal medical history when we diagnose PCOS. You can count on an unrushed consultation and a personalised treatment plan.

Gynaecologist Perth

PCOS diagnosis and treatment

Diagnosis

When you have been referred for possible PCOS(**), my first step is to look at your medical history and to aim for as much clarity as possible.
Before I diagnose you with PCOS, you need to have at least 2 of the following 3 factors:
  • high levels of androgens, either clinically (acne, hirsutism, male pattern hair loss) or biochemically (on blood tests),
  • irregular or absent periods,
  • polycystic ovaries on ultrasound.

There are a number of other metabolic conditions which can mimic PCOS and we need to exclude those conditions.

Diagnosis can be difficult in adolescents, where acne and irregular periods are common. There are some adolescents who meet some but not all the diagnostic criteria. They are in an “at risk” group and a definitive diagnosis may not always be possible until up to 8 years after periods start.

Treatment

You will need a clear diagnosis, with exclusion of those conditions which can masquerade as PCOS. Positive lifestyle factors such as healthy eating and regular exercise are important for all but especially those with PCOS due to the metabolic changes inherent in the condition.

“Optimisation of weight is important especially if it has crept up a bit. Even relatively modest amounts of weight loss, 5kg or so, can have a large impact of ovulatory function. Seeing a Dietitian or Psychologist can help.”

Dr Richard Murphy, Perth gynaecologist

When you are trying to conceive and are diagnosed with PCOS, Ovulation Induction treatment is the first line treatment for PCOS, where various medications are used to stimulate your ovaries to produce the perfect menstrual cycle. We aim for just one egg being released at ovulation and for this egg being supported by good robust hormone levels and a normal endometrium.

Fertility specialist and gynaecologist Perth

PCOS and fertility treatment

There is no reason that PCOS should stop you having children. If you have been in doubt about the connection between fertility and PCOS, please remember that women with PCOS have as many children as women without. Of course, if you have PCOS, you still want to avoid smoking and maintain good health. The same guidance applies for any other woman; do not leave things too long before you start trying for children.

In case you are having difficulties conceiving, Ovulation Induction (OI) treatment is commonly used for women with PCOS and effectively treats ovulatory disturbance. A number of medications can be used including Clomiphene, Letrozole and Recombinant FSH (Gonal-F or Puregon). I most frequently use recombinant FSH as this allows a graduated increase in the level of stimulation until the ovaries respond as we want them to.

It is important that any Ovulation Induction treatment cycle is carefully monitored to minimise the risks of multiple pregnancy, remembering that the best way to get a perfect baby is having them one at a time. Often Metformin is used, a medication commonly used in type 2 diabetes, which reduces the risk of over responding to ovarian stimulation with too many eggs. Unmonitored OI can result in twins (often tricky but good when things go well), triplets (very often a disaster for mums and babies) or worse!

Ovarian drilling, a surgical procedure where small areas of both ovaries are burnt at laparoscopy is an older and effective treatment for poor ovulation with PCOS. It is rarely used now as invasive surgery is needed, it does cause some loss of eggs from the ovaries and there are very safe and effective medications available now.

IVF is not first line treatment for the ovulation problems associated with PCOS because in an IVF cycle the embryo transfer needs to happen in the correct part of your cycle, 5 days after ovulation, so with an irregular cycle, “ovulation induction” type treatment is needed before transfer. Women with PCOS are at higher risk of Ovarian Hyperstimulation Syndrome, one of the most common and severe complications of IVF.

Acne and hair changes can both be treated medically. There is some overlap here between gynaecology, endocrinology, dermatology and general practice but I can address these issues and plan your treatment so everything is well coordinated.

Perth Gynaecologist

Will PCOS go away at menopause?

The menstrual problems associated with your PCOS will go away when you enter menopause but the other metabolic effects of PCOS will remain and it is in the postmenopausal years that you are most at risk of heart attack, stroke and other vascular disease. Menopause can be a difficult time for a lot of women. What I have learned is that it can also be a time to stop and reflect on life in a bigger, more holistic way.

Gynaecologist Perth

Why Dr Richard Murphy as your gynaecologist?

Whether you are looking to get pregnant sooner, later or not at all PCOS will need managing. If pregnancy is planned soon and your cycles are irregular or absent, then please come to see me.

The success rates for Ovulation Induction are very good. If you are looking at conceiving in the future, then planning early and perhaps making some adjustments beforehand can often make things much easier.

Even if you are not trying to conceive, the metabolic aspects of PCOS need addressing. Finally, we know that a lack of ovulation is the major risk factor for endometrial cancer. You need at least 4 episodes of Progesterone exposure per year to protect your endometrium from this risk. This usually occurs during normal ovulation. Endometrial protection is an important part of PCOS management.