Dear Friend of Jean Hailes
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Janet Michelmore AO
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Professor Helena Teede
Chair of Women’s Health
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Welcome to our national magazine. The last few months have been really busy for the team at the Jean Hailes Foundation for Women’s Health, culminating in some exciting news.
We are very proud to announce that our Director of Research, Helena Teede, has been made a full professor – an enormous honour for such a young endocrinologist. In fact, she is the youngest professor in medicine at Monash University. Professor Teede, 40, now holds the Jean Hailes/Monash University Chair of Women’s Health. The appointment exemplifies the university’s commitment to research and its effective translation of women’s health at a community level. Professor Teede will continue her clinical practice as well as researching how hormones affect heart disease, diabetes, polycystic ovarian syndrome and other illnesses that can so adversely affect women’s lives.
Heart disease is an illness we tend to ascribe to men. In fact, it’s the number one killer of both men and women. Recent research tells us women are slower to seek help when they experience angina or more seriously, a heart attack. Make sure you explain your symptoms to your doctor and don’t be embarrassed. Doctors are there to look after you.
I didn’t ever really think too much about heart disease until I was 47 years of age and my cholesterol I asked a lot of questions of my doctor and colleagues. After looking at what I was eating and also the amount of exercise I was doing, I began taking medication which, my doctor and I decided, was just the way it had to be because of my family history. I was determined to have a crack at really beating this thing. I insisted that my body pull itself back into line. I began walking the dog every morning for 45 minutes. She is great to talk to and has lost weight too!Five years later, I am managing to hold my cholesterol in check – and my blood pressure is right down. My doctor thinks I’m a bit of a star and there’s another benefit – any worries I have are put into clear perspective when I walk, limiting the chance of anxiety developing. If only I could stop eating chocolate!
Janet Michelmore AO
Director, The Jean Hailes Foundation.
 Janet can be contacted on 1800 151 441
Poly what?
 Most of us ovulate once a month when an egg fully develops and is released from the ovary. If we’re not pregnant, hormonal changes will cause a menstrual period 14 days later. If this process is disrupted for some reason, the egg may fail to release, there is no ovulation, a tiny cyst forms within the ovary and periods become irregular.
Women who have Polycystic Ovarian Syndrome (PCOS) do not ovulate as regularly as the rest of us. Many find hormone disruptions cause distressing symptoms and they are often at greater risk of diabetes and potentially of heart disease.
More common than you think
At a glance
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Polycystic ovarian syndrome (PCOS) is an extremely common yet largely unnoticed condition.
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Resistance to insulin in the body is one of the major causes. Women with PCOS have an up to seven-fold increase in diabetes risk.
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Women with PCOS often have elevated levels of insulin and male hormones.
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Women with increased body weight have worsening symptoms.
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Women with PCOS should be regularly monitored by their GPs for pre-diabetes and diabetes. This involves an oral glucose tolerance test because a fasting blood glucose test may not be definitive in women with PCOS.
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Treatment for PCOS is individualised and tailored to address specific symptoms.
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Many women with PCOS only find out they have it when they fail to get pregnant.
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Support network
The Polycystic Ovarian Syndrome Association of Australia (POSAA) has been providing support and information to anyone touched by PCOS since 1998. Sabra Lane, president of the organisation, says that the need for a national support group is apparent when you consider the 200,000 hits per month the POSAA website attracts.
“Many women with PCOS have known for years that there’s something wrong,” she says. “We often find women who have felt isolated and are relieved to be given a name for their problem, and also find that they are not alone. There are others who have been through the same thing.
”Besides organising regular group meetings across Australia, POSAA also hosts an online forum where women can exchange ideas and share stories in real time. Sabra says that because PCOS is so poorly recognised, even to some degree in the medical community, it’s vital that we establish national guidelines for diagnosis. “Because many women discover they have PCOS when they fail to fall pregnant, it is often treated as an infertility issue,” she adds. “We’d like to see all women tested for insulin resistance, because although 80 per cent of women with PCOS have insulin resistance, it’s not always recognised as a metabolic disorder.”
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“PCOS is a very common condition, affecting around 350,000 Australian women – or 7 per cent of women of reproductive age,” says research director Professor Helena Teede. “And it’s only recently that we’ve identified a hormonal imbalance or ‘insulin resistance’ as one of the primary causes of the condition.
”Insulin resistance is linked to both genetic and lifestyle factors. When the body’s insulin is not as effective because of this insulin resistance, the body compensates by making more and it’s this high level of insulin that compounds the problem. High insulin causes an increase in male hormones, such as testosterone, and also disrupts normal ovulation, causing small cysts to accumulate within the ovary.
Awareness, education, lifestyle changes and medical help
Women diagnosed with PCOS need understanding, reliable advice and education so they understand objectively what the problems are, according to Professor Teede. She also believes the general community and health professionals need to be well informed about this common condition. Healthy lifestyle is critical for women living with PCOS and many also need to have additional medical treatment.
“Treatment is individualised and will depend on the specific problem, be it infertility, pre-diabetes, excess hair or acne,” she explains. “After education and lifestyle changes, medical treatment, including the drug Metformin, may be prescribed to reduce insulin resistance. A low-dose oral contraceptive can help to regulate menstrual cycles.”
Research vital
Besides being actively involved in education and awareness programs, researchers at the Foundation recognise that medical research in this area is critical to answer important clinical questions on the causes and management of PCOS. Recent collaborative studies between the Jean Hailes Foundation for Women’s Health and Monash University have confirmed that women with PCOS have higher levels of insulin, higher cholesterol levels and evidence of early blood vessel damage. This research is some of the first to highlight that this risk is independent of body weight and is related directly to PCOS.
Foundation researchers are currently involved in several PCOS studies, trying to pin down the specific reason why insulin doesn’t work well in women with PCOS and searching for the ideal medical treatment. They are also studying the effectiveness of exercise in reducing heart disease risk and working on how PCOS affects quality of life, body image and libido.
What to look for
Although having multiple cysts on your ovaries is common, not everyone with cysts has PCOS and not everyone with PCOS has the same set of symptoms. If you have PCOS you may have:
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periods that are irregular, infrequent or heavy
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difficulty in becoming pregnant
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immature ovarian eggs that do no ovulate, forming small follicles
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exacerbation of symptoms by weight gain and an increase of fat in your upper body
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excessive facial or body hair
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acne on both the face and the body
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pre-diabetes or diabetes
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higher levels of blood fats, including cholesterol and triglycerides
Up to 25 per cent of reproductive-aged women have small cysts on the ovary. These women can have some, or all, of the above symptoms, but as many as 75 per cent have no other symptoms. Those with cysts alone are described as having polycystic ovaries, but not the polycystic ovarian syndrome.
Research into quality of life issues
Psychologist Dr Mandy Deeks is leading Foundation researchers in the quest to understand the quality of life aspects of PCOS, including depression, anxiety, libido and relationship issues. According to Dr Deeks, the symptoms of PCOS are often distressing and can impact enormously on many aspects of a woman’s life. “There is very little research into quality of life for women with PCOS, but we do know from the women we see that it certainly has an influence on mood. We think that these women may be more prone to depression and anxiety,” says Dr Deeks. “It may be that influences such as body image, issues around weight and infertility put a strain on women and their relationships, which will all impact on mood.”
Fiona’s story
Fiona was 19 years old when she discovered she had PCOS. Her symptoms, which included amenorrhoea (lack of menstruation), facial hair, acne and weight gain had appeared within a relatively short period.
“My periods had always been irregular but up to the age of 18 I had the clearest skin of all my friends,” she says. “I was physically very active, going to the gym regularly and also playing tennis and I was still finding it difficult to lose even one or two kilos.”
Fiona says her period would appear every two months, which became every three months and then simply stopped. As a nurse, she knew there was something amiss and so went to see a gynaecologist.
“It was a shock to hear at 19 that I would probably never fall pregnant naturally,” she explains. “I was prescribed an oral contraceptive to regulate my period a bit, but it didn’t help.”Fiona recently took part in an exercise trial for women with PCOS struggling to manage their weight. The collaborative trial, headed by Dr Nigel Stepto and Professor Helena Teede, is run through Monash University and the Jean Hailes Foundation for Women’s Health. Participants are prescribed, and supervised in, treadmill work at varying levels of intensity after an initial monitoring stage and with the expectation of a 12-week follow-up period.
“The program involved 12 weeks of endurance training, with sessions three times a week lasting around 50 minutes,” says Fiona. “We’re still at the follow-up stage now, but what I’ve noticed is an increase in energy, a more toned body and more regular periods. I’ve also had a problem with facial hair growth, which has slowed down since the trial.”
Fiona lost three to four kilos during the trial, and while she is still aiming for the 10 kilo loss that she and her husband want before trying for a pregnancy, she says she’s definitely more motivated and has the energy to persist with the exercise.
As an IVF nurse, Fiona is now planning to help support and educate PCOS couples through a Lifestyle Program based at Monash IVF.
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Resources
For further information on PCOS, to find out about current research studies or to purchase a copy of A Patient’s Guide to the Polycystic Ovary by Professor Gab Kovacs, go to our shop or call tollfree on 1800 151 441.
To contact the support group POSAA log on to www.posaa.asn.au or call 02 8250 0222.
This resource was developed with the support of the Australian Department of Health and Ageing.
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The Jean Hailes Foundation magazine is designed to be informative and educational. It is not intended that The Jean Hailes Foundation magazine provide specific medical advice or replace advice from your health professional. The Jean Hailes Foundation does not accept any liability to any person for the information or advice (or the use of information or advice) which is provided in this magazine or incorporated into it by reference. Information is provided on the basis that all persons reading the magazine undertake responsibility for assessing the relevance and accuracy of its content.
© 2006 The Jean Hailes Foundation for Women's Health.
Apart from fair dealing for the purposes of private study, research, criticism or review, as permitted under copyright legislation, no part may be reproduced or reused for any commercial purposes.
Note: This article is an archive. Whilst the Jean Hailes Foundation for Women’s Health has made every effort to ensure this information was accurate at the time of publication, the article content has not been updated since the date listed below.
Content created May 18, 2006
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