Have you got more facial hair than your hubby? Feeling fat and frumpy no matter how much you diet? Or maybe your periods are irregular or absent. These are just a few signs of polycystic ovarian syndrome (PCOS) - which now affects one in 10 Australian women. This hormone condition can be difficult to control, and the wide range of symptoms can be depressing and downright embarrassing, with hirsuteness often missed by the doctor, but cared for by the beautician.

The bad news is there's no cure. But the good news is that PCOS can be kept in check and serious side effects can be reduced. Once considered a gynaecological problem caused by immature follicles on a woman's ovaries, doctors now believe insulin resistance, a precursor to diabetes, is responsible.

Insulin is a controlling hormone, which allows glucose from the food we eat into our cells. When insulin resistance occurs, the hormone builds up and sends chaotic messages to other hormones, which control ovulation and hair development. High insulin also stimulates stress chemicals and turns off the fat-busting switch.

The results are obesity, acne, infertility, miscarriage, stress and a major risk for the development of diabetes. 'PCOS shouldn't be considered as one disease, but more a collection of problems,'
says Dr Warren Kidson, a senior endocrinologist at Sydney's Prince of Wales Hospital and the Royal Hospital for Women.
'It's important that a broad approach is taken by a general practitioner with an interest in this area, or involving several specialists such as an endocrinologist and a gynaecologist to manage and treat the varying symptoms.'

There is no single test to diagnose PCOS, but your doctor will need to take a medical history and perform a physical examination, which may include an ultrasound to look for cysts on the ovaries (polycystic) and check hormone levels for lack of ovulation and excess male hormones.

Diabetes risk
What's even scarier is that 50 to 70 per cent of women with PCOS have high insulin levels, which puts them at risk of type 2 diabetes. 'All women with PCOS should be tested for insulin resistance, impaired glucose tolerance and diabetes,' Dr Kidson says. 'Normally we think of insulin as a hormone that reduces blood sugar but in these women, for some reason, it stops the eggs in the ovary from maturing and from that a whole cascade of problems arises. 'It's a vicious circle because the more weight you gain, the more you become resistant to insulin, and the more insulin you then produce.'

Management strategy
The best way of managing PCOS is through permanent lifestyle changes. Try:

• Daily exercise of at least 10,000 steps on your pedometer.
  

• A low-GI diet that allows glucose to flow gently into the bloodstream. This is the key to reversing the trend towards diabetes and reducing insulin resistance.
  

• For overweight women with PCOS who have fertility problems, a diabetes medication called metformin is an effective treatment.

Dr Kidson says: 'Combined with diet, exercise and weight reduction, metformin can reduce the stress, suffering and financial burden of women whose fertility has been reduced.

'In women who take metformin, ovulation is stimulated by up to 90 per cent after six months, male hormone levels in women are lowered by around 50 per cent, and acne and excess body hair growth are also reduced.' Other benefits? In pregnancy, the miscarriage rate drops by about 80 per cent in women with PCOS and metformin accelerates weight loss in insulin-resistant women who are also exercising and on a diet.

Family affair
If a relative has PCOS, ask your doctor to check for insulin resistance - whether you're an Arthur or a Martha! Both sexes carry the gene for insulin resistance, which can manifest as diabetes in men and diabetes or PCOS in women.

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