PCOS

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, causing infertility and other serious health repercussions. In fact, physicians believe PCOS to be the most common reason for menstrual irregularities. 

What is PCOS?

Often starting as early as the teen years, PCOS affects a woman's endocrine (hormonal) system and in turn other body functions such as reproductive and cardiovascular functions and glucose metabolism. In addition, PCOS can be connected to more serious health problems such as heart disease and diabetes.

Usually a woman with PCOS has a normal uterus and fallopian tubes, but her ovaries may contain many small follicles or cysts that are visible in ultrasound images. The eggs in these follicles don't grow normally, and each month, new follicles develop and shrink into cysts. Rarely, the patient may ovulate and conceive, but more often the cysts remain too small.

The good news is that this type of cyst is not an indication of ovarian cancer. However, the cysts produce androgens, male hormones that lead to an imbalance in the woman's entire system and limiting her ability to conceive.

The worsening imbalance of hormone levels is the primary cause of PCOS-related diseases. For this reason, doctors use the term "hyperandrogenism" to describe PCOS because women with the condition have elevated levels of serum testosterone and androstenedione, two androgens (male hormones). As a consequence, hyperandrogenism suppresses ovulation.

Researchers have found a strong connection between PCOS and insulin resistance. In women with PCOS and insulin resistance:

• 50 percent will develop diabetes
  40 percent will develop gestational diabetes (during pregnancy)

Women with PCOS and insulin resistance are also more susceptible to heart disease, and endometrial (uterine) abnormalities, including uterine cancer.

How do you know you have PCOS?

Not all women with PCOS have the same symptoms. Some may notice these outward signs first:    

• Irregular or absent menstrual periods
• Acne
• Weight gain or difficulty losing weight
• Male pattern baldness or thinning hair on the scalp
• Hair growth on the face, back, chest, or abdomen (hirsutism)

Less visible symptoms may include:

• High blood sugar (hyperglycemia)
• High cholesterol and triglycerides

PCOS may be hereditary. Women with family members with PCOS or Type II diabetes are considered at higher risk.

Women who do not have a menstrual period for more than six of any 12 months should see a physician in order to investigate PCOS as a possible cause. Regardless of diagnosis, women with highly irregular or absent periods are at much higher risk for uterine cancer.

How is PCOS treated?

There is no cure for PCOS, but doctors can treat its symptoms successfully, including infertility. With focus and patience, sufferers learn to manage the disease, just as they might with any other life-long medical condition. Irritating but less serious symptoms like hirsutism, male-pattern hair loss, and acne will often respond to specific prescription medications that lower androgen levels.

Treatment can improve the chances of conception and reduce risks of diabetes or heart disease. Making lifestyle changes, especially nutritional and exercise habits, is a crucial part of treatment.

A key to reducing the symptoms of PCOS is the lowering of insulin levels. This can often be accomplished with medications.  Any diet and physical activity that improves overall health will also considerably affect a woman's hormone levels and reduce her PCOS symptoms.

Treating Infertility from PCOS

In any infertility treatment, the first steps are usually semen analysis for the male partner and examination of the woman's reproductive system.

Overweight women should begin a healthy weight-loss program before or during infertility treatment. Studies have shown that by simply improving their eating and exercise habits, some women experience spontaneous return of ovulation and regulation of menstrual cycles through weight loss.

Other women may need ovulation-inducing fertility medications, usually starting with clomiphene citrate tablets (the most common brand name is Clomid) or injectable drugs such as Follistim or Gonal-F. Treatment with these medications requires close monitoring by examination and ultrasound, as women with PCOS are more likely to have adverse reactions to fertility drugs. Injections of hCG are used to stimulate ovulation of matured follicles at just the right time.

If ovulation induction is followed by intrauterine insemination (IUI), the risk of a multiple pregnancy (twins or more) rises to about 18 percent. A better alternative may be in vitro fertilization (IVF), with very good chances of pregnancy and fewer odds of multiples.

Can you prevent PCOS?

To date, physicians have not found a way to determine which girls may develop PCOS after menarche (the beginning of menstruation). However, family history of obesity, diabetes, or infertility can be important indicators.

The earlier a young woman is diagnosed and begins managing PCOS, the less likely is long-term complications of infertility, heart disease, hypertension, and diabetes. Keeping family physicians and gynecologists informed about symptoms and following treatment plans helps the patient manage the disease.

For women who are not trying to conceive, hormone therapy through birth control pills or other hormonal contraceptives can be helpful. And all PCOS sufferers, regardless of desire to conceive or body weight, benefit from a healthy lifestyle of regular exercise and good nutrition.

Lastly, any woman with PCOS should be routinely monitored for complications such as:

• high blood pressure
• high cholesterol
• heart disease
• diabetes
• uterine cancer