POLYCYSTIC OVARIAN SYNDROME

Polycystic Ovarian Syndrome (PCOS) is characterized by irregular menstrual cycles (typically infrequent cycles), excess hair growth, and obesity. A relatively common gynecologic condition, PCOS affects an estimated 5-10% of the female population. Most women with PCOS suffer the effects from it for years, but are only properly diagnosed when they present to their doctors with infertility problems.

Women with PCOS can have few or many symptoms of the disease, and those symptoms can vary in severity depending on the woman. PCOS is diagnosed when a woman’s symptoms fit two of the three following criteria:

Irregular or absence of menstruation: adolescents can present with heavy periods; women usually present with infrequent to no periods.

Excess androgen production: elevated androgens (male sex hormones) in the body can cause excess hair growth in male pattern areas (face, groin, thighs, chest, arms), acne, and male pattern hair loss (not as frequent).

Enlarged ovaries or multiple cysts on the ovaries: demonstrated on pelvic ultrasound, cysts on the ovaries are actually the least common presentation in PCOS. In addition, some women with multiple cysts on the ovaries do not actually have PCOS.

The cause of PCOS is unknown, but the existence of high levels of insulin in the body seems to be the most accepted reason for PCOS development. Increased insulin, via many pathways in the body, leads to increased production of androgens. This increase in androgens disrupts the normal ovulation process, leading to infrequent or irregular menstruation. There is also some research that suggests that PCOS may be genetic.

In addition to a physical exam and history, PCOS is diagnosed by checking numerous hormone levels in the blood including, but not limited to: DHEA, LH, FSH, progesterone, prolactin, and TSH (thyroid level). Often a blood sugar test, an insulin level, and cholesterol/triglyceride levels are also checked. Occasionally, pelvic ultrasound is used to aid in the diagnosis.

Women with PCOS are statistically at higher risk for the development of type II diabetes, hypertension, elevated cholesterol levels, and cardiovascular disease. They are also at higher risk for uterine cancer if they go for longer periods of time without menstruating.

Although there is no cure for PCOS, it is a manageable condition. In women who are not seeking pregnancy, birth control pills or progesterone supplements are used to help regulate their periods. Metformin, a drug usually used in people with diabetes, can also be used to help increase ovulation frequency and decrease androgens. Spironolactone, a diuretic, is used to decrease excess hair growth and help manage acne. In women who are trying to conceive, Clomid is used to help stimulate ovulation; Metformin is sometimes used as an adjunct to Clomid. Women with PCOS can help their own condition through weight loss, increasing exercise, and following a low fat/low cholesterol diet.