Treatment of PCOS (Polycystic Ovary Syndrome)

PCOS overview

• • Polycystic ovary syndrome (PCOS) is a hormonal disorder that prevents a woman’s eggs from maturing and turns them into cysts, which often causes infertility.
  • PCOS is an extremely common reproductive disorder that affects an estimated 6-12 percent of U.S. women of reproductive age, according to the Centers for Disease Control and Prevention.
  • It is characterized by hyperandrogenism, which is an elevation of androgens, or male sex hormones, that exceed normal female levels and can cause symptoms that include unusual hair growth, acne and rapid weight gain.
  • There is no cure for PCOS, but medical treatments and changes to lifestyle, such as diet and regular exercise, can help manage symptoms by reducing testosterone production.

Causes of PCOS

The cause of PCOS is not fully understood, though a growing body of research suggests that the disorder may be linked to genetic abnormality. The hormonal imbalance in patients with PCOS is thought to be the result of either the overproduction of male hormones by the ovaries or an inability to regulate insulin levels. This is known as “insulin resistance.”

In the case of insulin resistance, a peptide hormone that regulates fat and carbohydrate metabolism is barred from entering cells. In compensation, the body increases production of the hormone and additional androgens.

PCOS symptoms

Due to the abundance of male hormones and abnormal female reproductive functions that are associated with the disorder, PCOS can create undesirable symptoms beyond infertility. Women who are diagnosed with this disorder may present symptoms that include:

• • Rapid weight gain and obesity.
  • Irregular or absent ovulation (anovulation).
  • Depression.
  • An increase in irregular hair growth especially on the face, arms, back and legs.
  • Ovarian cysts.
  • Pelvic pain.
  • Male pattern baldness.
  • Diabetes.
  • Acne.
  • Acanthosis nigricans, a skin condition that produces areas of dark discoloration in folds and creases of the body.

Obesity tends to make these symptoms more severe. Women should see a doctor for evaluation if they experience infertility, are concerned about irregularities in their menstrual cycle or if some of the symptoms above begin to worsen.

It is also important for women who suspect they might have PCOS to seek medical attention because the condition puts women at a higher than normal risk for high blood pressure, diabetes, heart disease and metabolic syndrome.

Diagnosing PCOS

Because there is no exact definition of PCOS in the medical community, the criteria for diagnosing the disorder can fluctuate among physicians. All doctors generally look for menstrual irregularities, high levels of androgens and multiple cysts of a particular size on one or both ovaries.

Some signs of PCOS may be observed through a thorough physical examination including height, weight, blood pressure, evaluation of thyroid size, breast and genitalia development, as well as testing of the ovaries and uterus for tenderness and position. The physician may also look for signs of symptoms, like hair growth, acne increase and increase in weight.

Blood testing may also be required, as the majority of patients with PCOS will have evidence of elevated male hormone levels and infrequent or no ovulation. The diagnosing doctor will also need to rule out other causes of these symptoms, such as thyroid gland problems, excess hormone production by the adrenal glands, and too much prolactin hormone produced by the pituitary gland.

Once other potential causes of symptoms are excluded, the doctor will thoroughly review family health history. PCOS runs in families and if a woman’s mother or sister has PCOS, this increases her chance of having it as well.

The physician may also do a pelvic exam or an ultrasound to evaluate the ovaries for the presence of cysts. He or she may feel the cysts in a pelvic exam, and the ultrasound may be recommended after that to get a more accurate picture of the cysts on the ovaries.

The woman’s uterine lining will also be evaluated for the proper thickness, as being thicker than normal could indicate irregular periods caused by PCOS and difficulty becoming pregnant. Women seeking answers regarding infertility or disrupted menstrual cycles may discover that they have PCOS through a variety of fertility testing.

Recommended treatments for PCOS

While there is no cure for PCOS, medical treatments and changes to lifestyle, such as diet, regular exercise and not smoking can help manage symptoms of the disorder by reducing testosterone production. Treatment for PCOS can focus on removing or reducing symptoms or on reversing infertility due to the disorder.

Patients not looking to become pregnant but wanting to manage symptoms may be prescribed birth control to slow the production of androgens, helping to maintain regular periods and reducing adverse effects, such as unusual hair growth. Insulin sensitizing medications can make the woman more responsive to insulin and stabilize sugar levels. This can affect symptoms of acne, hair growth and help make periods less irregular.

Significant advances in fertility medication have reversed the effects of PCOS for women seeking pregnancy. These medications include Clomiphene, letrozole and gonadotropins. A woman’s ovaries can often be stimulated with fertility medication to produce ovulation, and then the patient can pursue additional fertility treatments such as in vitro fertilization (IVF).

More invasive treatments, such as “ovarian drilling” (a surgery that removes part of the ovary to inhibit ovulation and lower testosterone levels), have also proven successful.