Polycystic ovary syndrome (PCOS) is the most common hormonal disorder among women of reproductive age. PCOS causes a woman’s body to produce excessive amounts of male hormones (androgens) which lead to the various manifestations of the disease.

PCOS disrupts the balance of both follicle stimulating hormone (FSH), the hormone that causes the follicle and egg to develop and luteinizing hormone (LH), the hormone that causes the follicle to release the egg. PCOS tends to run in families, but little is known about its cause or how it passes from one generation to the next.

PCOS patients can have a wide range of presentations. Not every woman who has difficulty ovulating will qualify for the diagnosis of PCOS. In an effort to clarify, an expert conference (Rotterdam, 2003) defined PCOS (after the exclusion of related disorders) as including two of the following three features: 1. Irregular or absent ovulation 2. Clinical and/or biochemical signs of excess androgens 3. Polycystic appearing ovaries by sonogram.

Symptoms of PCOS:
  1. Irregular menstrual periods (i.e. periods that last a long time, or occur infrequently)
  2. Excessive facial or body hair (called “hirsutism”)
  3. Acne
  4. Male-pattern baldness
  5. Obesity and/or unexplained weight gain
  6. Infrequent or absent menstruation in adolescents
  7. Pregnancy-related problems, including difficulty getting pregnant, having a miscarriage, and infertility

Complications of PCOS
If you have PCOS you are at a higher risk for these other conditions as well:

  • Type II Diabetes
  • High blood pressure (including pregnancy-induced high blood pressure)
  • Cholesterol and lipid abnormalities
  • Severe liver inflammation caused by fat accumulation (called fatty liver disease)
  • Sleep apnea
  • Abnormal uterine bleeding
  • Cancer of the uterine lining (endometrial cancer) caused by continuous high levels of estrogen without exposure to progesterone
  • Gestational diabetes
  • Depression and anxiety
  • Cardiovascular problems
Treatment for PCOS

No cure exists for PCOS, but treatments can help relieve symptoms, improve the quality of life, and reduce the risk of developing certain cancers.
Treatment generally focuses on management of the woman’s main concern(s), such as infertility, hirsutism, acne, and/or obesity.

The following are common treatments for PCOS:

  1. Lifestyle changes: Maintaining a healthy weight can help minimize PCOS symptoms and control diabetes. In addition, eating a diet with a lot of high-fiber carbohydrates helps slow the digestive process and control blood sugar levels. Exercise helps lower blood sugar levels and can also help relieve symptoms. Women who smoke have higher androgen levels, so quitting smoking is another positive lifestyle change to make.
  2. Hair removal: There are many ways to remove unwanted hair, including tweezing, shaving, depilatories, electrolysis (use of an electric current to destroy hair roots), and laser therapy.
  3. Oral contraceptives: Birth control pills (BCP) have a combination of estrogen and progestin and are commonly used to regulate the menstrual cycles of women with PCOS; they work by decreasing the level of androgens in the body and lessening PCOS symptoms. The presence of the progestin in the BCP protects the uterus against endometrial cancer.
  4. Progestin: can be taken for 10 to 14 days every 1 to 3 months to help regulate a woman’s menstrual cycle. It also reduces the risk of uterine cancer (a.k.a. endometrial cancer).
  5. Anti-androgen drugs: Taking anti-androgen drugs reduces androgens’ effect; the drugs can be used in combination with oral contraception to improve acne and/or to slow hair growth.
  6. Metformin: This drug, which is usually used to treat diabetes, improves the body’s response to insulin and can help regulate the menstrual cycle.
  7. Laparoscopic ovarian drilling: Used in extreme cases of PCOS, this outpatient surgery uses electricity or lasers to burn holes in the cysts on the surface of the ovaries in order to reduce the androgen load and improve the chances for ovulation. This treatment has become less popular as ovulation induction treatments have improved.
  8. Ovulation induction medications including both oral (i.e. Clomid) and injectable (i.e. FSH injections) are used for women whose main goal is becoming pregnant. If considering the use of FSH injections, frequent sonogram monitoring by a reproductive endocrinologist is recommended as these patients are at increased risk for a multi-fetal gestation. FSH injections would also be used for super-ovulation as part of an IVF cycle.
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