Polycystic Ovarian Syndrome (PCOS)

PCOS at a glance

  • Polycystic Ovarian Syndrome (PCOS) is one of the most common female endocrine disorders, causing ovulation and conception problems in about 5 percent of reproductive-age women, according to the American Society for Reproductive Medicine.
  • A woman with PCOS usually has a normal uterus and fallopian tubes, but the small follicles (egg-containing cysts) in the ovaries do not develop eggs properly.
  • Signs a woman may have PCOS are irregular or absent menstrual periods, excessive hair growth on the face, back or chest, acne, weight gain and insulin resistance.
  • PCOS can be treated and managed in a number of ways, depending on the symptom the patient is being treated for – including infertility.

Symptoms and risks of PCOS

For ovulation to occur, a normal, estrogen-dominant environment has to be present in the ovary. In women with PCOS, the normal hormonal balance between estrogen and androgens is abnormally tilted in the androgen direction. Rather than experiencing a normal growth of follicle that leads to ovulation, there is no growth and the woman does not ovulate. The woman does not lack eggs and in fact has many follicular cysts (hence the name polycystic ovarian syndrome). This can lead to a hormonal imbalance in the woman’s entire system, affecting the woman’s fertility and causing other serious health issues.

PCOS, also called Stein-Leventhal syndrome, can be diagnosed through ultrasound, which reveals the small ovarian cysts. Symptoms may include infertility, irregular menstrual periods, excessive growth of central body hair (hirsutism), and obesity. PCOS can also be associated with diabetes, heart disease, or hypertension.

Women with PCOS may develop metabolic syndrome, which is characterized by cholesterol abnormalities, hypertension, abdominal obesity, and insulin resistance that impairs blood sugar regulation. Women with PCOS are at risk of developing associated diseases, such as Type 2 diabetes and heart disease, and women who have family members with PCOS or Type II diabetes are considered at higher risk.

PCOS causes a lack of ovulation, exposing the uterine lining (endometrium) to continuous doses of estrogen that may cause excessive thickening of the endometrium. Heavy, irregular bleeding caused by the thicker endometrium may lead to endometrial cancer over time.

In addition, PCOS and insulin resistance show a strong connection. In women who have both, 50 percent develop diabetes and 40 percent develop gestational diabetes during pregnancy. Women with PCOS and insulin resistance are more susceptible to heart disease, abnormal breast milk production, and endometrial (uterine) abnormalities, including uterine cancer.

Signs a woman has PCOS

A woman is said to have PCOS if she has any two of the following:

  • Irregular or absent menstrual periods
  • Acne, excessive hair growth on the face, back, or chest (hirsutism), or elevated male hormone levels
  • Polycystic appearing ovaries (more than 12 peripheral follicles)

Women with PCOS may also have:

  • Weight gain or difficulty losing weight
  • Evidence of diabetes or insulin resistance

Health symptoms may include:

  • High blood sugar (hyperglycemia)
  • High cholesterol

Treating PCOS

Some patients are primarily concerned about treating PCOS to regain their fertility, while others are more concerned about menstrual cycle, hirsutism, or acne management. Whatever the reason, PCOS should be treated to ward off the long-term health risks it poses. The type of treatment used depends on the woman’s fertility desires.

PCOS cannot be cured, but its symptoms – including infertility – can be treated. Diet and exercise, which lower a woman’s weight, are the most effective means to treat PCOS but can also be challenging to incorporate into a patient’s lifestyle. PCOS is a lifelong medical condition that can be managed by prescribed medication, nutritional choices, and weight loss, which can also reduce risks of diabetes or heart disease and lower insulin levels, as well as improve ovulation and fertility. Cosmetic steps, such as electrolysis or laser hair removal, can also treat symptoms affecting hair growth or loss.

Treating infertility caused by PCOS

Infertility treatment begins with a male semen analysis and a female reproductive system examination. Women who are overweight are usually advised to pursue a healthy weight-loss program before any fertility procedures – studies have shown that losing weight with healthy eating habits and exercise can resolve infertility by allowing ovulation and regular cycles to return.

Other women may need additional fertility treatment, starting with ovulation-inducing oral medications like clomiphene citrate or letrozole. However, women with PCOS often suffer adverse reactions to fertility drugs, so they are monitored closely during the ovulation process. Frequently, women fail to conceive or even to ovulate using oral medications so injectable medications can also be used as second line treatments. Complications from injectable medicines such as multiple gestation and ovarian hypestimulation syndrome can occur, so injectable treatment needs to be monitored very closely. In vitro fertilization (IVF) may be the best option, lowering multiples pregnancy risks and offering favorable chances of pregnancy.

How to manage PCOS

Although it has not yet been discovered how to determine which women will develop PCOS, the earlier a woman is diagnosed and begins PCOS management, the less long-term complication of infertility, diabetes, hypertension, and heart disease she will have. All women suffering from PCOS, regardless of their desire to conceive, benefit from a healthy lifestyle of regular exercise and good nutrition, and those who are not trying to conceive may take hormone therapy such as birth control pills to regulate their menstrual cycles.

A woman with PCOS should be routinely monitored for:

  • Diabetes
  • High blood pressure
  • High cholesterol
  • Heart disease
  • Uterine cancer