Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome or PCOS, is a condition in which a woman’s levels of the sex hormones estrogen and progesterone are out of balance.  This leads to the growth of ovarian cysts (benign masses on the ovaries).  PCOS can cause problems with a women’s menstrual cycle, fertility, cardiac function and appearance.

Common PCOS signs and symptoms

–     Irregular menstrual periods – Menstrual disorders can include absent periods, periods that occur infrequently or too frequently, heavy periods, or unpredictable periods.

     –     Infertility  PCOS is one of the most common causes of female infertility.

–     Obesity – Up to 80% of women with PCOS are obese.

–     Excess hair growth on the face, chest, abdomen, or upper thighs – This condition called hirsutism, affects more than 70% of women with PCOS.

–     Severe acne or acne that occurs after adolescence and does not respond to usual treatments.

–     Oily skin.

–     Patches of thickened, velvety, darkened skin called acanthosis nigricans.

–     Multiple small cysts on the ovaries.

Causes

Although the cause of PCOS is not known, it appears that PCOS may be related to many different factors working together.  These factors include insulin resistance, increased levels of hormones called androgens and an irregular menstrual cycle.

Test and Diagnosis

There’s no specific test to definitively diagnose polycystic ovary syndrome.  The diagnosis is one of exclusion, which means your doctor considers all of your signs and symptoms and then rules out other possible disorders.

During this process, you and your doctor will discuss your medical history, including your menstrual periods, weight changes and other symptoms.  Your doctor may also perform certain tests and exams:

     –     Physical exam – During your physical exam, your doctor will note several key pieces of information, including your height, weight and blood pressure.

     –     Pelvic exam During a pelvic exam, your doctor visually and manually inspects your reproductive organs for signs of masses, growths or other abnormalities.

     –     Blood tests  Your blood may be drawn to measure the levels of several hormones to exclude possible causes of menstrual abnormalities or androgen excess that mimic PCOS.  Additional blood testing may include fasting cholesterol and triglyceride levels and a glucose tolerance test, in which glucose levels are measured while fasting and after drinking a glucose-containing beverage.

–     Ultrasound – An ultrasound exam can show the appearance of your ovaries and the thickness of the lining of your uterus.  During the test, you lie on a bed or examining table while a wand-like device (transducer) is placed in your vagina (transvaginal ultrasound).  The transducer emits inaudible sound waves that are translated into images on a computer screen.

Treatment and Drugs

Polycystic ovary syndrome treatment generally focuses on management of your individual main concerns, such as infertility, hirsutism, acne or obesity.

Lifestyle Changes

As a first step, your doctor may recommend weight loss through a low-calorie diet combined with moderate exercise activities. Even a modest reduction in your weight — for instance, losing 5 percent of your body weight — might improve your condition.

Medications

Your doctor may prescribe a medication to:

     –     Regulate your menstrual cycle – To regulate your menstrual cycle, your doctor may recommend combination birth control pills — pills that contain both estrogen and progestin.  These birth control pills decrease androgen production and give your body a break from the effects of continuous estrogen, lowering your risk of endometrial cancer and correcting abnormal bleeding.  As an alternative to birth control pills, you might use a skin patch or vaginal ring that contains a combination of estrogen and progestin.  During the time that you take this medication to relieve your symptoms, you won’t be able to conceive.

If you’re not a good candidate for combination birth control pills, an alternative approach is to take progesterone for 10 to 14 days every one to two months.  This type of progesterone therapy regulates your periods and offers protection against endometrial cancer, but it doesn’t improve androgen levels and it won’t prevent pregnancy.  The progestin-only mini pill or progestin-containing intrauterine device are better choices if you also wish to avoid pregnancy.

Your doctor also may prescribe metformin (Glucophage, Fortamet, others), an oral medication for type 2 diabetes that improves insulin resistance and lowers insulin levels.  This drug may help with ovulation and lead to regular menstrual cycles.  Metformin also slows the progression to type 2 diabetes if you already have prediabetes and aids in weight loss if you also follow a diet and an exercise program.

     –     Help you ovulate  If you’re trying to become pregnant, you may need a medication to help you ovulate.  Clomiphene (Clomid, Serophene) is an oral anti-estrogen medication that you take in the first part of your menstrual cycle.  If clomiphene alone isn’t effective, your doctor may add metformin to help induce ovulation.

If you don’t become pregnant using clomiphene and metformin, your doctor may recommend using gonadotropins — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) medications that are administered by injection.  Another medication that your doctor may have you try is letrozole (Femara).  Doctors don’t know exactly how letrozole works to stimulate the ovaries, but it may help with ovulation when other medications fail.

When taking any type of medication to help you ovulate, it’s important that you work with a reproductive specialist and have regular ultrasounds to monitor your progress and avoid problems.

    Reduce excessive hair growth  Your doctor may recommend birth control pills to decrease androgen production, or another medication called spironolactone (Aldactone) that blocks the effects of androgens on the skin.  Because spironolactone can cause birth defects, effective contraception is required when using the drug, and it’s not recommended if you’re pregnant or planning to become pregnant.  Eflornithine (Vaniqa) is another medication possibility; the cream slows facial hair growth in women.

 Lifestyle and Home Remedies

To help offset the effects of PCOS:

          Keep your weight in check  Obesity makes insulin resistance worse.  Weight loss can reduce both insulin and androgen levels and may restore ovulation.  No single specific dietary approach is best, but losing weight by reducing how many calories you consume each day may help with polycystic ovary syndrome, especially if you’re overweight or obese.  Use smaller plates, reduce portion sizes and resist the urge for seconds to help with weight loss.  Ask your doctor to recommend a weight-control program and meet regularly with a dietitian for help in reaching weight-loss goals.

          Consider dietary changes  Low-fat, high-carbohydrate diets may increase insulin levels, so you may want to consider a low-carbohydrate diet if you have PCOS — and if your doctor recommends it.  Don’t severely restrict carbohydrates; instead, choose complex carbohydrates, which are high in fiber.  The more fiber in a food, the more slowly it’s digested and the more slowly your blood sugar levels rise.  High-fiber carbohydrates include whole-grain breads and cereals, whole-wheat pasta, bulgur wheat, barley, brown rice and beans.  Limit less healthy, simple carbohydrates such as soda, excess fruit juice, cake, candy, ice cream, pies, cookies and doughnuts.

     –     Be active – Exercise helps lower blood sugar levels.  If you have PCOS, increasing your daily activity and participating in a regular exercise program may treat or even prevent insulin resistance and help you keep your weight under control.

>> BACK