Polycystic Ovary Syndrome (PCOS)

PCOS is a long-term disorder that requires management for much of your life, well beyond your reproductive years. It is a leading cause of menstrual irregularity and infertility. It may be a factor in excess hair growth and obesity (including increased cardiovascular risks). This topic provides information that may help you understand PCOS and its consequences better.

What is PCOS and What Does It Do?

PCOS is estimated to affect from 6% to 10% of adult women. The underlying cause is an abnormal level of certain hormones. Just before and during ovulation, you produce both estrogen and progesterone. You also produce a certain amount of male hormones (androgens). If the amount of androgens is excessive, it may prevent ovulation, causing infertility or irregular bleeding, along with other complications. These include unwanted hair (face, between breasts, upper arms, mild-to-severe acne and (in severe cases) deepening of your voice and scalp hair loss. Women with PCOS may also produce too much insulin, or ineffective insulin. In recent years there has been evidence that PCOS can be associated with cardiovascular risk and insulin resistance (leading to Type 2 Diabetes). Excessive androgens can also result in signifcant weight gain and increased muscle mass.

Diagnosing PCOS

The consensus is currently that PCOS is suspected if you have any two of the following three conditions:

These conditions may be caused by other things as well, so tests must be done to rule these out. Examples are androgen-secreting tumors, Cushings syndrome and late-onset congenital adrenal hyperplacia (CAH).

To properly diagnose PCOS, your physician must consider three things—your medical history, a current physical exam, and laboratory tests. A history of irregular periods beginning as early as 12 to 13 years old is typical, as are masculine hair and skin changes. Other indicators are female relatives with infertility, irregular periods, severe acne or excess hair growth. Another important sign is Type 2 diabetes in parents or aunts/uncles. To check for polycystic ovaries, an ultrasound may be performed.

A physical exam is vital to look for signs of excessive androgen (facial hair, etc.) but also general physical condition. About half of the women with PCOS are obese and have fat deposits in the abdomen, upper back and upper arms.

Treatment Options

Perhaps the most important treatment to address virtually all PCOS symptoms is ensuring proper nutrition and increasing physical activity. Nutrition counseling may be beneficial, and emphasis should be on eating fewer processed foods and more vegetables, fruits, chicken and fish. Along with diet and exercise there are treatment options including oral contreceptives (estrogens) to restore more regular menstrual cycle. In cases where insulin resistance increases with oral contraceptives, alternatives such as Metformin may be used as a supplement or replacement to the contraceptive This needs to be carefully supervised by your physician. When these treatments are used in combination with diet and exercise, menstrual regulation is typically obtained by 3 months.

For excessive hair growth (hirsutism) or hair loss (Alopecia), treatments to limit androgen reception may be added. These include spironolactone, finasteride and flutamide. The latter two require tests to monitor liver function. While these treatments may prevent future hair growth, they may not remove existing unwanted hair. Other hair removal methods may be necessary.

Inhibiting androgen reception can also provide the benefit of improving acne. Except for cystic acne (for which a dermatologist should be consulted), the above treatments combined with oral or topical antibiotics can provide significant improvement.

PCOS can be managed with proper treatment, and patients can get relief from most symptoms. Continued care is important to monitor potential effects of the treatment and make adjustments where indicated.