Polycystic Ovarian Syndrome (PCOS)
The most common endocrine disorder in women of reproductive age, polycystic ovary syndrome (PCOS) causes infertility and other serious health repercussions. In fact, PCOS is believed to be the most commonly found reason for menstrual irregularities in women of reproductive age. It often starts as early as the teen years.
What is PCOS?
PCOS is a condition that impacts a woman’s endocrine (hormonal) system, and in turn affects other body functions such as the reproductive and cardiovascular systems. In addition to causing infertility, PCOS can be connected to more serious health problems such as diabetes and heart disease and uterine cancer.
Women with PCOS usually have a normal uterus and fallopian tubes, but their ovaries sometimes contain many small follicles or cysts, visible in ultrasound images. The eggs contained in these follicles don’t grow normally. Each month, new follicles develop and shrink into cysts. Rarely, the patient may ovulate and conceive, but most of the cysts remain too small.
This type of cyst is not an indication of ovarian cancer. However, the cysts produce androgens, hormones that lead to an imbalance in the woman’s entire system. This imbalance affects her ability to conceive.
The primary cause of PCOS-related diseases stems from the worsening imbalance of hormone levels. Accordingly, “hyperandrogenism” is used to describe PCOS because women with the condition have elevated levels of serum testosterone and androstenedione, two androgens (male-like hormones). In turn, hyperandrogenism suppresses ovulation.
There is a strong connection between PCOS and insulin resistance.
In women with PCOS and insulin resistance:
- 50 percent will develop diabetes
- 40 percent will develop gestational diabetes (during pregnancy)
Women with PCOS and insulin resistance are also more susceptible to heart disease, abnormal breast milk production, and endometrial (uterine) abnormalities, including uterine cancer.
DHEA (Dehydroepiandrosterone) is a naturally occurring hormone
How do you know you have PCOS?
Not all women with PCOS have the same symptoms. Some may notice these outward signs first:
- Irregular or absent menstrual periods
- Weight gain or difficulty losing weight
- Male pattern baldness or thinning hair on the scalp
- Hair growth on the face, back, or chest (hirsutism)
Less visible symptoms may include:
- High blood sugar (hyperglycemia)
- High cholesterol
- PCOS may be hereditary
Women with family members with PCOS or Type II diabetes are considered at higher risk.Women who do not have a menstrual period for more than six of any 12 months should see a physician, as PCOS is a possible cause. Regardless of PCOS diagnosis, women who have extremely irregular or absent periods are at much higher risk for cancer of the uterus.
How to stabilize your hormones: A guide for PCOS patient
Dr. Mary Hinckley discusses how to stabilize your hormones and treat the symptoms of PCOS, including infertility.
How is PCOS Treated?
Infertility is considered a symptom of PCOS and can be treated.
PCOS sufferers cannot be cured, but their symptoms – including infertility – can be treated. Patients learn to manage the disease, just as they would any other life-long medical condition. Irritating but less serious symptoms like hirsutism, male-pattern hair loss, and acne will often respond to specific prescription medications that lower androgen levels. Electrolysis, laser hair removal and plucking maybe necessary for cosmetic reasons.
Treatment can improve the chances of conception and reduce risks of diabetes or heart disease. Making lifestyle changes, especially nutritional and exercise habits, is a crucial part of treatment.A key to reducing the symptoms of PCOS is the lowering of insulin levels. This can often be accomplished with medications. Any diet and physical activity that improves overall health will also considerably affect a woman’s hormone levels and reduce her PCOS symptoms.
Treating infertility caused by PCOS
The first steps in any infertility treatment will be semen analysis for the male partner and examination of the woman’s reproductive system.
Overweight women will be advised to begin a healthy weight-loss program before or during infertility treatment. Studies have shown that some women experience spontaneous return of their ovulation and regulation of their cycles by simply losing weight through healthful eating and exercise.
Other women may need the further assistance of ovulation-inducing fertility medications, usually starting with clomiphene citrate tablets (the most common brand name is Clomid) or injectable drugs such as Follistim or Gonal-F. Treatment with these medications requires close monitoring by examination and ultrasound, as women with PCOS are more likely to have adverse reactions to fertility drugs. Injections of hCG are used to stimulate ovulation of matured follicles at just the right time.
If ovulation induction is followed by intrauterine insemination (IUI), the risk of a multiple pregnancy (twins or more) rises to about 10-18 percent. In vitro fertilization (IVF) can also be the course of action, with very good chances of pregnancy and fewer odds of high-order multiples.
Some PCOS patients also develop high levels of fasting blood insulin, called hyperinsulinemia, which is determined through blood tests. These infertility cases can be more difficult to treat. If a patient does not respond to initial treatment with fertility medications or develops resulting complications, her physician may prescribe drugs also used to treat adult onset diabetes. Daily doses of these medications can reverse hormonal abnormalities and eventually return normal menstrual and ovulatory cycles.
Can PCOS be prevented?
To date, physicians have not found a way to determine which girls may develop PCOS after menarche (the beginning of menstruation.) However, family history of obesity, diabetes, or infertility can be important indicators.
The earlier a young woman is diagnosed and begins managing PCOS, the less likely is long-term complications of infertility, heart disease, hypertension, and diabetes. Keeping family physicians and gynecologists informed about symptoms and following treatment plans helps the patient manage the disease.
For women who are not trying to conceive, hormone therapy through birth control pills or other hormonal contraceptives can be helpful. And all PCOS sufferers, regardless of desire to conceive or body weight, benefit from a healthy lifestyle of regular exercise and good nutrition.
Lastly, any woman with PCOS should be routinely monitored for complications such as:
- High blood pressure
- High cholesterol
- Heart disease
- Uterine cancer
The Reproductive Science Center of the Bay Area is a leading pioneer in infertility treatments including IVF with egg donation and LGBTQ family building. We’ll work with you to help you achieve your dreams of having a baby.