Polycystic Ovarian Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is an endocrine disorder that affects about 5 to 10 percent of women during their childbearing years. Typically, the ovaries contain multiple small cysts, which are often slightly enlarged. About 1 in 5 women have polycystic ovaries appearing on ultrasound scans but do not have the other features of this syndrome. These cysts do not require surgical removal. Polycystic ovaries make more male hormones (androgens) than do normal ovaries. The exact cause for PCOS is not known, but sometimes it is hereditary.

PCOS is one of the common causes for infertility because women with PCOS do not ovulate regularly.

Medications to induce ovulation include clomiphene citrate and hormones such as FSH (follicle stimulating hormones). Some patients may require in vitro fertilization (IVF). Women with PCOS are at risk for ovarian hyperstimulation when given FSH, and IVF is one way to reduce the chance of hyperstimulation and multiple gestation.

Not all women with PCOS experience the same symptoms. There are several symptoms associated with PCOS including:

  • Irregular menstrual intervals – infrequent periods or absence of periods
  • Excess body hair (face, chest, abdomen)
  • Male pattern hair loss (typically scalp hair)
  • Acne
  • Weight gain/difficulty losing weight
  • Skin changes (skin tags, dark velvet-like thickening around the neck, under arms and folds of the upper thighs)
  • Infertility

Since the above symptoms can occur with disorders of other endocrine glands, it is important to get tested and confirm the diagnosis before initiating treatment.

Often, women with PCOS tend to put on weight easily and have difficulty losing weight. This is because women with PCOS are thrifty with calories. If they eat too much, extra insulin is needed to dispose of the extra sugar. Sadly, this tendency can also increase the risk of diabetes. This is more likely in those with a family history of adult-onset diabetes. Women with PCOS are more likely to develop high blood pressure and diabetes during pregnancy, particularly if they are overweight and have higher than normal insulin levels.

Excessive weight gain leads to obesity, which can worsen insulin resistance and symptoms of PCOS. Obesity itself, in the absence of PCOS, can increase insulin levels, cause excess body hair, and cause a woman’s periods to become irregular. Therefore not all overweight women have PCOS, although they may have similar symptoms.

The hormone changes in PCOS have been associated with increased risk for cholesterol abnormalities, insulin resistance, diabetes (adult type), heart disease, and endometrial cancer in later life. These risks can be reduced by proper nutrition and medications.

Treatment of PCOS is individualized and depends on whether or not pregnancy is being sought. Dietary modifications, weight management and regular exercise are important factors in the management of this condition in all women with PCOS, regardless of whether they are trying to conceive or not. Cosmetic treatment options to treat excess body hair, particularly facial hair, include electrolysis, laser treatment and typical medication which act at the hair follicle. There are medical and surgical options to treat the hormone abnormalities associated with PCOS. For women who are not trying to conceive, medical treatment options include oral contraceptives, progestational agents (that induce periods), and drugs that block the production or action of androgens. In some cases, surgery is performed to cauterize the cysts, which results in a decrease in male hormone levels and return of ovulation in some women. Insulin modifiers are useful in those women with high insulin levels and insulin resistance but do not benefit all women with PCOS. The safety of these medications in pregnancy has not been established.

Because the same treatment is not effective for everyone with PCOS, a complete evaluation, including factors such as severity and nature of the symptoms, a woman’s age, and her desire to have children must be considered.

Call 404-778-3401 to make an appointment with our reproductive endocrinologists.