Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) occurs when more male hormones than normal are produced by a woman's ovaries or adrenal glands. As a result, cysts (fluid-filled sacs) develop on the ovaries.

The cause of PCOS is unknown. However, genetics, is thought to play a role. Some studies have shown if a mother has PCOS, there is a 50% chance her daughter will have PCOS. Women who are obese are at an increased risk for polycystic ovary syndrome.

There is no cure but some medications can help control certain symptoms. Birth control pills can be given to help regulate menstrual cycles, reduce male hormone levels, and help with acne. Other medications can be prescribed to decrease hair growth and increase ovulation.

5-10% of women of childbearing age are affected by PCOS. However, PCOS can occur in girls as young as 11 years old.

As many as 5 million women in the United States may have PCOS however less than 50% of women diagnosed. This leaves millions of women undiagnosed.

The symptoms of PCOS can vary from woman to woman. Some of the symptoms of PCOS include:

• Infertility (not able to get pregnant) because of not ovulating. PCOS is the most common cause of female infertility.
• Infrequent, absent, and/or irregular menstrual periods
• Excess hair growth on the face, chest, stomach, back, thumbs, or toes
• Cysts on the ovaries
• Acne, oily skin, or dandruff
• Weight gain or obesity, usually around the waist
• Difficulty losing weight
• Male pattern baldness or thinning hair
• Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black
• Skin tags — excess flaps of skin in the armpits or neck area
• Pelvic pain
• Anxiety or depression
• Sleep apnea — when breathing stops for short periods of time while asleep

• Decreased sex drive

• Increase in stress levels

The cause of PCOS is unknown. However certain factors such as genetics, can play a role.

PCOS is associated with an imbalance of hormones. Polycystic ovary syndrome (PCOS) occurs when the ovaries make more androgens than normal. Androgens are male hormones that females make, but high levels of these hormones will affect the development and release of eggs during ovulation.

Some experts believe there is a link between insulin and PCOS. Insulin is a hormone that controls the change of sugar, starches, and other food into energy for the body. Many women with PCOS have too much insulin in their bodies due to an inability to use insulin correctly. Excess insulin seems to increase androgen production.

There is not a single test to diagnose PCOS. Your doctor may do the following to determine if you have PCOS.

Medical history. Your doctor will ask about your menstrual periods, weight changes, and other symptoms.

Physical exam. Your doctor will measure your blood pressure, body mass index (BMI), and waist size. He or she also will check the areas of increased hair growth. (Try to allow the natural hair to grow for a few days before your visit)

Pelvic exam. Your doctor may check your ovaries to see if they are enlarged or swollen.

Blood tests. Your doctor may order lab tests to look at androgen hormone and glucose (sugar) levels.

Vaginal ultrasound (sonogram). Your doctor will do a sonogram to look for cysts on your ovaries and check the endometrium (lining of the womb).

If you have PCOS, the best thing to do is take action to get your symptoms under control at an earlier age. This will help decrease your chances for having complications in the future. Ask your doctor about treating all your symptoms. In addition, you should be tested for diabetes regularly.

Eating a healthy diet, exercising, and avoiding smoking are all important lifestyle modifications to manage your PCOS.

Many women with PCOS are overweight or obese. Maintaining a healthy weight is important as this helps to lower blood glucose (sugar) levels, improve the body's use of insulin, and can regulate hormone levels. Even a 10 percent loss in body weight can restore a normal period and regulate your cycle.

If you feel embarrassed, worried about not being able to conceive, or depressed, there are support groups to help you cope with the emotional effects associated with PCOS. 

Women with PCOS are at higher risk for other health problems including diabetes, metabolic syndrome, heart disease, high blood pressure, and sleep apnea.

Women with PCOS have a normal uterus and healthy eggs. Many women with PCOS have trouble getting pregnant. PCOS is the most common cause of female infertility.

In addition, women with PCOS also may have:

• Miscarriage
• Gestational diabetes
• Preeclampsia- pregnancy induced high blood pressure
• Premature delivery

However, some women do not have any trouble getting pregnant.

Because there is no cure for PCOS, some medications can help control certain symptoms. Treatment goals will be based on the symptoms. Many women will need a combination of treatments. 

Some treatments for PCOS include:

Birth control. For women who do not want to get pregnant, birth control can:

• Regulate menstrual cycles
• Reduce male hormone levels
• Clear acne

However, if you stop taking birth control, your menstrual cycle will become abnormal again.

Diabetes medications. Metformin (glucophage) is used to treat type 2 diabetes. However, metformin has also been found to help with PCOS symptoms. Metformin affects the way insulin controls blood glucose (sugar) and lowers testosterone production. It slows the growth of abnormal hair and may assist in ovulation. In addition, metformin has shown to reduce body mass and improve cholesterol levels.

Fertility medications. Women with PCOS may have fertility problems due to the lack of ovulation. Fertility medications can help women with PCOS become pregnant by stimulating ovulation. Medications include:

• Clomiphene (Clomid, Serophene)
• Gonadotropin shots
• Letrozole

In vitro fertilization (IVF) may be an option for some women.

Surgery. "Ovarian drilling" is a surgery to increase the chance of ovulation.  When a woman does not respond to fertility medicines, this surgery may be an option. This surgery can lower male hormone levels and help with ovulation.

Other surgeries and procedures are available and will depend on your situation. Talk to your doctor about all of your options.

Medicine for increased hair growth or extra male hormones. Spironolactone (Aldactone), is a medication used to treat high blood pressure, but has been shown to manage hair growth in women. Your doctor may prescribe spironolactone with birth control pills. However, this medication should not be taken if you are trying to become pregnant.

Other options include:

• Vaniqa cream to reduce facial hair
• Laser hair removal or electrolysis to remove hair
• Hormonal treatment to prevent new hair from growing

Acne

Your doctor can also prescribe topical creams and oral antibiotics for acne.

There is continued research for new ways to treat PCOS.

• Researchers are looking at the diabetes medicine, metformin, and its potential to prevent or decrease the chance of having problems while pregnant. Metformin also lowers male hormone levels and limits weight gain in women who are obese when they become pregnant.
• Recent research has shown bariatric (weight loss) surgery may be effective in resolving PCOS in morbidly obese women. (Morbid obesity means having a BMI of more than 40, or a BMI of 35 to 40 with an obesity-related disease)
• Troglitazone was shown to help women with PCOS. However, it was taken off the market because it caused liver problems. Similar medications are being tested in small trials.

Women with PCOS have greater chances of developing several serious health conditions, including life-threatening diseases. Recent studies found that women with PCOS:

• Are more likely to have diabetes or pre-diabetes before the age of 40 (50 %).
• Are 4 to 7 times more likely to have a heart attack.
• Are at increased risk for high blood pressure.
• Are more likely to have high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol.
• Are more likely to develop sleep apnea.
• May also develop anxiety and depression.
• Are at risk for endometrial cancer.
  • Irregular menstrual periods and the lack of ovulation is associated with the production of estrogen but not progesterone. Each menstrual period, the endometrium (lining of the womb) sheds. Without progesterone, the endometrium becomes thick and over time, this can lead to endometrial hyperplasia (too much growth) and cancer.