PCOS

Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) affects about 5-10% of US women aged 20-40, making it the country’s most common hormonal disorder for females of reproductive age. The word “polycystic” means “many cysts” and the condition is named for one of its main symptoms: the presence of large cysts on the ovaries. These cysts tend to be up to three times the size of normal ovarian cysts and often there are many of them, creating an appearance like a string of pearls.

PCOS is a leading cause of infertility and is known to increase the risk of miscarriage. Women with PCOS may also be more susceptible to other health conditions later in life, such as diabetes, high cholesterol, high blood pressure, and heart disease. However, early diagnosis and treatment of the disease lowers the risk of these potential long term complications.

Diagnosis
If you suffer from any of the above symptoms, your doctor may initiate a series of tests. The first of these is a pelvic examination, during which your doctor can feel if you have any cysts on your ovaries. Your doctor may then carry out a full physical examination which will generally require a detailed history of your menstrual cycles, reproductive history, birth control usage, and pregnancies.

If cysts are found, your doctor may refer you for a vaginal ultrasound, which screens the ovaries and examines the condition of the cysts.

Your doctor may also recommend a series of blood tests to check your hormone levels, insulin and glucose levels, and your cholesterol.

Risks associated with PCOS
PCOS is a leading cause of fertility problems and can significantly increase the risk of miscarriage. It may also contribute to ongoing health problems in later life.

Fertility and miscarriage. PCOS can prevent ovulation for some women which means that they can't get pregnant. Some women continue to menstruate but their periods may be infrequent. There are several types of medication that may be prescribed to help in this situation including fertility drugs, steroids, or insulin-sensitizing medications. The reasons why women who have PCOS experience higher rates of miscarriage are not yet known. This is an area of ongoing study. If you have PCOS, preventing miscarriage is possible if you work with your doctor and normalize hormone levels to improve ovulation. You can also aim to normalize blood sugar, glucose, and male hormone levels.

Diabetes. Insulin resistance is a symptom of PCOS. Insulin is a hormone that helps to transfer sugar from the bloodstream to the parts of the body that need energy, such as tissues and organs. Insulin resistance occurs when the body resists this process and, in an attempt to rectify the imbalance, more insulin is secreted. Many of the symptoms of PCOS are thought to be related to an excess of insulin. When there is too much insulin present, the ovaries produce extra testosterone which in turn contributes to irregular menstruation and many other symptoms of PCOS, such as cysts, facial and body hair, acne, and hair thinning. Insulin resistance may also contribute to the distribution of fat – many women with PCOS carry weight around the abdomen. Excess abdominal fat makes insulin resistance worse. Up to 40% of women with PCOS will develop either impaired glucose tolerance, which is a pre-diabetic condition, or diabetes by the time that they are 40 years old.

Other risks. PCOS is also linked to abnormal uterine bleeding and a pre-cancerous condition called endometrial hyperplasia. These conditions develop as a result of too much estrogen and too little progesterone. Over a period of time, endometrial hyperplasia can also develop into endometrial cancer (cancer of the uterine lining). High cholesterol, atherosclerosis (hardening of the arteries), high blood pressure, and heart disease are also associated with PCOS over the longer term. PCOS may also contribute to depression and mood swings.

Treatment
At this stage there is no known cure for PCOS, although the syndrome can be managed effectively with medications, including birth control pills. One of the most important aims of treating PCOS is to minimize any long term complications associated with the condition including heart disease, diabetes, obesity, high blood cholesterol, and high blood pressure. A low-fat, low glycemic diet with an emphasis on weight control and regular exercise is generally a good prescription for managing the symptoms of PCOS.

If you are obese or overweight, losing weight and maintaining a healthy weight may actually greatly reduce your symptoms. A healthy, balanced diet and plenty of exercise will also help. Many of the symptoms of PCOS respond to weight loss and exercise because both of these improve insulin sensitivity.

Hormones, insulin sensitizing medications, and sometimes androgen-blocking drugs can also be used in treatment. Insulin sensitizing drugs should not be used during pregnancy or if there is a possibility of pregnancy.

Different medications can be used for the various other symptoms of PCOS, including medications for regulating your menstrual cycle, medications for reducing excessive hair growth, and medications to help achieve pregnancy. Hair removal treatments are also an option.

It’s best to talk to your doctor about the most effective ways to manage your condition and treat your symptoms. Regular visits to your doctor are recommended.


The cysts associated with PCOS develop during the process of ovulation. Every month, as part of a woman's normal cycle, the ovaries produce an egg. Most ovarian cysts form on the ovaries if the follicles (sacs) that contain the egg mature but do not release the egg into the fallopian tube. For women who have PCOS, the presence of cysts may ultimately prevent ovulation. In PCOS the cysts are multiple and often larger than usual.

Specific causes of PCOS are not known, but research suggests that excess insulin plays a role in many of the symptoms of PCOS. Excessively high levels of insulin in the body are thought to have the effect of preventing ovulation and causing a rise in so called “male hormones” or androgen (testosterone) levels. Excess androgen can result in symptoms such as long coarse hair on your face and body, acne, and male pattern baldness. However, not all women with PCOS have these symptoms.

PCOS is also often associated with Type 2 diabetes and obesity. It is generally believed that PCOS has a genetic component influenced by environmental factors such as diet and exercise, which is also often the case with Type 2 diabetes and obesity. Although it is unclear whether obesity causes PCOS or the other way around, some women find that their PCOS and diabetes symptoms disappear with weight loss, regular exercise, and a diet lower in fat and carbohydrates.

Symptoms of PCOS
As PCOS is a group of symptoms rather than a single condition, cysts are not the only defining factor. Sometimes a doctor will diagnose PCOS when cysts are not present but many of the other symptoms are. Three very common symptoms are:

Infrequent or irregular periods, often beginning in adolescence. “Irregular” means your cycle occurs at intervals of 35 days or longer or less than eight times a year. This is a result of an absence of ovulation or infrequent ovulation.
Increased levels of male hormones, such as testosterone. This often results in acne, oily skin or dandruff, male pattern baldness or thinning hair, and excess hair growth on the face, chest, stomach, thumbs or toes.
Obesity. This is a factor in 50-60% of PCOS cases, but of course, that means 40-50% of women with PCOS are of normal weight. Weight gain may also be a symptom. Insulin resistance is common in PCOS and probably plays a role in weight gain.

Other symptoms include:

Ongoing pelvic pain for more than six months
Diabetes, over-production of insulin or inefficient use of insulin by the body
High triglycerides
High blood pressure
High cholesterol
Heart disease
Skin tags or tiny excess flaps of skin in the armpits or neck area
Infertility
Difficulty becoming pregnant
Acanthosis nigricans: darkened, velvety skin on the nape of your neck, armpits, inner thighs, vulva, or under your breasts