1. What is PCOS and how do I get it?
Polycystic ovary syndrome (PCOS), also known as Stein-Leventhal Syndrome, is a common disorder, affecting about 5%-10% of childbearing age women. PCOS is a frequent cause of infertility, menstrual irregularity and hirsutism (excessive hair growth).
The term “polycystic” originates from multiple ovarian cysts (fluid-filled sacs that hold eggs, called follicles) seen on ultrasound in patients with PCOS.
The exact origin of PCOS is unknown. It is thought, that in PCOS hormonal imbalances cause the ovaries to overproduce androgens (male hormones). Another hormone that plays a role in PCOS is insulin. Insulin is a hormone that controls the body’s use of sugar (glucose).
PCOS might have a genetic predisposition. Women with PCOS are usually born with it. H ormone changes may begin as early as the very first menstrual cycle or occur over time.
Women with PCOS may be at increased risk for developing obesity, cholesterol abnormalities, hypertension, Type 2 diabetes, and possibly heart disease ( metabolic syndrome).
Lack of ovulation (egg release from follicles) and therefore lack of hormone progesterone (hormone, that causes shed of uterine lining each month) may result in excessive thickening (hyperplasia) of the endometrium (uterine lining) and, if untreated, even endometrial cancer.
PCOS is a lifelong condition, but it can be controlled and treated.
2. What are the symptoms of PCOS?
Signs and symptoms vary in women with PCOS and may include:
- Excess hair on the face and body (known as hirsutism)
- Acne, oily skin or dandruff
- Darkened color and change in texture of the skin along the neck and armpits and on the groin and inner thighs
- Obesity, usually extra weight around the waist
- Irregular menstrual periods or no periods
- Trouble getting pregnant
- Vaginal yeast infections
- Hair loss or thinning (male pattern baldness)
- Pelvic pain
- Type 2 diabetes
- High cholesterol
- High blood pressure
- Skin tags, or tiny excess flaps of skin in the armpits or neck area
- Sleep apnea-excessive snoring and breathing stops at times while asleep
3. I was told that I have a lot of cysts in the ovaries on my ultrasound. Does it mean that I have PCOS?
No. Twenty percent of women have polycystic appearing ovaries on ultrasound with no other abnormalities found.
The diagnosis of PCOS is considered if two of the following three characteristics are present:
1• chronic anovulation (absence of ovulation)
2• chronic hyperandrogenism ( excessive amount of “ male “ hormones such as testosterone are produced by the ovaries
3• polycystic appearing ovaries ( enlarged ovaries with many small cysts, fluid-filled sacs, that give the pearl-necklace appearance on ultrasound).
4. How is PCOS treated?
Treatment depends on your symptoms and whether you want to become pregnant.
Diet and exercise is an important component of therapy. Weight loss improves the frequency of ovulation, improves fertility, lowers the risk of diabetes, and lowers androgen levels.
Oral contraceptive pills (OCs) are commonly prescribed to reduce hirsutism and acne, maintain regular menstrual periods, prevent endometrial cancer, and prevent pregnancy.
Hormone progesterone may be prescribed to regulate menstrual periods and prevent endometrial cancer. However, it is not a contraceptive pill and does not prevent pregnancy.
OCs may be combined with medications that decrease androgen action, such as spironolactone, to improve hirsutism. Vaniqa ® cream has been approved to reduce facial hair. These medications can affect the development of male fetus and should not be taken if pregnancy is possible. Methods that remove hair, such as electrolysis and laser, are also helpful. Long-term treatment might be necessary to see improved results.
If infertility is your main concern, oral medications, such as clomiphene citrate (Clomid ® , Serophene ® ), and/or
medications that increase your body’s sensitivity to insulin, such as metformin (Glucophage ® ), may lead to more regular ovulation.
Gonadotropins (injectable fertility medications), may be
used to induce ovulation if you do not respond to simpler treatments. PCOS patients are at increased risk of multiple births when using these medications.
Regardless of your primary goal, PCOS should be treated because of the long-term health risks it poses. With proper treatment, PCOS can be managed and your symptoms can be relieved.
5. Is surgery available to treat PCOS?
Surgery, called ovarian drilling (destroying small portion of ovary) is available to induce ovulation. However, it works only short-term and carries a small risk of developing scar tissue around the ovaries. Non-surgical options should be considered before the decision for surgery is made.
6. Are women with PCOS at increased risk of complications during pregnancy?
Yes. There appears to be a higher rate of miscarriage, gestational diabetes, pregnancy-induced high blood pressure, and premature delivery in women with PCOS. Researchers are studying how the medicine, metformin, prevents or reduces the chances of having these problems.