Polycystic ovary syndrome (PCOS) is one of the most common hormonal abnormalities in women, affecting approximately 6 to 7% of American women.
The core symptoms for PCOS are irregular menstrual cycles and elevation in androgen (testosterone) levels. Assorted symptoms may include obesity, insulin resistance, abnormal levels of cholesterol, fatty liver, and obstructive sleep apnea. Irregular cycling starts at puberty and continues into adulthood. Elevated androgen levels may cause unwanted hair growth, male pattern hair loss, and acne. Sometimes a woman will have no symptoms but measurement of testosterone reveals significant elevation.
The syndrome is inherited in a complex fashion and is likely to have several modes of inheritance, which are not well understood currently.
The diagnosis of PCOS is made through observation of clinical criteria. While multiple definitions have been proposed, the “Rotterdam” criterion is most frequently utilized.
Two of the three criteria
-oligo and/or anovulation (irregular or no menstrual cycle)
-chemical or biochemical evidence of elevation in androgens
-polycystic ovaries by ultrasound
There are several conditions which must be ruled out such as late-onset congenital adrenal hyperplasia, elevation in prolactin, thyroid disease or the presence of an androgen secreting tumor.
PCOS is managed since a “cure” is not possible. The goal of treatment dictates the treatment plan. For many young women, managing irregular menstrual cycle and relieving symptoms of elevated testosterone is desired.
Generally, the use of oral contraceptive pills with androgen blockers (e.g. spironolactone) results in sustained suppression of symptoms. Managing weight gain often involves the use of metformin, dietary programs, and exercise. If fertility is desired, the use of medications to induce ovulation is warranted. When fertility is complete, therapy to minimize the risk of cardiovascular and cerebrovascular disease is indicated. Partnering with a knowledgeable clinician is important through the transitions of aging which results in improved managements of symptoms.
In the last installment during September, which is PCOS month, fertility enhancing strategies will be reviewed.
In women with PCOS, infertility is common. It is not uncommon to ovulate regularly for two to three months immediately following cessation of oral contraceptive pills.
Reduction of insulin resistance improves ovulatory response which can be achieved by weight reduction. The use of the insulin sensitizing agent, metformin, is often helpful. Two drugs in pill form (clomiphene and letrozole) frequently result in an ovulatory response.
If oral agents are not successful, the use of injectable hormones (gonadotropins) is very successful; however multiple gestation may result so care is needed when using gonadotropins.
If medications to induce ovulation are not successful, a surgical procedure in which controlled damage to the ovaries is affected through a minimally invasive route may be utilized. With treatment, successful pregnancy is generally achieved.