Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome or PCOS is a common hormonal disorder in women and it involves multiple organs in the body. Even though the name implied multiple cysts in the ovaries, some women may not have cysts in the ovaries. It is estimated that about 5 to 10 percent of women in the U.S have polycystic ovary syndrome. PCOS is often found in women who are in their childbearing age but it can also occur in young girls who just reach puberty. Currently, research studies showed that PCOS runs in the families. If your mother or sister is diagnosed with PCOS, 

Scientists do not know the exact causes of PCOS yet. Nevertheless, it is found to be associated with imbalance of several hormones including estrogen and progesterone (female hormones), androgen (male hormone), LH and FSH (from pituitary gland in the brain) and insulin. Insulin is the hormone that regulates blood glucose. In a normal menstrual cycle, LH, FSH, estrogen and progesterone play a role in oocyte (egg) development and ovulation, which is the released of the matured egg for fertilization. In PCOS, too much insulin is produced but the body cells are resistant to insulin uptake. Therefore, blood glucose remains high. In addition, it causes increased production of androgen (male hormone) in the ovaries. Too much androgen interferes with ovulation. Thus, fertility problem, excess body hair and irregular menstrual cycle are common among women with PCOS. Some women may also develop multiple cysts in the ovaries.

There is a variety of symptoms associated with PCOS and it varies from one woman to another. Most women experience irregular periods where they have less than 8 periods per year. Period may be heavy and prolonged when they have it. Many women with untreated PCOS have difficulty getting pregnant. Because of too much androgen (male hormone), women develop male-like features such as hirsutism in which excess hair growth on the face, chest and belly. Furthermore, they may experience hair loss or male-pattern baldness and deepening of the voice.

Some women develop acne from oily skin due to androgen and they may notice dark patches of skin around the neck, groin area and under arms. Insulin impairment causes weight gain and obesity, which is common among women with PCOS. Some women develop type II diabetes. Both obesity and diabetes increase the risk of heart disease and many women also suffer from sleep apnea in which your breathing stops briefly during sleep. People with sleep apnea experience fatigue and increased daytime sleepiness.

There is no specific test for PCOS. It is often diagnosed by taking a complete medical history, blood tests and pelvic ultrasound. The doctor will ask you about your period and other symptoms you may have. You do not need to have all the symptoms mentioned above to make a diagnosis of PCOS. He or she will do a physical exam and pelvic exam to check for abnormalities. The doctor will order blood tests for pregnancy test, fasting blood glucose and cholesterol, androgen hormone level and thyroid-stimulating hormone. Some doctors will do glucose tolerance test where your fasting blood glucose and blood glucose after drinking a sugary drink are measured. You may be asked to have a pelvic ultrasound to check for cysts in your ovaries.

PCOS is treated by managing or reducing the symptoms with oral medications. For women who are not planning to get pregnant, your doctor will prescribe birth control pills to regulate your menstrual period. Birth control pills decrease the production of male hormone so it is effective for reducing facial hair growth, deepening of the voice and male-pattern baldness. It can also help clear acne. You may experience nausea, bloating and breast tenderness from birth control pills but those often resolve in a few months. Laser hair removal is an option if you have a lot of excess hair on the face and other parts of the body.

If you are not a candidate for birth control pills, another medication called spironolactone (Aldactone) is an option. It is a medication to reduce androgen hormone production as well as lowering the blood pressure. It is effective for treating excess hair growth, male-pattern baldness and acne problem. However, it can cause birth defects if you become pregnant.

Metformin (Glucophage) is a diabetes medication to improve insulin function and it is given to regulate blood glucose. Metformin also helps regulate menstrual period. Unlike other diabetes medications, metformin does not cause weight gain. The doctors will also recommend lifestyle changes such as diet and exercise if you are overweight or obese. Losing a few extra pounds can lower your blood glucose and keep your periods regular.

There are fertility medications available if you are planning to get pregnant. PCOS causes infertility by blocking ovulation. Clomiphene (Clomid and Serophene) is an oral medication that stimulates ovulation. Studies showed that 50 percent of women with PCOS become pregnant after getting treated with clomiphene. You will need to lose a few extra pounds if you are overweight. If you still do not ovulate with clomiphene, gonadotropin therapy (FSH and LH injections) is recommended. Some doctors may refer you for in vitro fertilization (IVF) treatment. It is a more expensive fertility treatment and it has increased chance of multiple births.

Contributed by Patricia Hsiao M.D.