What is polycystic
ovary syndrome?
Polycystic ovary syndrome (PCOS) is an imbalance in female
sex hormones in women, which may cause problems such as excess hair growth,
irregular menstrual cycles, trouble getting pregnant, ovarian cysts, and
obesity. The most widely accepted criteria for diagnosis includes having at
least 2 of the following 3 conditions: irregular or no ovulation, high levels
of androgen (a male hormone) determined by either a blood test or symptoms, or multiple
cysts on the woman’s ovaries. Often times many other diseases need to be ruled
out in order for PCOS to be diagnosed. Some of these diseases include androgen
secreting tumors, enlargement of the adrenal gland, and high levels of
prolactin.
How many women are
affected by PCOS and why should I worry about it?
PCOS currently affects anywhere from 4% to 12% of
reproductive-aged women, making it the most common hormonal disorder in this
age range. Many women are unaware they have PCOS until they try to
become pregnant; diagnosis typically happens when women are in their 20s and
30s. The following list shows some, but not all, health risks that
are associated with PCOS:
- Pregnancy complications
- Infertility
- Type 2 diabetes mellitus
- Cardiovascular diseases
- Endometrial cancer
- Depression
What are some of the
signs and symptoms of PCOS?
PCOS is associated with many vague signs and symptoms. Women
with PCOS may experience some of the following:
- Irregular or absence of menstrual cycles
- Excess hair growth in unusual places
- Struggling to get pregnant
- Unexplained weight gain
- Pelvic pain
- Acne after pubescence that does not go away with usual treatments
- Oily skin
What can I expect
when I go to my doctor?
There are multiple tests your doctor may choose to run to
help make a diagnosis of PCOS, and to rule out other possible causes of PCOS
symptoms.
Menstrual Cycle History and Pelvic Exam: Your doctor may ask
about your previous menstrual cycles to try and determine if irregular
ovulation is occurring. Be prepared to provide a previous history of your
menstrual cycle for a longer duration than normally asked. An ultrasound, or
other imaging technique, may be done to determine if your ovaries have any
cysts.
Physical Exam: Since weight gain is a common sign of PCOS,
your doctor may measure your weight and compare it to your previous weight.
Body Mass Index (BMI), waist circumference, and blood
pressure may be measured as well.
Blood Tests: A battery of blood tests may be conducted not
only to help diagnose PCOS but also to rule out other causes of high levels of
androgen hormones. Some of the following hormone levels may be
tested: testosterone, thyroid stimulating hormone, prolactin, luteinizing
hormone, anti-mullerian hormone, and dehydroepiandrosterone sulfate (DHEA-S).
Even though this is a long list, typically one blood draw is all that is needed
to test all of these levels. Your doctor may also instruct you to not eat before
your office visit in order to perform an oral glucose tolerance test. This is when
the insulin response to glucose in an unfed state is tested; your doctor will
provide further instructions.
What are the
treatment options for PCOS?
Treatment for PCOS ranges widely depending on the individual
patient goal. The first line treatment recommendation for all symptoms is
lifestyle modifications including diet and exercise. This has been shown to
decrease a woman’s risk for cardiovascular disease and restore ovulation. It is
important to remember that treatment for excess hair growth may take 6 to 12
months to see an improvement. Oral medications are unable to affect the hair
that has already grown, therefore it may take longer to see an effect. Guidelines
for treatment recommendations come from the American College of Obstetricians
and Gynecologists and the Endocrine Society.
Treatment for absent or irregular menstrual cycles (less
than 8 menstrual cycles per year):
- Combined (estrogen and progesterone) hormonal contraceptives
o First
choice for this symptom
o Examples
include oral contraceptives, the patch, and the vaginal ring
o Helps
regulate menstrual cycles, decrease acne, and improve excess hair growth
- Metformin
o Second
choice for therapy for women who cannot take contraceptives
o Helps
regulate insulin levels and potentially affects menstrual cycles
- Progesterone Withdrawal Bleeding
o Causes
menses for women who do not want to use hormonal contraceptives
o Recommended
every 1-3 months
Treatment for infertility:
- Estrogen modulators (clomiphene, letrozole, etc.)
o First
choice for women who experience difficulty getting pregnant
o Can
be combined with metformin, although unclear if it affects the ability to get
pregnant
- Exogenous gonadotropins
o Examples
of exogenous gonadotropins include purified urinary follicle-stimulating
hormone (u-FSH), human menopausal gonadotrophin (hMG), and gonadotrophin-releasing
hormone analogues (GnRH-a)
o Second
choice for women who experience difficulty getting pregnant
- Procedures
o Laparoscopic
ovarian drilling removes ovarian cysts for women who don’t respond to
clomiphene
o Timed
intercourse and intrauterine insemination for women on clomiphene
o In
vitro fertilization (IVF) is the last line therapy for women with PCOS who have
difficulty getting pregnant
Treatment for glucose intolerance:
- Metformin
o An
insulin sensitizer that helps decrease the circulating levels of insulin
o Given
to women with type 2 diabetes mellitus
Treatment for excess hair growth:
- Combined hormonal contraceptives
o First
choice for this symptom
o Can
add metformin
- Spironolactone
o Given
at higher doses it can help decrease hair growth
Treatment for acne:
- Combined hormonal contraceptives
- Spironolactone
- Topical creams or gels
o Topical
retinoids
o Topical
benzoyl peroxide
- Topical or oral antibiotics
- Isotretinoin
What can I do to help
prevent complications if I already have PCOS?
It is important for women with PCOS to treat all symptoms,
not just one. For example, changes in insulin levels may not cause physical
symptoms, but they can lead to diabetes and future health complications.
Therefore, it is important to regularly test for diabetes. Another way to help
prevent future complications is through lifestyle modifications, including diet
and exercise. Even a 5% decrease in body weight has shown to improve many
symptoms of PCOS and help prevent future complications such as cardiovascular
disease and diabetes.
Where can I find more
information about PCOS?
PCOS Foundation
PCOS Awareness Association
American College of Obstetricians and Gynecologists
U.S. Department of Health and Human Services, Office on
Women’s Health
Mayo Clinic
Kendall
Elayne Buchmiller
UIC
- College of Pharmacy
Drug
Information Extern
Class
of 2016 President
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