Polycystic Ovary Syndrome (PCOS)

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Question: I have had irregular periods since I was 13. My primary care physician said it might take a few years for my cycle to be regular, but my OB/GYN recently diagnosed me with Polycystic ovaries and explained that is why my periods have been irregular. Could you explain to me what polycystic ovaries are and what I can do to treat them? 

Answer: 

Polycystic ovary syndrome (PCOS) is the most common hormonal disorder among women of reproductive age. PCOS is a hormonal disturbance that causes a female’s body to produce excessive amounts of androgens, or male hormones, such as testosterone. Hormones are small chemical messengers released into the bloodstream in small doses that affect the body in large ways. Women are usually born with thousands of eggs in their ovaries, and these eggs are usually surrounded by cells. Every month, these cells develop into follicles, small groups of cells that are hollow at the center. Each ovarian follicle contains one egg. In most menstruating woman, one ovarian follicle grows and releases an egg every month. PCOS disrupts the balance of both follicle-stimulating hormone (FSH, the hormone that causes the follicle and egg to develop) and luteinizing hormone (LH, the hormone that causes the follicle to break and release the egg). This hormonal imbalance causes the woman’s body to create higher-than-normal levels of androgens, which women normally produce in very small amounts.

The very high levels of LH that result from PCOS block both egg growth and ovulation. Ovulation occurs when the woman’s egg breaks out of the follicle and travels through the fallopian tubes. One of two things can result from this: if sperm is present, it will fertilize the egg. If sperm is not present, menstruation will occur. In PCOS, this does not always happen, because the follicle and egg have both developed improperly. Instead, the undeveloped follicle forms a small ovarian cyst. The syndrome obtained its name from the multiple, poorly formed follicles that form cysts because these were once considered to be PCOS’s main characteristic.

PCOS tends to run in families, but little is known about its cause or how it passes from one generation to the next. Researchers believe that environmental factors including diet, exercise, pollution, and stress, play a role in PCOS development along with underlying genetic interactions, excessive exposure to male hormones (androgens) in fetal life, excess insulin production, and predispositions.

Symptoms

  • Infrequent or prolonged menstrual periods
  • Excessive hair growth (hirsutism)
  • Acne
  • Male pattern baldness
  • Obesity and/or unexplained weight gain
  • Infrequent or absent menstruation in adolescents
  • Difficulty getting pregnant
  • Enlarged ovaries with cysts when viewed with ultrasound

Complications

If you have PCOS you are at a higher risk for these other conditions:

  • Type II Diabetes
  • High blood pressure
  • Cholesterol and lipid abnormalities
  • Elevated levels of c-reactive protein (a cardiovascular disease marker)
  • Nonalcoholic steatohepatitis – severe liver inflammation caused by fat accumulation in the liver
  • Sleep apnea
  • Abnormal uterine bleeding
  • Endometrial cancer (cancer of the uterine lining) caused by continuous high levels of estrogen
  • Gestational diabetes or pregnancy induced high blood pressure

Tests/ Diagnosis/Treatment

Tests

If your healthcare provider suspects that you have PCOS they will most likely perform a series of tests to determine your diagnosis

  • Physical examination (height, weight, blood pressure)
  • Pelvic exam
  • Blood tests for cholesterol, glucose, and excess androgens

Treatment

No cure exists for PCOS, but treatments can be helpful. Polycystic ovary syndrome treatment generally focuses on management of your individual main concerns, such as infertility, hirsutism (extra hair), acne and/or obesity.

Oral contraceptives (birth control pill) are the most common medications used to regulate menstrual cycles in women with PCOS since they decrease the level of androgens in a body. These protect women from endometrial cancer or overgrowth of the uterine lining by prompting a woman to menstruate every month. Sometimes, they help with acne and hirsutism (hair growth). Women can develop nausea, breast tenderness, and bloating when they begin the pill, but these symptoms usually disappear after two or three months. Irregular menstrual cycles generally return when oral contraception is stopped.

Some women with PCOS choose to take progestin, another method of treatment for menstrual irregularity. Taking the hormone for 10 to 14 days every one to three months induces a period in almost all women with PCOS. However, this method does not provide contraception or help with the cosmetic concerns (acne and hirsutism). It does reduce the risk of uterine cancer though.

Anti-androgen drugs, such as spironolactone, decrease the effect that androgens have on the body. These can be used in combination with oral contraception to alleviate acne or slow hair growth.

Excessive hair growth can be removed through tweezing or shaving, use of depilatories (liquid or cream used for hair removal), electrolysis (use of an electric current to destroy hair roots), or laser therapy. Sometimes, medications help, but these tend to be more effective in men.

Metaformin (Glucophage ®) is a medication that improves the body’s response to insulin. Developed as a treatment for type II diabetes, this medication could help PCOS patients who struggle with menstruation or obesity in certain situations. It is not normally recommended for women with PCOS who have trouble becoming pregnant or who have hirsutism, but it could increase weight loss if the person is already eating a healthy diet and exercising. 

In extreme cases there is also the option of laparoscopic ovarian drilling. Laparoscopic ovarian drilling is an outpatient surgery when a surgeon uses electrical or laser energy to burn holes in the follicles on the surface of the ovaries to induce ovulation.

In addition, two lifestyle choices are often discussed as remedies for PCOS: 

1. Exercise helps lower your blood sugar levels. For women with polycystic ovary syndrome, an increase in daily physical activity and participation in a regular exercise regimen are essential for treating or preventing insulin resistance and for helping weight-control efforts.

2. Choose carbohydrates that are high in fiber. The more fiber in a food, the more slowly it's digested and the more slowly your blood sugar levels rise. High-fiber carbohydrates include whole-grain breads and cereals, whole-wheat pasta, bulgur, barley, brown rice, and beans. Limit less healthy, simple carbohydrates such as soda, excess fruit juice, cake, candy, ice cream, pies, cookies and doughnuts. Here is a link to the Center of Young Women’s Health’s nutrition suggestions for women with PCOS

Additional research may determine which specific dietary approach is best, but it's clear that losing weight by reducing total calorie intake benefits the overall health of women with polycystic ovary syndrome. Working with your doctor and registered dietitian will help determine the best dietary plan for your specific needs.

Resources:

The Center for Young Women’s Health has a wealth of information on PCOS and living with PCOS: http://www.youngwomenshealth.org/pcosinfo.html

 The Polycystic Ovarian Syndrome Association is a non-profit organization dedicated to help women with PCOS. I highly recommend checking out their website: http://www.pcosupport.org/

The Mayo Clinic provides comprehensive information on PCOS:

http://www.mayoclinic.com/health/polycystic-ovary-syndrome/DS00423

This National Institute for Health site provides an overview of PCOS: 

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001408/

 
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