Polycystic Ovary Syndrome (PCOS) is the most common endocrine problem – it is caused by a hormone imbalance in the body – as well as the most common cause of infertility in women. PCOS affects 6.5 to 8 percent of women, and the prevalence is 3-4 times higher in overweight or obese women, as weight gain is a symptom of PCOS. It is important to know that PCOS is a syndrome, not a disease, as there are multiple potential causes and women can experience a range of symptoms.
Hormones are chemical messengers that trigger different processes in the body. The role of some hormones in the body is to tell another hormone to release and do its job. In PCOS, some hormones do not perform as they should, creating a “domino effect” on other hormones. If left untreated, this condition has life-long implications, not only causing an increased incidence of infertility but also metabolic problems: patients with PCOS are commonly insulin-resistant, and obesity occurs in approximately one half of adolescents and adults with this condition. These problems may lead to type 2 diabetes, hypertension, and cardiovascular disease.
The two most common symptoms of PCOS are irregular menstruation and excessive levels of male hormones, or androgens, which are usually produced in small amounts in the ovaries. The irregular menstruation is characterized by infrequent or absent periods. Ovulation is also affected by excessive male hormones. In women with PCOS, a pelvic ultrasound usually shows multiple small follicles in both ovaries. These follicles may grow, but none may become large enough for ovulation. When ovulation doesn’t occur, progesterone is not produced. Without progesterone, a woman’s cycle will be absent or irregular. In addition, severe acne, excess facial hair (hirsutism), and hair loss (pattern alopecia) can also result from excessive male hormones.
Due to infrequent ovulation and menstrual periods, tissue build-up may occur inside the uterine cavity (hyperplasia) which may lead to abnormal bleeding and rarely to uterine cancer. Also associated with this condition is an increased rate of pregnancy loss as well as complications during pregnancy such as gestational diabetes or pregnancy-induced hypertension.
The risks from PCOS associated with type 2 diabetes are mainly being overweight, having a family member who had type 2 diabetes, and your ethnicity. About 40-80 percent of children and adolescents with type 2 diabetes have at least one parent affected by PCOS and 85 percent have a first- or second-degree relative with this condition.
Treating the symptoms of PCOS is important not only to decrease the unpleasant aspects of this condition but also to help prevent long-term health problems. In general, a low carbohydrate diet and regular exercise can be very effective in improving the weight-related signs and symptoms of PCOS. The medication Metformin, a diabetes medication, may enhance weight loss when used with a low calorie diet and may also normalize the menstrual cycles. About 20 percent of the time, gastrointestinal side effects may occur with this medication, but the majority of the time it is well tolerated if the dosage is increased gradually or the extended release version of this drug is used. Kidney and liver function studies should be part of a baseline as well as follow-up studies.
If you have PCOS and want to get pregnant, different treatment options are available. You should talk to your doctor about the best treatment plan for you; Clomid, a medication that induces ovulation, can be used alone or in combination with Metformin. In recent multi-medical center studies, findings indicated that Clomid is superior to Metformin in achieving as well as maintaining pregnancy compared with Metformin alone. However, there is an increased rate of twin gestation.
If the above treatment fails, gonadotropin medication can be used to induce ovulation, but the rate of multiple gestation is clearly increased with this type of treatment.
If you do not wish to get pregnant, oral contraceptives can be used to regulate your menstrual cycles. This will also reduce excessive hair growth and acne by reducing the male hormones originating from the ovaries.
Polycystic Ovary Syndrome has lifelong implications with the risk of infertility, metabolic syndrome, type 2 diabetes and cardiovascular disease. Early diagnosis and treatment of PCOS will significantly reduce the risk of complications arising from this common medical condition.