William Hurd
William Hurd
MD, MSc, MPH, Professor of Obstetrics and Gynecology at University of Alabama School of Medicine and Professor Emeritus at Duke University.

Polycystic Ovary Syndrome (PCOS) – Diagnosis and treatment

What is PCOS?

Polycystic ovary syndrome, often referred to as PCOS, is one of the most common hormonal problems in women. It affects at least 10% of women during their childbearing years. Most women with PCOS have irregular or absent menstrual periods, and the majority also have increased hair on the face, chest and/or lower abdomen. Many women will have difficulty getting pregnant. In addition, more than half of women with PCOS are overweight. Fortunately, all these problems can be effectively treated.

PCOS gets its name from the common ultrasound finding of multiple small ovarian cysts, each less than ½ inch (10 mm) in diameter. These small cysts are not the cause of PCOS or any other problem but appear to be the result of not ovulating every month. They are completely unrelated to the large cysts that women occasionally experience that can cause pain or other more serious problems.

PCOS gets its name from the common ultrasound finding of multiple small ovarian cysts

Evaluation for PCOS

If a woman thinks that she might have PCOS, she should visit her Gynecologist for evaluation and treatment of her most bothersome symptoms. Women with PCOS are often referred to a Reproductive Endocrinologist. These gynecology subspecialists are experts in evaluating and treating female endocrine problems such as PCOS, as well as problems related to infertility.

Evaluation for PCOS includes a physical exam, a transvaginal ultrasound to look for polycystic ovaries, and a number of blood tests. The most important blood tests make sure there are not unusually high levels of male hormones (that all women have) and screen for other associated conditions including hypothyroidism, high cholesterol and diabetes. Adult onset diabetes is more common in women with PCOS, particularly those who are overweight. For this reason, a diabetes screen should also be repeated every year or so.

Doctor explaining PCOS to a patient

Treatment for PCOS

Treatment for PCOS depends on what is most troublesome to each patient. Problems linked to PCOS and treatment options are listed here:

Infertility:

Infertility associated with PCOS is the result of decreased ovulation (egg release) and is treated with oral fertility pills to induce ovulation. These pills result in pregnancy within a few months in the majority of patients with PCOS with only a small increased risk of twins. Women who do not get pregnant after 6 months or more of ovulation induction can be treated with in vitro fertilization (IVF), which is certainly more effective but much more expensive. One of the few positive aspects of PCOS is that patients with this condition undergoing IVF usually get many more eggs and embryos than the average infertile woman.

Irregular Periods:

 

 

Many women with PCOS are not interested in becoming pregnant, but are bothered by irregular menstrual periods and/or increase hair growth on their face, chest or lower abdomen. The simplest treatment for both of these problems is oral contraceptive pills that contain the hormones estrogen and progesterone. In addition to decreasing the chance of pregnancy, contraceptive pills result in regular, light periods in the majority ofmost women with PCOS. These pills also protect the lining of the uterus (the endometrium) from overgrowth (referred to as hyperplasia) that can result in heavy bleeding and is associated with an increased risk of cancer in some women with PCOS. An alternative form of contraceptive commonly used in women with PCOS is a hormone-containing intrauterine device (IUD).

Excessive Body Hair:

 

 

Contraceptive pills have the added benefit of decreasing hair growth as a result of estrogens ability to both decrease production and increase binding of male hormones. However, it takes at least 6 months for women with PCOS to notice a difference in hair growth while taking oral contraceptive pills. This is because it takes months for the old hair to begin to fall out and be replaced by the finer, shorter hair resulting from hormone treatment. Many women remove the excess hair with a variety of techniques until the estrogen has a chance to work on the new hair. Efficient hair removal techniques can be temporary, such as hair removal creams or shaving, or more permanent, such as electrolysis or laser therapy.

Increased Weight:

Increased weight is another potentially disturbing problem associated with PCOS. For some women, increased weight is the cause of PCOS, and losing weight will result in the return of regular periods and decreased hair grown. PCOS can also be the cause of increased weight, presumably because the increased male hormones these women sometimes have can increase appetite and make it more difficult to lose weight. For some women, oral contraceptives can makes weight loss easier by decreasing male hormones. However, the most effective way to lose weight remains a combination of increased physical activity, decreased portion size and decreased carbohydrate intake. Although these efforts are easy to remember, they are often very difficult to put into practice long term, and thus participation in a formal weight loss program can be extremely helpful for overweight women with PCOS.

Increased weight is a potentially disturbing problem associated with PCOS

Other Medications:

Another medication often used to treat women with PCOS is metformin. This medication increases the effectiveness of the naturally insulin that occurs in the body. Metformin both increases the chance of ovulation and decreases the risk of becoming diabetic in women with PCOS, especially those who are overweight. It also makes weight loss easier in some women with PCOS. For this reason, metformin is often used in women with PCOS who are trying to become pregnant or who have borderline diabetes.

What you should do if you suspect PCOS

The most important point to remember is that women should not ignore the symptoms that they think might be caused by PCOS. If a woman thinks she might have PCOS, she should make an appointment for evaluation and treatment with either a Reproductive Endocrinologist or a Gynecologist who has a special interest in PCOS. Finding the most effective treatments with the least side effects as early as possible is the best way to help women manage PCOS rather than letting it control their lives!