By Shyama S. Mathews, MD
Polycystic ovarian syndrome (PCOS) is a common condition, affecting one in 10 women of childbearing age.
Left untreated, PCOS can cause infertility as well as a range of other serious conditions that may have lifelong consequences.
However, the condition can usually be managed with medications that reduce symptoms and lower the risk for complications and through weight loss for those who have the condition and are also overweight.
Hormonal and Metabolic Problems
Polycystic ovarian syndrome is characterized by hormonal and metabolic problems that affect all areas of the body, not just the reproductive system. Contrary to its name, PCOS does not always cause cysts on the ovaries.
Though the exact cause is not known, PCOS is believed to be related to a combination of factors, including genetics as well as insulin resistance and high levels of hormones called androgens.
Insulin resistance occurs when the body’s cells do not respond normally to insulin, a hormone that controls how food is changed into energy. When this happens, the level of glucose in the blood increases, prompting the body to produce more insulin. Over time, insulin resistance can lead to type 2 diabetes.
High levels of androgens can prevent the ovaries from ovulating or releasing an egg during menstruation, resulting in infertility among other symptoms.
As the American College of Obstetricians and Gynecologists (ACOG) notes, common symptoms of PCOS include:
• Irregular menstrual periods. Women with PCOS may miss periods, have periods that occur infrequently or too frequently, or have heavy or unpredictable periods.
• Infertility. Polycystic ovarian syndrome is one of the most common causes of female infertility.
• Obesity. As many as four in five women with PCOS are obese.
• Excessive hair growth on the face, chest, abdomen, or upper thighs. This condition, called hirsutism, affects more than seven in 10 women with PCOS.
• Severe acne or acne that occurs after adolescence and does not respond to usual treatments.
• Oily skin.
• Patches of thickened, velvety, darkened skin, particularly along neck creases, in the groin and underneath breasts.
• Multiple, small, fluid-filled sacs on the ovaries.
Because PCOS is a chronic condition that affects the entire body, it can cause serious health complications.
For example, when insulin resistance is the cause of PCOS, it increases the risk for type 2 diabetes and also raises the chances of developing cardiovascular disease and a condition called metabolic syndrome. Metabolic syndrome contributes to both diabetes and heart disease.
In addition, according to ACOG, some women with PCOS develop a condition called endometrial hyperplasia in which the lining of the uterus becomes too thick, increasing the risk of endometrial cancer.
Women with PCOS also may be at greater risk for sleep apnea and depression.
Diagnosis and Treatment
Diagnosis of PCOS typically begins with a visit to a gynecologist. The doctor will conduct a physical exam, review your symptoms, and likely order lab work to evaluate the levels of insulin and androgens in your blood. An ultrasound may also be ordered to check for cysts on the ovaries.
Once diagnosed, a variety of treatments are available. Though PCOS is not curable, the symptoms can be managed. Many women will need a combination of treatments including:
• Weight loss. For women who are overweight, losing weight may help lower blood glucose levels, improve the way their body uses insulin, and help hormones reach normal levels. Even a small amount of weight loss can help make menstrual periods more regular, according to ACOG. Weight loss may also improve cholesterol levels and relieve some symptoms such as excessive hair growth and acne. (It is important to remember, however, that not all women with PCOS are overweight.)
• Hormonal birth control. Hormonal birth control using estrogen and progesterone can be used for long-term treatment of PCOS in women who do not wish to get pregnant. Birth control medication can regulate the menstrual cycle, reduce excess hair growth, control acne, and decrease the risk of endometrial cancer.
• Insulin sensitizing drugs. Insulin-sensitizing drugs used to treat diabetes are frequently used in the treatment of PCOS, according to ACOG. These drugs help the body respond to insulin and can help lower androgen levels and improve ovulation.
• Hair removal or slowing hair growth. In addition to hair removal creams, laser hair removal or electrolysis to remove excess hair, a prescription skin treatment can slow down the rate of hair growth in unwanted places.
Treatment for PCOS is tailored to meet each woma’s individual needs, including whether she wants to get pregnant.
If you have been diagnosed with PCOS, talk with your doctor about a treatment approach that is right for you.
To find a physician with Penn Medicine Princeton Health call 888-742-7496 or visit www.princetonhcs.org.
Shyama S. Mathews, MD is a board certified gynecologist, minimally invasive gynecologic surgeon, and a member of the Medical Staff at Penn Medicine Princeton Health.