Understanding and Treating PCOS

What is PCOS?

Polycystic Ovarian Syndrome, commonly referred to as PCOS, is believed to affect between 5-10% of women of childbearing age.  It is one of the most common hormonal disorders and therefore a major cause of infertility.  The condition is also known as polycystic ovaries, polycystic ovary disease, or polyfollicular ovarian disease.

PCOS is characterized by many small cysts on the ovaries, which are producing higher than normal amounts of androgens (male hormones).  This can interfere with development and subsequent release of eggs.  Under normal conditions, the follicle will release a mature egg so it can be fertilized in the uterus.  In the case of a woman with PCOS, the eggs contained within these follicles may not fully mature, or the maturation may be altered.

Cysts are formed when the follicles build up in the ovaries when they should be released during the menstrual cycle.  It is very common for women with PCOS to have irregular periods because they are not ovulating/releasing an egg each month.  Some women miss their periods altogether.  In summary, a woman with PCOS is probably not releasing an egg each month, and the egg itself might be compromised and not fully developed.  It is worth noting that not all women with PCOS have difficulty becoming pregnant, and most pregnancies are usually normal!

The exact cause of PCOS remains unknown.  They cysts themselves seem a logical place to point the finger—but some women without PCOS even have small numbers of ovarian cysts.  Therefore, the cysts may not be the root cause of PCOS.  Some women with the syndrome exhibit insulin resistance; and too much insulin signals the ovaries to release extra amounts of androgens into the bloodstream.

Treatment for PCOS

Losing weight has been shown to help with diabetes, high blood pressure, and high cholesterol. Even a weight loss of 5% of total body weight has been shown to help with the imbalance of hormones and also with infertility.

Medications used to treat the abnormal hormones and menstrual cycles of polycystic ovary syndrome include:

• Birth control pills or progesterone pills, to help make menstrual cycles more regular.
• Metformin, a medication that increases the body’s sensitivity to insulin, can improve the symptoms of PCOS and sometimes will cause ovulation and the menstrual cycles to normalize. For some women, it can also help prevent type 2 diabetes and add to weight loss when a diet is followed.
• LH-releasing hormone (LHRH) analogs
• Treatment with clomiphene citrate (Clomid) causes the egg to mature and be released. Sometimes women need this or other fertility drugs to get pregnant.

Pelvic laparoscopy to remove a section of the ovary or drill holes in the ovaries is sometimes done to treat the absence of ovulation (anovulation) and infertility. The effects are temporary.

This Patient Fact Sheet on PCOS by ASRM contains some great information for your consideration.  If you suspect you may have PCOS, it is a good idea to seek further evaluation.  The reproductive endocrinologist at RRC are specialists in polycystic ovarian syndrome. Contact us for a consultation today!

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