What is PCOS?

PCOS is a disorder that occurs when levels of certain hormones are abnormal. Women with PCOS may have irregular or no menstrual periods, infertility, excess hair growth, and may even have long-term health problems. Polycystic Ovarian Syndrome can be treated, so continue reading to find out about signs/symptoms, causes, diagnosis, and treatment of PCOS.

Causes

The exact cause is unknown. However, we do know that excess androgens (testosterone, male hormones, etc.) are produced. The elevated insulin levels cause increased production of testosterone production. This can prevent ovulation (release of the egg from the ovary) and lead to infertility. The elevated testosterone levels also cause many of the symptoms listed in the section above. With suppression of ovulation, the ovarian hormones (estrogen, progesterone) become more imbalanced. Testosterone and insulin continue to increase, and a “snowball” effect ensues.

Signs and Symptoms

  • Women with PCOS have a history of irregular menstrual cycles and often have difficulty conceiving.
  • They may also have a male hair growth pattern (upper lip, chin, between their breasts, abdomen, etc).
  • With PCOS, many women have high insulin levels and/or their insulin does not work properly. This is one reason these women tend to gain weight and have a hard time losing weight. This also puts them at increased risk for diabetes, high blood pressure, and diabetes in the future.

Diagnosis

  • Women who have signs of androgen excess and are anovulatory (not ovulating) are considered to have PCOS, so a medical history and physical exam can point us toward the diagnosis.
  • Labs can also be done to evaluate certain hormones that come from the brain and the ovaries. Usually these labs are done at specific days of the menstrual cycle.
  • Ultrasound may also be done to look for numerous small cysts seen in PCOS.

Treatment

  • Medication can be used, and the specific medication chosen depends on the symptoms and whether or not the patient wants to become pregnant. If pregnancy is not desired, birth control pills are the most commonly prescribed medication. Other forms of hormone therapy may be used as well. This usually helps to fix the hormone imbalance seen with polycystic ovarian syndrome. If pregnancy is desired, medication to help lower insulin levels (for example metformin) and medication to induce ovulation (for example clomiphene) may be given. There are other medications that can also be used to help with androgen excess and some of the possible associated health problems.
  • Lifestyle changes include diet, exercise, and weight loss. With sufficient weight loss, insulin levels decrease, ovulation may occur spontaneously, and many of the symptoms improve and may even resolve.