Polycystic Ovarian Syndrome (PCOS)
By Joshua M. Hurwitz, MD
Reproductive Medicine Associates of Connecticut
Polycystic Ovarian Syndrome (PCOS) is a medical condition that causes infertility by preventing women from ovulating. It is a common condition, affecting 5- 10% of women of reproductive age. In terms of conceiving a baby, the hormonal imbalances created by PCOS prevent the ovary from ovulating and releasing an egg to meet with the sperm.
The goal of fertility therapy for patients with PCOS is to restore hormonal balance and induce ovulation. This is achieved by treatment with stimulatory medicines that can either be oral pills (such as clomiphene citrate or letrozole), or injectable medicines, termed gonadotropins. Some patients with PCOS need more advanced fertility treatments, such as IVF, if their ovaries are either resistant to initial treatment or respond too well to treatment.
Many women with PCOS have ovaries that are producing excess hormones, specifically the male hormone testosterone. In addition, they can have a decreased sensitivity to insulin for which their bodies compensate by over-producing insulin. The overactive ovaries and high levels of insulin may contribute to the development of hirsuitism (excessive body hair) and worsen the already present ovulation disorder. There is evidence that excess insulin plays a role in the development of PCOS, it is therefore hypothesized that reducing the circulating levels of insulin may help restore normal reproductive function. This may be accomplished by weight loss, improved nutrition, and exercise. These lifestyle changes should be the first line of therapy for any woman with PCOS.
Additionally, there is some evidence that insulin sensitizing agents can aid in both the medical and fertility therapy of PCOS. The best studied insulin sensitizing agent available in the United States for women with PCOS is metformin (Glucophage®). Metformin reduces circulating insulin and androgen levels and may restore normal ovulation in select women with PCOS. The most current scientific evidence shows that metformin alone does not usually restore ovulation, but in some women it may possibly improve the ovarian response to fertility medications. Most patients with PCOS do not need metformin, and the decision to prescribe metformin is made by your physician on a case-by-case basis to ensure personalized treatment plans.
In addition to these infertility and reproductive problems, there are also health issues for patients with PCOS that include: irregular menstrual periods, obesity, high cholesterol, high blood pressure and a pre-disposition towards Type 2 diabetes. Some of these symptoms, if left untreated, can lead to heart disease later in life.
Diagnosing PCOS: Symptoms and Tests
We can diagnosis women with PCOS by reviewing your symptoms: infertility, irregular menstrual periods (or skipping them entirely), severe and chronic acne and excessive body hair growth. The symptom that brings most women to see a specialist is irregular menstrual periods. If you are having fewer than 4-6 menstrual periods per year, you should have the lining of your uterus evaluated for overgrowth, a condition known as endometrial hyperplasia. You should also have a fasting sugar test to make sure you do not have a pre-diabetic condition called Insulin-Resistance that is common in patients with PCOS. Additionally, cholesterol levels and blood pressure should be checked regularly. It is also important to maintain a routine of diet and exercise. Many studies have shown an improvement in every aspect of PCOS with a sustained loss of 5-10% of your body weight, regardless of your starting weight.
Treatment of PCOS: Four Main Goals
In terms of treatment, there are four main goals.
- If you are trying to have a baby, you should see a fertility specialist, called a Reproductive Endocrinologist & Infertility specialist, as soon as possible.
- Maintain the health of your body to prevent heart disease and diabetes.
- The severe acne and excessive hair growth of PCOS can be treated both medically and cosmetically.
- If you are not interested in becoming pregnant, your OBGYN can help regulate your menstrual periods in order to protect the lining of your uterus from overgrowth. This is usually accomplished through the use of birth control pills for cycle regulation.
Helping patients with PCOS achieve their family-building goals is our primary goal here at RMACT, but we never lose sight of the medical issues associated with this common condition.
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