Polycystic Ovary Syndrome (PCOS)
What is Polycystic Ovary Syndrome (PCOS)?
Polycystic ovary syndrome (PCOS) is a health problem that affects approximately 1 in 10 women of childbearing age. Women with PCOS have hormonal imbalances and metabolic abnormalities that may affect their overall health and appearance. This syndrome is characterized by hyperandrogenism (elevated testosterone levels), ovulatory dysfunction, and polycystic ovaries. PCOS is also a common and treatable cause of infertility. The cause of PCOS remains unknown and treatment is based largely on your symptoms.
Not every woman with PCOS has every symptom:
- Irregular menstrual cycles –having infrequent periods (oligomenorrhea), stopping menses completely(amenorrhea), or at times frequent, heavy, and sporadic bleeding.
- Hirsutism -growing thick, dark hair on the upper lip, chin, sideburn area, chest, belly.
- Acne and oily skin on the face, chest, and upper back.
- Thinning hair or hair loss on the scalp (androgenic alopecia).
- Weight gain and obesity or difficulty losing weight.
- Difficulty becoming pregnant.
Etiology or Causes of PCOS and its symptoms
The exact cause of PCOS is not known. Most experts believe there are several factors, genetics may play a role. In PCOS, the ovaries do not work normally and produce too much testosterone(hyperandrogenism). Testosterone is called a “male hormone,” the ovaries usually produce very small amounts, but in PCOS, they make more, and this can contribute to acne, increased hair growth, and sometimes hair loss from the scalp. Usually, a woman’s ovary will make a “follicle” or cyst each month, which produces hormones that lead to the release of its egg or “ovulation.” But in women with PCOS their ovaries make many small follicles or cysts instead of one larger one, which contributes to the hormonal imbalance, and ovulation does not occur. Periods then become irregular. On a pelvic ultrasound, a woman with PCOS may have ovaries that show many small follicles or cysts, though this can be seen in women without PCOS as well.
Insulin is a hormone that controls how the food you eat is changed into energy. Insulin resistance is when the body’s cells do not respond to the insulin and blood levels of insulin become higher than normal. Many women with PCOS have insulin resistance, especially those who are overweight or obese.
There is no universally accepted definition of PCOS. The most current accepted definition is The Rotterdam criteria 2003, where TWO out of three signs and symptoms are required for diagnosis:
- Oligomenorrhea or Amenorrhea
- Polycystic ovaries by ultrasound
Risks or health consequences
- Endometrial cancer (the lining of the uterus) –is caused by the hormonal imbalance and lack of ovulation that leads to infrequent menses. This lining can become too thick over time and lead to abnormal cell growth such as hyperplasia and even cancer. This risk is also increased in women who are obese. This can be prevented, generally with hormones.
- Insulin resistance and its associated conditions such metabolic syndrome, leading to diabetes and cardiovascular disease. These conditions can be managed with dietary changes and increase in physical activity resulting in weight loss, and medication.
- Infertility –this can be improved with medication as well as addressing factors associated with obesity and insulin resistance such as diet and exercise.
- Mood disturbance and depression
Evaluation and tests used in diagnosing and managing
- Physical exam –looking for acne, balding, body hair distribution, blood pressure, weight, pelvic exam, acanthosis nigricans (dark velvety patches of the skin in body folds and creases).
- Blood tests to measure levels of hormones, blood sugar, and cholesterol.•Pregnancy test if you have missed any periods.
- Pelvic ultrasound –is sometimes used to aid in the diagnosis of PCOS or evaluation of the ovaries and lining of the uterus. But it is not always necessary, as the diagnosis can be made on history and symptoms alone.
There is no cure for PCOS, but symptoms can be managed with a combination of treatment options.•IF you are overweight or obese, losing weight can often improve many of your symptoms and insulin resistance. Losing just 5 percent of your body weight can help significantly. As an example, for a person who weighs 200 pounds losing this would mean 10 pounds.
- Prescription medications – To regulate menses and protect the endometrial lining: hormonal birth control pills, patch, injection, vaginal ring, hormonal IUD, cyclic progesterone, and sometimes metformin.
- To treat acne and facial hair growth: birth control pills, spironolactone, and sometimes metformin. As well as topical medications, laser therapy, and electrolysis.
- Insulin Resistance –medications that treat diabetes such as metformin.
- Most women with PCOS are able to get pregnant. Losing weight can help make your periods more regular and improve your chances of becoming pregnant.
- Your OB/GYN physician can give you medication to help you ovulate and improve your chances of becoming pregnant.
- In vitro fertilization (IVF)
It is very possible to live a full and normal life with PCOS. But it is important to see your physician. Treatments will help your symptoms and protect you from other diseases.
In an emergency go to Mount Nittany Medical Center or call 911 for an ambulance.
Test Results and Advice Nurse
Send a secure message to the advice nurse via the UHS website or call 814- 863-4463.
Appointments can be made online via the UHS website, by phone 814-863-0774, or in person. If you are unable to keep your appointment, please call or go online to cancel. Otherwise, you will be charged for the visit.
This content is reviewed periodically and is subject to change as new health information becomes available. This information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. 06/08/20