PCOS

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PCOS Diagnosis

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder causing infertility in 3 percent to 10 percent of reproductive-aged women. PCOS prevents follicles in the ovary from producing and releasing mature eggs. This results in polycystic ovaries (i.e., ovaries with many small follicles or cysts), infertility and hormonal imbalances.

Fertility specialists define PCOS as the presence of chronic anovulation (not ovulating) or an excess of male hormones (androgens). The precise cause of PCOS is not known.

Missed or Skipped Periods

Chronic anovulation typically leads to “missed” or “skipped” periods. Women with PCOS usually have fewer than eight menstrual cycles per year, and it is not uncommon to skip periods entirely. Anovulation can be caused by chronic hormone abnormalities  including pituitary signaling hormones such as follicle stimulating hormone (FSH) and luteinizing hormone (LH), excess estrogen, decreased progesterone, increased androgens and insulin resistance.

Excess of Male Hormones

Hyperandrogenism seen in PCOS is an excess of “male” hormones (androgens) such as testosterone and androstenedione.

PCOS Symptoms

PCOS symptoms may include the following:

  • Menstrual irregularities
  • Trouble getting pregnant due to lack of ovulation
  • Increased hair growth in a male distribution pattern (e.g., on face and chest)
  • Acne
  • Obesity

Other problems associated with PCOS include: increased miscarriage rates and long-term health problems, including diabetes, dyslipidemias (high cholesterol and triglycerides), uterine cancer, and cardiovascular disease.

If diagnosed properly, several treatment options are available that can lead to positive reproductive outcomes and that will mitigate many of the other long-term health effects of PCOS.

PCOS Treatment

PCOS and Menstruation

Anovulation (not ovulating) can lead to an abnormal overgrowth of the uterine lining (endometrial hyperplasia), which increases the risk of uterine cancer.

Menstrual abnormalities can be treated with medications that might include oral contraceptives to regulate the menstrual cycle.

PCOS and Hormones

The goal of PCOS treatment is to decrease the amount of androgens in the bloodstream, thereby decreasing the clinical effects of androgens on the body (e.g., facial hair growth and acne). The most common treatment is low-dose oral contraceptives. Oral contraceptives decrease androgens in a variety of ways.

PCOS and Insulin Resistance

Insulin resistance and hyperinsulinemia (elevated blood insulin levels) are common in women with PCOS. These metabolic abnormalities can lead to impaired glucose tolerance and Type 2diabetes mellitus. Some women achieve positive results by going on the type of diet used for diabetes prevention.

Currently, metformin, an insulin-sensitizing medication, is used for the treatment of patients with PCOS. The goals of treatment include improving insulin resistance and lowering insulin levels. An improvement in ovulatory function can also be obtained.

PCOS and Fertility

Women with PCOS are either oligo ovulatory or anovulatory, meaning that they ovulate less often than normal or not at all. If ovulation does not take place, there is no opportunity for egg-sperm interaction and pregnancy to occur. The goal of treatment for infertility in PCOS is to cause ovulation to occur predictably.

If ovulation or pregnancy is not attained with these more conservative treatments, they can be combined with gonadotropin therapy (FSH or human menopausal gonadotropin – HMG – injections. However, gonadotropin therapy may include side effects such as increased multiple pregnancy rates and ovarian hyperstimulation syndrome (OHSS).

For more information on PCOS, or to talk with a fertility specialist about fertility treatment options in Los Angeles, Orange County, North San Diego or Rancho Cucamonga, contact us today.