Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is a condition that affects a woman’s hormones and ovaries. PCOS affects up to 7 percent of women of childbearing age and is the leading cause of female infertility. Some women learn they have PCOS when they have problems becoming pregnant.
Women with PCOS have high levels of male hormones (androgens), which may interfere with normal ovarian function. Affected women often do not ovulate regularly. PCOS also affects other bodily systems, increasing a woman’s risk for diabetes and heart disease. Signs and symptoms of PCOS include:
• Irregular or absent menstrual periods
• Ovaries containing many small cysts (fluid-filled sacs)
• Increased facial hair
• Weight gain or obesity
• Male-pattern baldness
• Abnormal blood sugar levels or diabetes
• High blood pressure
The exact cause of PCOS is not known. However, there are quite a few factors that may play a role:
• Genetics: Women who have a mother or sister with PCOS, are more likely to develop PCOS.
• Hormonal imbalance: Women who have PCOS seem to make more androgens (male hormones) than women who do not have PCOS. All women produce some male hormones, but levels that are too high may affect egg development and ovulation.
• Insulin: Insulin is a hormone that allows cells to convert sugar (glucose) to energy. Women with PCOS tend to have too much insulin. And excess insulin seems to result in increased androgen production.
There is no specific diagnostic test for PCOS. Diagnosis is usually based on:
• Signs and symptoms, including menstrual irregularities
• Physical examination
• Blood tests to check androgen and blood sugar levels
• Ultrasound of the ovaries
There is no cure for PCOS so the goal of treatment is to manage symptoms and prevent complications. There are a number of ways that this can be accomplished. Women with PCOS who are overweight or obese should attempt to lose weight. Women who lose even 10 percent of their body weight can improve menstrual irregularities, lower androgen levels and reduce their risk of diabetes. Weight loss can improve fertility, as well.
Women who do not wish to become pregnant right away can take birth control pills. Birth control pills help to regulate the menstrual cycle and reduce androgen levels. In some cases, metformin (Glucophage), an oral diabetes drug, may be used instead of or in addition to birth control pills. Metformin also helps reduce androgen levels and may help with weight loss.
Women who want to get pregnant and are having difficulty conceiving can be treated with medications that stimulate ovulation. If those medications are not successful, other fertility treatments can be considered.
Studies suggest that women with PCOS who become pregnant are at increased risk of gestational diabetes, preeclampsia (a pregnancy-related form of high blood pressure) and premature birth. Women with PCOS should see their health care provider before pregnancy to make sure any health problems, such as diabetes, are under control, and that any medications they take are safe. When they become pregnant, they should go to all their prenatal appointments so that any complications can be diagnosed and managed before they become serious.