Polycystic Ovarian Syndrome (PCOS) is a common hormonal disorder among women in their reproductive years. The name comes from the appearance of the ovaries, which are typically enlarged and containing numerous small cysts located on the outer edge of each ovary. PCOS occurs because of changes in certain hormone levels in the body: estrogen and progesterone, which are the female hormones that help a women’s ovaries release an egg; and androgen, a male hormone that is found in small amounts in women.
We do not completely understand why these changes occur, but we do know that it makes it harder for a woman’s ovaries to release a fully grown egg. Usually one or more eggs are released during a woman’s menstrual cycle, which is called ovulation. In PCOS, mature eggs are not released from the ovary and can instead form very small cysts in the ovary.
Symptoms of PCOS can begin shortly after a woman starts menstruating or later on in her reproductive years, for instance, after substantial weight gain. These symptoms vary from person to person. Some of the common characteristics of PCOS are noted to be:
• Menstrual cycles that arrive longer than 35 days
• Less than eight menstrual cycles a year
• No menses for four or more months
• Long menses that last longer than 10 days
• Excess facial and/or body hair
• Adult acne or severe adolescent acne
• Male-pattern baldness
• Darkening of the skin around the armpits, neck, breast and groin
• Decreased breast size
• Enlargement of the clitoris
Having polycystic ovarian syndrome can increase the likelihood of developing type 2 diabetes, high blood pressure, cholesterol abnormalities, elevated C-reactive protein, which is a cardiovascular disease marker, metabolic syndrome, severe liver inflammation, sleep apnea, gestational diabetes, pregnancy-induced hypertension and infertility. These conditions occur more frequently in women who are also obese.
Diagnosing PCOS is one of exclusion, meaning that your health care provider considers all of your signs and symptoms and then rules out other possible disorders. There is no one specific test for PCOS. You will need to complete a medical history in which the health care provider asks about your menstrual periods, weight change, and other symptoms. A physical exam along with a pelvic exam is also required to assess your blood pressure, height, weight, and reproductive organs for any abnormalities. You may need to undergo some blood tests to measure the levels of several hormones in order to exclude other causes of menstrual abnormalities and androgen excess that can mimic PCOS symptoms. A pelvic ultrasound is also helpful because it can show the appearance of your ovaries and evaluate the thickness of the uterine lining.
Polycystic ovarian syndrome treatment often focuses on managing the patient’s primary concern such as irregular menses, acne, infertility, or facial hair growth. First, there are medications that can regulate your menstrual cycle, such as a low dose birth control pill. This will help decrease androgen production, decrease abnormal uterine bleeding, and may help with acne. An alternative approach will be taking progesterone for only 10 to 14 days each month. This medication would regulate your menses, but it does not improve androgen levels. Your health care provider may also use an oral medication for type 2 diabetes called metformin (Glucophage). This drug improves ovulation and regulates menstrual cycles by lowering insulin levels. It also slows the progression to type 2 diabetes if you already have pre-diabetes and helps with weight loss when used with a diet and exercise program.
Secondly, when infertility is your main concern, your health care provider may use a combination of metformin and clomiphene citrate (Clomid). This medication lowers estrogen levels and is used in the beginning of your menses to promote ovulation. If clomiphene and metformin are not effective, then your health care provider may use two gonadatropins: follicle-stimulating hormone and luteinizing hormone medications, which are administered by injection. If the medications don’t help you get pregnant, an outpatient surgery called laparoscopic ovarian drilling may be an option for some women.
Finally, excessive facial hair growth has medications that can help prevent future hair growth and other treatments for the hair that is currently there. Your health care provider may recommend birth control pills to reduce your androgen production. Alternatively, you may consider spironolactone (Aldactone) that blocks the effects of androgens on the skin. Eflornithine (Vaniqa) is a cream that also slows facial hair growth in women. For a more permanent reduction of hair growth, a woman can undergo laser hair removal or electrolysis. This treats the hair that is already present.
Weight gain and obesity is common in women with PCOS. Losing just five percent of your body weight can help your hormone imbalance, reduce risk of type 2 diabetes, hypertension, and high cholesterol and help with fertility. Paying attention to the foods you eat may help offset some of the effects of PCOS. You want to choose a diet that is low in simple carbohydrates such as white breads, white pastas, sodas, candy, cookies, cake, and donuts. These foods increase your blood sugar levels, which increase insulin production and the symptoms of PCOS.
Increasing your intake of the complex carbohydrates—such as multi-grain breads, whole wheat pastas, and brown rice, which are high in fiber, allows for a slower digestion and subsequently a more even blood sugar level. Exercise also helps lower blood sugar levels. If you have PCOS, increase your daily activities and participate in a regular exercise program. This may help you lose weight and treat or prevent insulin resistance, which contributes to PCOS. Consult your health care provider before starting any diet or exercise program to make sure that it is right for you.
Melissa Waddell, WHNP, a Hampton Roads native, is a nurse practitioner at Atlantic Ob/Gyn. Please call 757-463-1234 or visit www.atlanticobgyn.com.