All About Polycystic Ovarian Syndrome

By Eva Briggs

Polycystic ovarian syndrome (PCOS) is the most common endocrine problem in reproductive age women in the United States. About 7 percent of women have PCOS.

The disorder causes three key features: First, too much of the hormone androgen (hyperandrogenism). Second, infrequent, irregular menstrual periods (oligomenorrhea). Third, polycystic ovaries.

The diagnosis of PCOS requires two out of those three symptoms. There isn’t a single definitive test available to diagnose PCOS.

Hyperandrogenism causes excessive acne, hair loss in a male-pattern baldness distribution and increased hair growth in a male pattern. Blood tests for elevated androgen levels aren’t usually needed unless the hyperandrogenism symptoms are excessive or if they start suddenly and progress rapidly. In that case, blood tests help rule out the possibility of a tumor secreting male hormones.

Menstrual problems include oligomenorrhea (infrequent cycles more than 35 days apart) or amenorrhea (no menstrual periods for six to 12 months after a regular cyclic pattern has been established). Adolescents often have irregular periods at first, so this symptom shouldn’t be diagnosed until two years after a woman begins menstruating.

Polycystic ovaries are defined as 12 or more follicles in a single ovary. The number could be 25 or more follicles when using newer and more sensitive technology. If a woman has both hyperandrogenism and menstrual abnormalities, then an ultrasound might not be needed for diagnosis.

Women with PCOS are at increased risk of diabetes and metabolic syndrome (high blood sugar, high blood pressure, and abnormal cholesterol levels). PCOS patients also may have infertility issues. The exact cause of PCOS is uncertain. It likely results from a genetic redisposition coupled with environmental factors.

Treatment depends on whether a woman desires pregnancy and which symptoms are most troublesome. For women desiring pregnancy, the medications clomiphene (Clomid) or letrozole (Femara) induce ovulation. Women who want to control menstrual irregularities but don’t desire pregnancy can use hormone-containing contraception such as birth control pills, patch, vaginal ring or the levonorgestrol containing IUD (Mirena).

Sometimes surgery is used to restore ovulation in women resistant to clomiphene. Lasers or electrosurgical needles make multiple punctures of the ovary via a laparoscopic approach. This lowers male hormone levels and increases a hormone called follicular stimulating hormone (FSH). It’s less likely to cause multiples babies (twins or triplets) than fertility drugs. Potential complications are scarring, as well as possible impairment of future infertility by decreasing ovarian reserve.

Insulin resistance may lead to pre-diabetes or diabetes, and the first line of treatment is metformin.  Women who wish to become pregnant can take it. Diet, exercise and weight loss are also beneficial.

The first line of treatment for hirsutism (excessive hair growth) is the birth control pill. But it may take as long as six months for improvement to begin. Other ways to treat hirsutism are the medicine eflornithine (Vaniqa), electrolysis and lasers. The medicines spironolactone and flutamide have been used but there isn’t a lot of data for their effectiveness.

Acne is common and the first line of treatment is hormonal contraception. It can be combined with typical topical acne medicines such as benzoyl peroxide, retinoids and antibiotics.

Women with PCOS should be followed by their physicians due to the long-term increased risk for diabetes, metabolic syndrome and endometrial cancer. Pregnant women with PCOS are at increased risk of gestational diabetes, preeclampsia, cesarean delivery and delivering early or late.

Eva Briggs is a medical doctor who works at two urgent care centers (Central Square and Fulton) operated by Oswego Health.