Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.

The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications such as type 2 diabetes and heart disease.

Symptoms

Signs and symptoms of PCOS often develop around the time of the first menstrual period during puberty. Sometimes PCOS develops later, for example, in response to substantial weight gain.

Signs and symptoms of PCOS vary. A diagnosis of PCOS is made when you experience at least two of these signs:

Irregular periods. Infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS. For example, you might have fewer than nine periods a year, more than 35 days between periods and abnormally heavy periods.Excess androgen. Elevated levels of male hormones may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne and male-pattern baldness.Polycystic ovaries. Your ovaries might be enlarged and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly.

When to see a doctor

See your doctor if you have concerns about your menstrual periods, if you’re experiencing infertility or if you have signs of excess androgen such as worsening hirsutism, acne and male-pattern baldness.

Causes

The exact cause of PCOS isn’t known. Factors that might play a role include:

Excess insulin. Insulin is the hormone produced in the pancreas that allows cells to use sugar, your body’s primary energy supply. If your cells become resistant to the action of insulin, then your blood sugar levels can rise and your body might produce more insulin. Excess insulin might increase androgen production, causing difficulty with ovulation.Low-grade inflammation. This term is used to describe white blood cells’ production of substances to fight infection. Research has shown that women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgens, which can lead to heart and blood vessel problems.Heredity. Research suggests that certain genes might be linked to PCOS.Excess androgen. The ovaries produce abnormally high levels of androgen, resulting in hirsutism and acne.

Treatment

PCOS treatment focuses on managing your individual concerns, such as infertility, hirsutism, acne or obesity. Specific treatment might involve lifestyle changes or medication.

Lifestyle changes

Your doctor may recommend weight loss through a low-calorie diet combined with moderate exercise activities. Even a modest reduction in your weight — for example, losing 5 percent of your body weight — might improve your condition. Losing weight may also increase the effectiveness of medications your doctor recommends for PCOS, and can help with infertility.

Medications

To regulate your menstrual cycle, your doctor might recommend:

Combination birth control pills. Pills that contain estrogen and progestin decrease androgen production and regulate estrogen. Regulating your hormones can lower your risk of endometrial cancer and correct abnormal bleeding, excess hair growth and acne. Instead of pills, you might use a skin patch or vaginal ring that contains a combination of estrogen and progestin.

Progestin therapy. Taking progestin for 10 to 14 days every one to two months can regulate your periods and protect against endometrial cancer. Progestin therapy doesn’t improve androgen levels and won’t prevent pregnancy. The progestin-only minipill or progestin-containing intrauterine device is a better choice if you also wish to avoid pregnancy.

To help you ovulate, your doctor might recommend:

  • Clomiphene. This oral anti-estrogen medication is taken during the first part of your menstrual cycle.
  • Letrozole (Femara). This breast cancer treatment can work to stimulate the ovaries.
  • Metformin. This oral medication for type 2 diabetes improves insulin resistance and lowers insulin levels. If you don’t become pregnant using clomiphene, your doctor might recommend adding metformin. If you have prediabetes, metformin can also slow the progression to type 2 diabetes and help with weight loss.
  • Gonadotropins. These hormone medications are given by injection.

To reduce excessive hair growth, your doctor might recommend:

  • Birth control pills. These pills decrease androgen production that can cause excessive hair growth.Spironolactone (Aldactone). This medication blocks the effects of androgen on the skin.
  • Spironolactone can cause birth defects, so effective contraception is required while taking this medication. It isn’t recommended if you’re pregnant or planning to become pregnant.Eflornithine (Vaniqa). This cream can slow facial hair growth in women.
  • Electrolysis. A tiny needle is inserted into each hair follicle. The needle emits a pulse of electric current to damage and eventually destroy the follicle. You might need multiple treatments.

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