Understanding Polycystic Ovarian Syndrome (PCOS)
What is Polycystic Ovarian Syndrome (PCOS)?
Polycystic Ovarian Syndrome, or PCOS for short, is the number one cause of infertility in the United States. One in ten women suffers from the condition, which can strike as early as puberty. During normal ovulation and menstruation, eggs grow within tiny fluid filled sacs within the ovary. When the egg has matured, the fluid sac breaks open, and the egg can freely travel through the fallopian tube into the uterus. In women with PCOS, hormonal imbalances within the ovary (namely an imbalance of luteinizing hormone and follicle-stimulating hormone) prevent eggs from maturing and follicles from being released. The fluid sacs continue to grow as cysts, which appear as a “string of pearls” in the ovary on an ultrasound. Women suffering from PCOS also may produce higher levels of testosterone, androstenedione and dehydroepiandrosterone (DHEA).
The condition is not fatal, but complications can inhibit a woman’s lifestyle in numerous ways. Symptoms include absent or sporadic menstrual periods, infertility, weight gain, pelvic discomfort, acne, dandruff, oily skin, darkened patches of skin, skin tags in the armpit and neck, unexplained anxiety or depression (or depression related to appearance), or sleep apnea. High amounts of testosterone may be present, causing symptoms such as excessive hair growth (hirsutism) and male pattern baldness. Some women will experience all of these symptoms; others will experience only a few, or even none except for irregular periods.
Causes of PCOS
The exact cause of PCOS is unknown. Research suggests that there may be a genetic link, as women with a mother or sister with PCOS are more likely to have it. More recent research has suggested that there is a link between insulin and PCOS. Diabetes Type II is common in women with PCOS. Many women with the condition have a high level of insulin in their system, but are unable to properly synthesize it. Excess insulin results in elevated androgens, which are also linked to many symptoms associated with PCOS.
Diagnosis
While there is no single PCOS “test” to determine if the condition is present, several tests can be done in tandem to determine if PCOS is the cause of symptoms. These tests will include ruling out other possible conditions, including Cushing’s syndrome, congenital adrenal hyperplasia, and hyperprolactinemia.
Blood work will be done to determine hormone levels. Any of the following may be measured:
- Follicle Stimulating Hormone (FSH)
- Estradiol (E2)
- Luteinizing Hormone (LH)
- Prolactin
- Progesterone (P4)
- Thyroid Stimulating Hormone (TSH)
- Free Triiodothyronine (T3)
- Free Thyroxine (T4)
- Total Testosterone
- Free Testosterone
- Dehydroepiandrosterone Sulfate (DHEAS)
- Sex Hormone Binding Globulin (SHBG)
- 17 Hydroxyprogesterone
- Fasting Insulin
- Fasting Glucose
- Glucose Tolerance Test with Insulin (GTT / IGTT)
- Cholesterol
- Triglycerides
- C-Peptide
In addition to blood work, a physical will be done to evaluate general health including:
- Weight and Body Mass Index (BMI)
- Blood pressure
- Hair growth patterns
- Medical history
A pelvic exam will be conducted as well to feel for any excessive ovarian swelling, tumors, or growths.
Ultrasounds will be done to view the ovaries, measure the number of cysts and their size.
Treatment
Polycystic Ovarian Syndrome does not have a cure. Treatments may assist with conceiving a child, inducing menstrual periods, clearing up acne, or removing unwanted hair. Management of PCOS is important, especially in cases where obesity or diabetes is a factor. Diet changes and exercise will be recommended for women who are high weight. For women who are not currently trying to become pregnant, birth control pills will help regulate periods. A bonus of birth control pills is that they can often reduce acne and excess hair growth. Diabetes medications such as Metformin may be prescribed, but using these medications for PCOS is still under review by the Food and Drug Administration and is not considered approved usage. Women trying to get pregnant will have several options including in-vitro fertilization, oral fertility medications, hormone injections, and IUI (intra-uterine insemination). Women with PCOS have a higher miscarriage rate due to imbalances in progesterone and other pregnancy-sustaining hormones, and thus pregnancies in PCOS sufferers must be monitored carefully.
