Polycystic Ovary Syndrome (PCOS) Overview
Polycystic Ovary Syndrome (PCOS) is one of the most common problems affecting women. PCOS can affect menstrual cycles, fertility, and hormone levels, as well as appearance, including acne, facial hair growth and female pattern balding (thinning of the hair on the top of the scalp with preservation of the hairline). It is also a metabolic problem that affects several body systems. The condition gets its name because there are often an increased number of small painless cysts in the ovaries (polycystic ovaries).
The syndrome is defined by hormonal problems and an irregular menstrual cycle, with or without polycystic ovaries. PCOS is sometimes called “ovarian androgen excess,” because the ovaries start producing male hormones (androgens) in slightly increased amounts. It is important to note the difference between ovaries with cysts and PCOS. Polycystic ovaries are often, but not always, seen in women with PCOS.
The condition also can affect women’s self-esteem and psychological health because of the baffling symptoms (click here for a list of possible symptoms). The first signs of PCOS may be the growth of facial and body hair, hair thinning, acne, and weight gain. However, women who are thin can also have PCOS. A woman may find that she is infertile, unable to become pregnant. Some women may suffer from depression because of the severity of these symptoms or simply because of the workings of the disease itself.
A specialist familiar with this syndrome, such as an endocrinologist is the best source for diagnosing this condition. Women with PCOS may have a number of seemingly unrelated symptoms. The diagnosis of PCOS diagnosis is made in several different ways, including taking your medical history, performing a physical exam, and checking your hormone levels, (or say “and possibly looking at your ovaries by ultrasound”).
The cause of PCOS is unknown, although some scientists believe people may be able to inherit the condition. There is still no cure for PCOS. Doctors can only treat symptoms. Even though there is no cure, certain treatments are helping women to lead healthier and more satisfying lives.
Polycystic Ovary Syndrome (PCOS) Symptoms
PCOS is not easy for doctors to diagnose. The common symptoms of PCOS include irregular or absent menstrual cycles and evidence of excess male hormones, such as facial hair growth, acne, and hair thinning (female balding). Many, but not all, women with PCOS are overweight. Even if several of the symptoms that follow are present, a woman may not have a case of PCOS. They may have a condition that affects the adrenal gland or the thyroid gland, for example.
The underlying cause of PCOS is an imbalance of hormones. This imbalance often seems to be linked with the way the body processes insulin. Insulin is a hormone produced in the pancreas that promotes use of blood sugar (glucose). Insulin problems can increase male hormone production by the ovaries.
Women who think they may have PCOS should see their doctor. While PCOS may bring obvious symptoms, such as more body hair, it can also hold dangers. PCOS may put women at risk for diabetes, heart disease, and cancer of the uterus.
Women who are approaching menopause, the time of life when periods begin to taper off and then stop, may notice that most of their PCOS symptoms start going away. Some may even begin to have regular cycles as they approach menopause.
Some conditions related to PCOS may not be obvious but are potentially dangerous:
Diabetes – Most women with PCOS have problems using their body’s insulin. About 30% of women with PCOS have a problem processing blood sugar, called glucose intolerance. This is a major risk factor for adult-onset diabetes.
- Heart and blood vessel disease – People with high insulin levels, as in PCOS, often have low levels of so-called good cholesterol (HDL cholesterol) and high levels of other fats, including triglycerides. These factors are known to increase the risk of heart attack or stroke later in life. Women with PCOS also can have elevated bad cholesterol (LDL) levels.
- Cancer of the uterus – The lining of uterus normally builds up and is shed with the menstrual period each month. Because of irregular menstrual cycles and lack of ovulation, the lining of the uterus may not shed as often as it should. If PCOS goes untreated, this may increase the risk of cancer of the uterus.
In PCOS, a variety of obvious symptoms can occur. Remember, PCOS is a syndrome, and each person will have a different set of symptoms. If you have two or more of the following symptoms, you should go to your doctor for an accurate diagnosis and the right treatments.
- Irregular periods – Nine or fewer menstrual cycles per year may be a sign of PCOS. Bleeding may be heavier than normal. These conditions are caused by a hormone problem, because the ovaries are not working properly and producing hormones that keep the menstrual cycle regular.
- Infertility – Because women with PCOS don’t have regular menstrual cycles, many are unable to get pregnant. With help, women with PCOS can get pregnant, however. A number of infertility treatments are available. (See section on Treatments.)
- Hirsutism – Hirsutism means excess hair, which can be a difficult symptom for many women. For most women with PCOS, hair in the mustache and beard areas becomes heavier and darker. Masculine hair on the arms and legs and more hair growing in the pubic region, abdomen, chest or back are also possible. This symptom is caused by high levels of male hormones (androgens), as are thinning hair and acne.
- Thinning hair – Just as heavier hair growth is possible, scalp hair thinning may be present. This is caused by higher levels of androgens.
- Acne – Acne (pimples and oily skin) can also bother women with PCOS. The acne is usually found around the face (especially along the jaw line), chest, and back.
- Weight gain – Many women with PCOS gain weight around their middles taking on an apple shape rather than a pear shape. Such weight gain is linked with problems with the proper use of glucose and insulin in the body.
- Other skin problems – Skin tags, thick lumps of skin that can be as large as raisins, can form and usually are found in the armpits or neck. These can easily be removed. Darkening and thickening of the skin also can occur around the neck, groin, underarms, or skin folds. This condition, called acanthosis nigricans, is a sign of an insulin abnormality.
- Depression and anxiety – Because of the nature of many of these symptoms, woman may find themselves more anxious or depressed by their appearance, or by their inability to become pregnant.
Polycystic Ovary Syndrome (PCOS) Treatment Options
Treatments for PCOS can help to relieve distinct symptoms, like acne and weight gain. Some treatments help put your body back into balance with the proper amounts of hormones. For the symptoms described above, the following treatment options have helped many women:
Birth control pills (oral contraceptives) that contain female hormones can bring on more regular periods and help treat the problem of irregular menstrual cycles. These contraceptive pills help to lower levels of androgens and can improve acne and hair growth as well.
Insulin-sensitizing medications used to treat adult-onset diabetes are useful for many women with PCOS. These medications are not FDA-approved for the treatment of PCOS. By lowering insulin levels, they may improve the regularity of menstrual. Metformin is the drug of choice, but doctors should prescribe the drug with caution. There is not yet enough information to recommend this drug for all women with PCOS. (Another similar acting drug, troglitazone, was removed from the market because of liver damage in patients who had diabetes). Ask your doctor about metformin. It may be helpful in some women to induce ovulation and may play a role in preventing early pregnancy loss. It has been used during pregnancy but there is no consensus on this use at present.
Ovulation Induction. In some women who wish to become pregnant, inducing ovulation (release of an egg) is necessary. This is usually accomplished by taking a pill called clomiphene citrate for five days. Other treatments include the injection of the brain hormone GnRH or gonadotropins. Other infertility treatments include additional medications and even surgery to induce ovulation. High-tech treatments include in vitro fertilization, in which an egg fertilized with sperm is implanted in the uterus.
Androgen-lowering drugs can be used to treat several PCOS symptoms. Spironolactone and flutamide can help to relieve the symptoms of excessive or thinning hair and acne. They can be taken along with oral contraceptives.
An anti-hair-growth drug also can help to slow the growth of facial hair in women with PCOS. The drug is not a depilatory that loosens and gets ride of hair. Eflornithine hydrochloride, the active ingredient, blocks an enzyme found in the hair follicle of the skin that is needed for hair growth. This results in slower hair growth after a few weeks of treatment.
Other treatments for excess hair include bleaching and shaving your excess hair, which are safe and easy approaches. Waxing, tweezing, depilatory creams, and electrolysis and laser treatments to remove hair may also be effective treatments for excess hair.
Treatments for hair loss tend not to work for everyone. Some women find improvements with the use of anti-androgen pills, and others find that the same medication that men use (Rogaine) can help too.
Sticking to a special diet is a very important aspect of PCOS care. Some women with PCOS find success by reducing their total intake of carbohydrates (cereals, breads, pastas) and choosing to eat different types of carbohydrates that are less processed (whole wheat, brown rice, beans). Replacing manufactured carbohydrate products with whole grains, fruits and vegetables can help to reduce your insulin response. The diet also should include enough protein to control the amount of sugar in the blood.
Exercise also can help the body use insulin better, and help with weight loss and keeping off weight.
Acne treatments sold over the counter can also help to control the skin blemishes that can arrive with PCOS.
To treat skin problems other than acne, ask your doctor. Your doctor or dermatologist can remove skin tags using just a simple anesthetic on your skin. Acanthosis nigricans (skin darkening) sometimes can be lightened by reducing your insulin level. Other treatments include Retin-A, 15% urea, alpha hydroxy acid, and salicylic acid.
Polycystic Ovary Syndrome (PCOS) Lifestyle and Prevention
If you have been having irregular periods and some of the other symptoms discussed on this PCOS page, please see your doctor or endocrinologist. Having infrequent periods is not just a nuisance – it can lead to complications like cancer of the uterus.
PCOS appears to be an inherited condition. If your sister has had PCOS, you may want to be checked for the syndrome. Likewise, if you have or have had PCOS, your sister should probably be tested.
Monitoring your health is important if you have been diagnosed with PCOS:
- Overweight women with PCOS should have at least one oral glucose tolerance test to check for your risk of diabetes. The fasting blood glucose test is not adequate to diagnose diabetes in women with PCOS. The oral glucose tolerance test requires you to visit the doctor or laboratory in the morning after an overnight fast, and to drink a concentrated sugar drink. Blood is drawn before and after the drink. The glucose level exactly two hours after the drink is used to diagnose diabetes mellitus or an increased risk of diabetes called impaired glucose tolerance.
- Because of the possible increased risk of cardiovascular disease in women with PCOS, you should have your blood pressure and your LDL (bad) cholesterol, HDL (good) cholesterol, and triglyercide levels checked. This is especially important if you are overweight.
Staying as healthy as possible is the goal. The following changes can help to improve your body’s response to extra insulin and can help reduce your risk of diabetes, heart disease, and stroke:
- Try to stay on a healthy diet with adequate amounts of protein. Your reproductive endocrinologist or doctor should be able to suggest a healthy diet to follow;
- Add whole grains, fruits, and vegetables to your diet; and
- Exercise regularly to keep your weight in check.
Taking oral contraceptives and anti-androgen treatments also can help to keep your PCOS symptoms in check.
Finally, if you are not happy with your doctor, find a specialist who will listen to your concerns. Women with PCOS often have special concerns about their appearance that are directly tied to their condition. You and your doctor must act as partners to manage all aspects of this complex condition.
Menopause is part of the normal life cycle of women. When a woman has passed through menopause, her monthly periods end, and she no longer can get pregnant naturally. Many women welcome the new kind of life that menopause brings, with freedom from pregnancy and child-raising responsibilities. The average age for menopause is about 51 years old in the United States.
The changes of menopause begin when your ovaries, the organs that form eggs, no longer produce eggs, and their production of female hormones decreases. Hormones are chemicals that are formed in glands and move through the blood to cause effects on other body organs.
Two hormones made in the ovaries, estrogen and progesterone, help to keep a woman’s monthly period going in a regular cycle. When you approach mid-life, estrogen begins to drop to low levels. The reproductive organs gradually shut down, just as they gradually became active during puberty. Eventually your periods will end.
The menopausal transition may take from one to 10 years, and during that time hormone levels can be higher and lower than normal. Some months you may have a period and in others you may not. During this time, you may still be able to get pregnant.
Menopause usually happens naturally as women age. Menopause also can occur for other reasons, however, including removal of both ovaries, radiation or chemotherapy, gland disorders, or very poor health.