Understanding Polycystic Ovary Syndrome

Polycystic Ovary Syndrome (PCOS) is one of the most common causes of female infertility, affecting as many as 5 million women in the United States. Women with PCOS have problems ovulating which leads to irregular or absent menstrual cycles. In addition to the menstrual abnormalities, there are hormonal imbalances that lead to other conditions and these should be addressed whether or not a woman is interested in having children.

While doctors don't know exactly what causes PCOS, also called Polycystic Ovarian Syndrome, they do know the effects. The most common symptom is menstrual irregularity, which is caused by the ovulation dysfunction. In addition to the irregular or absent ovulation, the ovaries tend to produce more androgens (e.g. testosterone) compared to most women.

Women with PCOS are often resistant to insulin, the hormone that moves sugars from the bloodstream into tissues such as muscle. As a result of the insulin resistance, higher levels of glucose can accumulate in the bloodstream and more. Insulin is then needed to move that glucose into the cells. Insulin resistance can lead to weight gain and eventually diabetes. 

In addition to infertility and irregular periods, women with PCOS with insulin resistance may notice weight gain and dark patches in the skin folds. The increase in androgens can cause excessive hair growth on the face and body (called hirsutism), thinning hair on the head and acne. A pelvic ultrasound may reveal many small cysts on the ovaries. A physical exam, blood tests to check for abnormal hormone levels, and an ultrasound may be used to confirm the PCOS diagnosis.

Although PCOS is a particular concern for women who are trying to become pregnant, it is a serious condition that should be addressed for anyone experiencing the symptoms. Left untreated, the imbalance of hormones can lead to diabetes and unchecked weight gain can lead to additional health problems. The absent or infrequent menstrual cycles will increase the risk for endometrial (uterine) cancer.

Although there is no cure for PCOS, doctors can recommend many successful treatments. For women trying to conceive, there are a variety of medications that can stimulate ovulation. Clomid and letrozole are oral medications commonly used, but not all women with PCOS will ovulate with these. Some will require injections of hormones to stimulate ovulation. Doctors may give women who are not trying to conceive oral contraceptives to regulate menstrual cycles and reduce androgens, which will decrease acne and excessive hair growth. Lifestyle adjustments, such as improved nutrition and exercise, help with weight management and diabetes prevention.