Between 5 and 10 percent of women have polycystic ovary syndrome (PCOS), also known as hyperandrogenism or androgen excess syndrome, a condition that can affect a woman’s menstrual cycle, ability to have children, hormones, heart, blood vessels and appearance. PCOS presents many complications, infertility being one of the most disconcerting. Dr. Daniel Schubert, assistant professor and director of gynecology and pelvic surgery at The University of Tennessee College of Medicine at Erlanger Hospital, says the “decreased ability to become pregnant, which is alone quite distressing, is the reason many women present to a physician.” Although the cause of PCOS is not entirely known, successful treatments are available.
By Rebecca Rochat
Health Problems Related to PCOS
Infertility caused by PCOS (a hormonal, not reproductive condition) is related to the absence of ovulation, due to high levels of androgens, “male” hormones, which adversely affect the development and release of eggs during ovulation. PCOS can also cause missed or irregular periods or small cysts in the ovaries.
Women with PCOS and diabetes are at higher risk for pregnancy complications such as miscarriage, gestational diabetes, preeclampsia and pregnancy-induced high blood pressure. Other conditions associated with PCOS include insulin resistance, impaired glucose tolerance, hypertension, increased rates of cardiovascular disease and thick or darkened skin on the neck, armpits, inner thighs, vulva or under breasts. According to Dr. Schubert, these conditions can have “lasting and progressive detrimental health effects. Thus, the need to diagnose and treat PCOS has more effects on long-term health than are readily visible.”
Signs and Symptoms
According to Dr. Christian Radpour with Galen Medical, the “classic” signs of PCOS include:
• Absent or infrequent menstrual periods – menstrual intervals longer than 35 days, fewer than eight menstrual cycles a year, or prolonged periods that are scant or heavy
• Enlarged polycystic ovaries – ovaries containing numerous small cysts
• Excess androgen – excess facial and body hair, adult acne or severe adolescent acne, or male pattern baldness
• Obesity – a common condition but one that does not affect all women with PCOS
Causes of PCOS
Doctors and researchers do not know exactly what causes PCOS, but the symptoms do tend to run in families. Dr. Radpour says, “Heredity may play a role in PCOS, but the complete etiology of the syndrome has not been fully determined.” Dr. Schubert also comments that PCOS linked to a genetic predisposition is very difficult to pinpoint. PCOS is believed to result from a combination of genetic predisposition and environmental factors.
Two major risk factors are obesity and psychological stress. Dr. Schubert says that up to 70 percent of women with PCOS are overweight. A family history of hypertension and diabetes is also common in women with PCOS.
According to Dr. Jessica Scotchie of Tennessee Reproductive Medicine, the syndrome is thought to be linked to increased androgen production in the ovaries and an inherited insulin receptor activity dysfunction in the tissues. Other risk factors include excess production of insulin by the pancreas, which is thought to boost androgen production in the ovaries, and low grade inflammation.
Early diagnosis and treatment of PCOS can help reduce the risk of long-term complications. Although usually undiagnosed until a woman tries to become pregnant, many abnormalities and some symptoms of PCOS are present even before a girl’s first menstrual period. Dr. Scotchie explains that even though PCOS cannot be diagnosed in pre-menstrual girls, many of the associated conditions (obesity, insulin elevation and borderline diabetes) may be present before puberty.
The first step in diagnosing PCOS is to rule out other conditions. There is no one test that will definitively diagnose PCOS, but it is possible to rule out other possible disorders. In diagnosing PCOS many factors will be evaluated such as a medical history (irregular menstrual periods and weight gain), physical and pelvic examinations, blood tests to measure hormone levels, and a pelvic ultrasound which shows the appearance of the ovaries.
Dr. Schubert cautions against making a diagnosis solely on the basis of ultrasound results. “Under normal circumstances, reproductive women should, and will, have cysts on the ovaries, which are called polycystic appearing ovaries, and have no correlation with PCOS.”
Women who are diagnosed with PCOS may have symptoms of PCOS without ovarian cysts, while some women who have cysts show no other symptoms. In order to correctly diagnose PCOS, a woman must present with at least two other symptoms, such as menstrual abnormalities or excessive androgen production.
Infertility and other manifestations of PCOS are treatable in a majority of cases. Women with PCOS can become pregnant either through lifestyle changes or with medication. Losing weight can trigger body changes that restore ovulation and improve pregnancy chances.
Dr. Radpour advises that “maintaining a healthy diet, healthy weight with regular exercise and efforts to reduce stress may help avoid or treat PCOS.” Dr. Scotchie says that lifestyle changes are the “most effective way” to alleviate symptoms of PCOS and notes that losing as little as 10-15 percent of body weight is often enough to restore menstrual cyclicity.
If fertility and eventually pregnancy do not occur as a result of lifestyle changes, medications such as Clomiphene and/or Metformin may be prescribed. Hormones known as gonadotropins can also be used to treat infertility. Dr. Scotchie says, “Success with oral medications is often related to starting weight. With heavier patients having a lower likelihood of responding to oral medications, we move on to injectable therapy, in which case we can always make a woman ovulate.”
Treatment for PCOS also commonly focuses on management of other secondary manifestations such as hirsutism, acne and obesity. Some treatments may be as simple as diet and weight management, which can reduce insulin and androgen levels. Women who lose weight are more likely to have restored ovulation, lower levels of androgens and lower blood pressure. Insulin-sensitizing agents, anti-androgens and birth control pills may be prescribed to regulate menstrual cycles, reduce male hormone levels and to help clear acne and hirsutism.
Women with PCOS may be concerned about fertility issues, embarrassed about their appearance or become depressed, which is why timely and correct diagnosis is crucial. The earlier the diagnosis, the sooner symptoms of PCOS and other possible health risks can be addressed and managed.
Rebecca Rochat is a resident of Chattanooga. She attended the University of Tennessee where she earned a B.S. in child development and M.S. in textiles, merchandising and design. In addition to freelance writing, Rebecca serves as an adjunct instructor at the University of Tennessee at Chattanooga.