Guide to Polycystic Ovary Syndrome

September is Polycystic Ovary Syndrome (PCOS) awareness month.

PCOS is one of the most common female hormonal disorders affecting approximately 1 in 10 women of childbearing age yet it is being reported that it can take doctors an average of two years to diagnose.  It is also one of the biggest causes of infertility affecting an estimated 5 million women in the U.S.

We spoke with Dr. Jane Frederick, an internationally noted fertility reproductive endocrinologist, about PCOS and put forward a few questions from our members.

 

What is Polycystic Ovary Syndrome (PCOS)?

Polycystic Ovary Syndrome, known commonly as PCOS, refers to a hormone disorder affecting 3-10% of women. Considered a leading cause of female infertility, PCOS reduces the ability of the ovaries to mature and release eggs into the uterus. Other symptoms of PCOS include the creation of polycystic ovaries, characterised by multiple cysts and small follicles; chronic anovulation, or an inability to ovulate; and hormonal imbalance, including high levels of the male hormone androgen.

Though PCOS affects a relatively high percentage of women, the cause is unknown and can be found in girls as young as 11 years old. Women with PCOS are more likely to have a daughter with the disease. The diagnosis includes signs mothers can recognize early on in their daughters such as irregularities in menstrual cycles; the presence of acne and hair growth in areas more common to men, such as the face and chest; and obesity, particularly in the midsection and hormonal imbalance. Health problems often associated with the disorder include a high risk for miscarriage and long-term medical problems, such as diabetes, cardiovascular disease, and uterine cancer.

What are the symptoms of PCOS?

It’s important to note that if you have PCOS you might only experience a few of these symptoms if any at all. The important thing is that if you are experiencing any, it’s always best to get checked out at the GP.

Common symptoms of PCOS include:

  • Irregular periods or no periods at all
  • Difficulty getting pregnant (because of irregular ovulation or failure to ovulate)
  • Excessive hair growth (hirsutism) – usually on the face, chest, back or buttocks
  • Weight gain
  • Thinning hair and hair loss from the head
  • Oily skin or acne

Can PCOS Cause Infertility or Difficulty Conceiving?

Some women may not realize they have Polycystic Ovaries until they try to conceive. PCOS often goes unnoticed. But if you’ve been trying to conceive naturally for over a year, you should speak to your doctor about getting tested. Your doctor can help you develop a plan for getting pregnant. Some strategies, such as losing weight, healthy eating, and in certain cases, medications, can increase your chances for getting pregnant.

Women with PCOS frequently suffer from chronic anovulation, a condition that can cause them to go through fewer than eight menstrual cycles each year; frequently, they skip their periods altogether. Furthermore, the hormonal imbalance associated with PCOS can result in symptoms ranging from an excess of estrogen or androgen to decreased levels of progesterone (the hormone important to the menstrual cycle) and resistance to insulin.

What Happens with PCOS During Pregnancy and What Are the Dangers?

Women with PCOS who become pregnant may experience more health problems than the general population including:

  • High blood sugar levels which can lead to diabetes
  • Pregnancy-induced high blood pressure
  • Miscarriage
  • Premature delivery
  • Pre-eclampsia (high blood pressure, protein traces in the urine)
  • Macrosomia (a newborn with an excessive birth weight)

All of these serious problems are yet more evidence that it is extremely important to address PCOS and make the lifestyle changes necessary to reverse it and the underlying cause of insulin resistance. This is vital to prevent the health issues that can compromise long-term wellness for both mother and child during and after pregnancy. Insulin resistance reduces the insulin sensitivity of your cell walls. Glucose has to pass through the cells walls to be converted to energy. Insulin assists in this process. When the cells walls have become de-sensitized to insulin by insulin resistance, the process can break down. Glucose cannot get into the cell, and remains in the bloodstream, causing elevated blood sugar levels. This process can lead to weight gain and obesity, key factors in creating PCOS.

What Should PCOS Patients Do About the Condition During Pregnancy? After Pregnancy Are There Any Special Considerations for Women with PCOS?

Metformin (Glucophage) is a drug often prescribed for women with PCOS who are trying to get pregnant, and in the early stages of pregnancy. Metformin improves the cell’s response to insulin and helps move glucose into the cell. As a result, the body will not be required to make as much insulin and helps to balance the hormones in PCOS. Weight loss through exercise and changes in diet and lifestyle can also be effective in treatment for PCOS and pregnancy. Women should seek out a specialist who can provide nutritionally and exercise guidelines to enhance their weight loss success. This is critical for the health of the woman and her baby.

How Can PCOS Be Treated?

Infertility experts usually rule out other causes of anovulation and hyperandrogenism (an excess of male hormones) before diagnosing PCOS and establishing a treatment approach for the disorder. Management of PCOS requires a treatment program focused on four individual areas: encouraging fertility; restoring regular menstrual cycles while preventing disorders of the endometrium (uterine lining); treating the symptoms of acne and abnormal hair growth, and lowering insulin levels. Research shows that diet and exercise can go far in reducing the obesity associated with PCOS and, as a result, restore normal ovulation and menstruation cycles. Many women with PCOS report difficulty in losing weight. Experts recommend diets in which carbohydrates largely come from fruits, vegetables, and whole grains. If not done through weight loss, balancing insulin levels often requires medication, such as the type 2 diabetes drug metformin. Infertility specialists typically treat hormonal symptoms, in particular, the excessive level of androgen, by prescribing low-dose oral contraceptives. This approach should reduce the acne and hair growth; however, the latter symptom may require electrolysis, waxing, or some other removal method performed in conjunction with medical treatment. In cases of excessive hirsutism, and anti-androgen drug can be prescribed. To increase infertility, PCOS patients can undergo a number of conservative treatments, such as fertility drugs like Clomid to help ovulation and achieve a successful pregnancy. The important message mother should know is that PCOS is a very treatable disorder, and women should seek out the infertility specialist for help in the diagnosis and treatment.

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