Polycystic Ovary Syndrome (PCOS)
What is PCOS?
PCOS is the most common hormonal disorder in women, affecting 5-10% of the female population. The symptoms usually start in adolescence, but can appear in the 20’s or 30’s. It is called a “syndrome” because it presents as a variable group of symptoms. No two patients have the same exact constellation of symptoms.
What Causes PCOS?
The actual cause of PCOS is unknown. It appears that women are genetically prone to this disorder. Female relatives of a patient with PCOS have a 50% chance of having it themselves. Certain lifestyle factors such as a high calorie, high carbohydrate diet and inadequate exercise may worsen many of the symptoms.
Symptoms of PCOS
1. Irregular menstrual periods caused by a lack of ovulation
2. Infrequent, often heavy menstruation or no menstruation
3. Build up of the lining of the uterus
Signs of excess male hormones
2. Insulin Resistance
3. Abnormally high cholesterol levels
4. High blood pressure
Altered reproductive hormone levels
1. High testosterone and other male hormones like “DHEAS”
2. Low progesterone levels as a result of not ovulating
3. More of the hormone LH than the hormone FSH
4.High insulin levels and sometimes high glucose (sugar) levels
A recent consensus conference of experts agreed that patients with at least 2 of the following symptoms can be diagnosed as having PCOS:
1. Irregular menstrual periods or signs of not ovulating
2. Physical or laboratory signs of excess male hormones
3. An ultrasound showing polycystic appearing ovaries
Treatment Options for PCOS
PCOS is a syndrome and not a disease, so the treatment is targeted at the most concerning symptoms. Lifestyle changes and treatments to prevent diseases associated with PCOS can also be implemented. If you think PCOS is affecting your fertility, please contact us today.
Irregular menstrual periods:
The most common treatment for irregular periods is the birth control pill. The pill provides the right hormonal signals to the uterus to allow regular menstrual periods, and to keep the lining of the uterus from getting too thick. This effect allows for lighter periods and a reduced risk of cancerous changes to the lining. It also suppresses the ovaries, so that they do not make as much testosterone. Another hormonal option is to give progesterone for 5-10 days each month. This will cause the thickened lining of the uterus to slough off within one week. This treatment is often given (after a negative pregnancy test) prior to starting birth control pills or fertility treatments. Neither treatment makes the ovaries ovulate.
Excess hair growth:
This frustrating problem is due to the effects of excess testosterone on the hair follicles. Normally in women hair follicles on the face and lower abdomen don’t make thick hair, but with excess testosterone they do. The follicles may also make excess sebum leading to acne, or grow hair so fast that it falls out. One effective treatment is the birth control pill which lowers testosterone levels and lessens hair growth and acne. It takes several months to see the improvement. Other medicines that block testosterone production such as spironolactone (Aldactone), flutamide (Eulexin) and finasteride (Proscar) can be given but must be accompanied by birth control because they can cause birth defects, particularly in male fetuses. A facial cream called Vaniqa is also available to help suppress facial hair growth. Electrolysis and laser hair removal are also used, once the testosterone levels are suppressed.
It is estimated that up to ¾ of patients with PCOS have some form of insulin resistance (described above), particularly those who are overweight or obese. Up to 15% of patients actually have diabetes. Studies have shown that weight loss can improve or eliminate these problems, but many patients also need the help of a medication Glucophage, to lower insulin levels and balance their sugar metabolism. This is important for overall health because it will decrease the risk of diabetes and heart disease. Glucophage must be monitored carefully to limit side effects and to ensure proper dosing. The medication can also can allow the ovaries to start functioning normally, which could result in more regular menstrual cycles, ovulation and pregnancy.
Infertility problems occur with PCOS because of the lack of ovulation. The most common treatment for inducing ovulation is to give the fertility pill Clomiphene Citrate (Clomid, Letrozole). Clomid helps the body make more follicle stimulating hormone (FSH) to stimulate the growth and release of follicles and their eggs. Eighty percent of patients will ovulate and half of those who ovulate will ultimately conceive after several attempts. There is a modest increase in the risk of having twins (5-10%) with Clomid. Some patients do not respond to Clomid and may require other therapies. One option is to give Glucophage to lower insulin levels to help the ovaries ovulate, or respond better to other fertility medications. Another option is to use fertility shots that contain pure FSH. These shots directly stimulate the ovaries, but must be used carefully because patients with PCOS can have an excessive response to these medicines and make too many eggs, increasing the risk of multiple pregnancies including the possibility of triplets or higher order pregnancies. Therefore these medicines must be monitored carefully by a trained Fertility Specialist (Reproductive Endocrinologist). Some patients will benefit from In Vitro Fertilization (IVF), where eggs are removed from the ovaries after stimulation with fertility shots, then mixed with sperm in a dish in the laboratory to create embryos that are then replaced back into the uterus. A limited number of embryos can be replaced, and the remaining embryos frozen if desired, to limit the risk of higher order multiple pregnancies (triplets or more).
South Jersey PCOS Specialists
The PCOS doctors and specialists at South Jersey Fertility Center are highly experienced in helping patients achieve their dream of starting their family. We service fertility patients in New Jersey through our offices in Marlton, Burlington, Sewell, and Egg Harbor.