The most prevalent hormonal disorder of women of child-bearing age, polycystic ovary syndrome (PCOS) can lead to infertility as well as serious complications such as diabetes, heart disease or stroke.
According to the Mayo Clinic, PCOS affects about five million Americans and is named for the multiple cysts lining the outer edge of the ovaries. Its cause is unknown but may be linked to insulin resistance, according to the Polycystic Ovarian Syndrome Association.
PCOS can show up anytime between adolescence and post-menopause, but symptoms vary between patients in both type and severity, according to the Mayo Clinic. An abnormally high level of androgens, or male hormones, is typically present in women with PCOS, and about 60 percent are overweight or obese.
Insulin resistance — the body's inability to effectively use insulin to metabolize sugar — is thought to play a prominent role in PCOS, as is heredity.
According to the U.S. Department of Health and Human Services, symptoms include:
- Infrequent, irregular or absent menstrual periods
- Hirsutism, which is increased hair growth on the face, chest, abdomen, back, toes or thumbs
- Ovarian cysts
- Acne or oily skin
- Weight gain or obesity
- Male-pattern baldness or thinning hair
- Thick, dark patches of skin on the neck, arms, breasts or thighs
- Skin tags, which are excess flaps of skin in the armpit or neck area
- Pelvic pain
- Anxiety or depression
- Sleep apnea
Diagnosis & Tests
Since no single test can detect PCOS, other possible conditions must first be ruled out, according to the Mayo Clinic. Tests typically include:
- Physical exam: Blood pressure, waist size and body mass index (BMI) are measured, and areas of excess hair growth are noted.
- Pelvic exam: Enlarged or swollen ovaries palpated by the doctor can indicate many small cysts.
- Blood tests: Androgen and glucose levels are checked.
- Vaginal ultrasound: A sonogram wand, which uses sound waves to produce images of the pelvic area, is placed in the vagina. Ovarian cysts and a thicker uterine lining (from irregular periods) can suggest PCOS.
To confirm a diagnosis of PCOS, two of three major symptoms must be present: menstrual abnormality, excess androgen and polycystic ovaries. Some PCOS patients' ovaries appear normal, and other women with cysts may not have PCOS.
Certain conditions can be triggered by PCOS, some of them serious. Obesity makes them more likely, according to the Mayo Clinic. Complications include:
- Type 2 diabetes
- Cholesterol abnormalities
- High blood pressure
- Elevated C-reactive protein levels, which can indicate cardiovascular disease
- Metabolic syndrome, a group of signs that indicate increased risk for cardiovascular disease
- Non-alcoholic steatohepatitis, severe liver inflammation caused by excess fat in the liver
- Sleep apnea
- Cancer of the uterine lining
- Diabetes or high blood pressure during pregnancy
Treatment & Medications
PCOS has no cure, so treatment focuses on symptom management. Aside from lifestyle changes to promote weight loss, certain drugs — including insulin — can be prescribed to regulate hormone levels.
According to the Department of Health and Human Services, these include:
- Birth control pills, which can control menstrual cycles, reduce androgens and help clear acne.
- Fertility medications, which can stimulate ovulation in PCOS patients who wish to become pregnant. These drugs include clomiphene (also known as the brand name Clomid or Serophene), which are taken orally; or gonadotropins such as follicle-stimulating hormone (FSH) or luteinizing hormone (LH), which are injected.
- Anti-obesity drugs such as orlistat (Xenical) and sibutramine (Meridia).
- Anti-androgens such as spironolactone (Aldactone) or flutamide (Eulexin).
- Diabetes medications such as metformin (Glucophage).
If fertility medications don't work, surgery is sometimes performed on the ovaries to increase chances of ovulation. Called “ovarian drilling,” the ovaries are punctured with a small needle that carries an electric current, which can induce ovulation by reducing androgen levels, according to the Mayo Clinic. The surgery is done laparoscopically using a tiny camera to see the pelvic organs through small incisions in the abdomen.