Polycystic ovary syndrome (PCOS) is a complex disorder with a variety of treatments. Medication is often needed, but lifestyle changes such as losing weight, increasing activity and limiting carbohydrates are also key to reducing symptoms and complications, says Valentine J. Burroughs, MD, Director of Endocrinology, Diabetes and Metabolism for Highland Medical, P.C., and Montefiore Nyack Hospital.
“It is important to diagnose and treat PCOS early, to reduce the risk of long-term complications such as type 2 diabetes and heart disease,” Dr. Burroughs said.
PCOS is a hormonal disorder most frequently seen in women of reproductive age. Multiple cysts develop in each ovary. The cysts are immature ovarian follicles containing eggs, which are ordinarily released from the ovaries during ovulation. High hormone levels stop follicle maturation and subsequent ovulation. These immature follicles accumulate in the ovaries.
PCOS causes infrequent, irregular or prolonged menstrual periods. Women with the condition often have excess levels of the male hormone androgen produced by the ovarian cysts. They also may have elevated insulin levels due to resistance to the biologic effects of insulin. Prolonged high insulin levels increase the risk of diabetes. About 10% of women with PCOS also have type 2 diabetes mellitus, and up to 35% of women with PCOS have prediabetes.
The exact cause of PCOS is unknown.
Symptoms and Diagnosis of PCOS
The symptoms of PCOS include hair growth on the face, chest, and belly. Acne, fatigue, and male-pattern baldness are other common symptoms. Women with the disorder often have infrequent, irregular, or prolonged menstrual cycles. About half of women with the condition are overweight or obese, with fat concentrated in the abdomen.
Because women with PCOS often don’t ovulate, they often have fertility problems. Depression and anxiety are also common signs of PCOS. “Mental health issues can be related to the woman’s hormone imbalance, but they also may be related to issues of body image and how the women feel about themselves,” Dr. Burroughs said. Sleep apnea is also common in PCOS, which may be due to the high rate of obesity among patients.
To diagnose PCOS, the doctor will ask about a woman’s medical history and conduct a physical exam. The doctor may order an ultrasound of the abdomen, including the pelvic organs and liver (fat deposits on the liver can be a sign of PCOS). Transvaginal ultrasound may be done to look for cysts in the ovaries. The doctor also may order blood tests to measure male hormone levels, insulin levels, cholesterol levels.
Treatment consists of lifestyle changes and treating individual symptoms and pharmacologic therapy Dr. Burroughs says. Lifestyle changes include weight loss through a low-calorie, low-carbohydrate diet combined with exercise. Even losing a modest amount of weight may improve PCOS. Losing weight can reduce levels of insulin and androgen, and also can help with infertility.
Medications for PCOS may include:
- Birth control drugs to control the menstrual cycle, and reduce excess hair growth, abnormal bleeding, and acne
- For women who want to become pregnant, drugs that simulate ovulation such as Clomid
- The diabetes drug Metformin to lower insulin levels
- Drugs to reduce excessive hair growth, such as Aldactone
- Medications to treat depression and anxiety
“Treating PCOS is a team effort, involving the woman, her primary care physician, her OB/GYN to manage fertility, and an endocrinologist, who specializes in hormone disorders,” Dr. Burroughs said. “By working with her doctors, a woman can get help to prevent complications and lead a healthier life.”