A PCOS Tip Sheet

a blog by David Kreiner, M.D., F.A.C.O.G., East Coast Fertility, September 14, 2010

September is PCOS Awareness Month. Many women don’t know that PCOS is the most common endocrine disorder of reproductive age women, occurring in over 7 percent of women at some point in their lifetime. It usually develops during the teen years.

Treatment can assist women attempting to conceive, help control the symptoms and prevent long-term health problems. If you think you have PCOS — or are struggling with PCOS — here are some things that you should know:

• Polycystic Ovary Syndrome (PCOS) is a condition in which a woman’s hormones are out of balance. It can cause problems with your periods and make it difficult to get pregnant. PCOS may affect the way you look and can be associated with a variety of health problems including diabetes, hyperlipidemia and hypertension.
• The most common cause of PCOS is glucose intolerance resulting in abnormally high insulin levels. If a woman does not respond normally to insulin, her blood sugar levels rise triggering the body to produce more insulin. The insulin stimulates your ovaries to produce male sex hormones called androgens. Testosterone is a common androgen and is often elevated in women with PCOS. These androgens block the development and maturation of a woman’s ovarian follicles, preventing ovulation resulting in irregular menses and infertility. Androgens may also trigger development of acne and extra facial and body hair. It will increase lipids in the blood. The elevated blood sugar from insulin resistance can develop into diabetes.
• Symptoms may vary. The most common are acne, weight gain, extra hair on the face and body, thinning of hair on the scalp, irregular periods and infertility.
• Ovaries develop numerous small follicles that look like cysts, hence the name polycystic ovary syndrome. These cysts themselves are not harmful but in response to fertility treatment can result in a condition known as Hyperstimulation syndrome. Hyperstimulation syndrome involves ovarian swelling, fluid accumulating in the belly and occasionally around the lungs. A woman with Hyperstimulation syndrome may become dehydrated, increasing her risk of developing blood clots. Becoming pregnant adds to the stimulation and exacerbates the condition, leading many specialists to cancel cycles in which a woman is at high risk of developing Hyperstimulation. They may also prescribe aspirin to prevent clot formation. These cysts may lead to many eggs maturing in response to fertility treatment also placing patients at a high risk of developing a high order multiple pregnancy. Due to this unique risk it may be advantageous to avoid aggressive stimulation of the ovaries unless the eggs are removed as part of an in vitro fertilization procedure.
• A diagnosis of PCOS may be made by history and physical examination, including an ultrasound of the ovaries. A glucose tolerance test is most useful to determine the presence of glucose intolerance and diabetes. Hormone assays will also be helpful in making a differential diagnosis.
• Treatment starts with regular exercise and a diet including healthy foods with a controlled carbohydrate intake. This can help lower blood pressure and cholesterol and reduce the risk of diabetes. It can also help you lose weight if you need to.
• Quitting smoking will help reduce androgen levels and reduce the risk for heart disease. Birth control pills help regulate periods and reduce excess facial hair and acne. Laser hair removal has also been used successfully to reduce excess hair.
• A diabetes medicine called metformin can help control insulin and blood sugar levels. This can help lower androgen levels, regulate menstrual cycles and improve fertility. Fertility medications, in particular clomiphene, are often needed in addition to metformin to get a woman to ovulate and will help many women to conceive. The use of gonadotropin hormone injections without egg removal as part of an IVF procedure may result in Hyperstimulation syndrome and/or multiple pregnancies, and therefore one must be extremely cautious in its use. In vitro fertilization has been very successful and offers a means for a woman with PCOS to conceive without a significant risk for developing a multiple pregnancy especially when associated with a single embryo transfer. Since IVF is much more successful than insemination or intercourse with gonadotropin stimulation, IVF will reduce the number of potential exposures a patient must have to Hyperstimulation syndrome before conceiving.

  It can be hard to deal with having PCOS. If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition. Ask your doctor about support groups and for treatment that can help you with your symptoms. Remember, PCOS can be annoying, aggravating and even depressing, but it is fortunately a very treatable disorder.