Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome (PCOS) is a common condition that affects 5-10% of women and is primarily characterized by irregular menses and excess androgens (male hormones).  The cause of PCOS is not completely known, but what we do know is that abnormal hormonal signals from the brain and elevated levels of androgens affect the way the ovaries function. These alterations in the normal female hormonal system can have multiple different adverse effects on a woman’s health.

Effects On The Menstrual Cycle

In a normal menstrual cycle, the ovary will release an egg (ovulation) approximately 2 weeks after the first day of menses.  If pregnancy does not occur, the next menses will start approximately 2 weeks later, completing the normal menstrual cycle. In PCOS patients, ovulation does not occur regularly which can cause menses to come weeks or months later than normal. This results in abnormal bleeding patterns and can even increase one’s risk of uterine cancer if left untreated. The good news is this abnormal bleeding can be treated to regulate the menstrual pattern.

Effects On Fertility

Issues with ovulation are responsible for 25% of all cases of infertility. PCOS is the most common cause of ovulatory dysfunction.  This can lead to lower pregnancy rates and infertility.  Multiple different treatment options are available to help PCOS patients achieve pregnancy.

Other Effects On Health

PCOS can cause or contribute to other issues besides menstrual irregularities and infertility including:

• Obesity, difficulty losing weight
• Acne, male pattern hair growth (hirsutism)
• Sleep apnea
• Insulin resistance/diabetes
• Endometrial hyperplasia/cancer
• Heart disease

Evaluation

Evaluation for PCOS begins with a careful history and physical exam by your provider at Northside Northpoint OB/GYN. It will also likely include:

• Lab tests to check for other hormonal abnormalities, androgen levels
• Assessment of ovulation- through home ovulation tests or blood draw
• Ultrasound to evaluate the uterus and ovaries- ovaries typically have a “polycystic” appearance with multiple small immature follicles (there are not actually cysts on the ovaries)

Treatment

Treatment of PCOS is determined initially by the symptoms the patient has and her desire for pregnancy.

If pregnancy is not desired, treatment options include:

• Weight loss through healthy diet and exercise if the patient is overweight
• Irregular menses: oral contraceptives, progesterone medications (pills, IUD, implant), metformin
• Acne: oral contraceptives, spironolactone (an anti-androgen medication), dermatologic medications
• Hirsutism (male pattern hair growth): oral contraceptives, spironolactone, cosmetic hair removal

If pregnancy is desired, treatment options include:

• Weight loss through healthy diet and exercise if the patient is overweight
• Ovulation induction using medications (clomid, letrozole)
• Metformin
• Referral to Reproductive Endocrinologist

If you think you could have PCOS, please contact us at Northside Northpoint OBGYN. Our providers are well-versed in evaluating and treating PCOS to help you achieve your personal health goals.