Understanding Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is a condition that affects up to 12% of women in their childbearing years. It is one of the most common causes of infertility (inability to become pregnant) in women. Most women learn that they have PCOS in their 20s and 30s when they are trying to conceive. However, PCOS can occur at any age after your first menstrual period and can affect your health throughout your lifetime.

What Is Polycystic Ovary Syndrome (PCOS)?

PCOS is a condition in which your ovaries make more androgen (male sex hormone) than normal. Many women who have PCOS develop multiple small fluid-filled sacs, known as cysts, in their ovaries. Sometimes, a woman does not make enough of the hormones that promote ovulation (release of an egg during the menstrual cycle). When ovulation does not occur, cysts may form in the ovaries, producing excess androgen.

What Causes PCOS?

The cause of PCOS is not clearly understood. However, many experts agree that the following factors may play a role in the development of PCOS:

• High androgen levels: Although androgens are male hormones, women make small amounts of androgen in their ovaries. Women with PCOS have higher levels of androgen than normal, which can interfere with ovulation.
• High insulin levels: Many women with PCOS have insulin resistance. This means that their bodies make insulin, but their cells do not effectively use the circulating insulin. This leads to high levels of insulin, which can eventually lead to type 2 diabetes.
• Genetics: PCOS can be hereditary(run in your family). You are more likely to have PCOS if a female relative, such as your mother, sister, or aunt, has this condition.

What Are the Symptoms of PCOS?

Not all women with PCOS have the same symptoms. The severity of the symptoms may vary between women, and some women may not have symptoms at all. Common symptoms of PCOS include:

• Acne
• Enlarged ovaries containing multiple cysts
• Increased hair growth (hirsutism), especially on the face or chin
• Infertility
• Irregular menstrual periods
• Skin darkening, especially in the groin area, under the breasts, or in the neck creases
• Skin tags (small flaps of extra skin)
• Thinning hair or hair loss
• Weight gain

How Do You Diagnose PCOS?

There is no single diagnostic test for PCOS. Your healthcare provider may talk to you about your medical history and may recommend the following methods to help determine if you have PCOS:

• Physical exam: Your doctor will check your blood pressure and weight or body mass index (BMI). They will also look for skin tags and any changes in skin color.
• Pelvic exam: Your doctor may check for enlarged ovaries and other signs of excess androgen.
• Ultrasound: An ultrasound of your pelvic area will help your healthcare provider see if you have cysts in your ovaries.
• Blood tests: Your doctor may check the androgen levels in your blood. He or she may also check your cholesterol and blood sugar levels and the levels of other hormones to determine if you have other health conditions. Symptoms of other health issues, such as thyroid disease, may resemble those of PCOS.

What Are the Treatments for PCOS?

No cure exists for PCOS, but treatments are available to relieve the symptoms. If you are not trying to get pregnant, the following treatments may help improve your symptoms:

• Hormonal birth control containing both estrogen and progestin: Whether it is a pill, a patch, or a vaginal ring, hormonal birth control can help regulate your period, lower your risk of endometrial cancer, help improve your acne, and reduce excess facial hair.
• Medications that block androgen: Medications that block the effects of androgen can help reduce hair loss, improve your acne, and reduce unwanted facial hair. Drugs that block androgen effects include spironolactone (Aldactone) and finasteride (Proscar, Propecia).

If you want to get pregnant, your doctor may recommend the following medications to treat your symptoms and help stimulate ovulation:

• Metformin (Glucophage): Metformin is used to treat type 2 diabetes. It can lower your blood sugar and improve your body's ability to use insulin. Metformin can lower androgen and insulin levels and promote ovulation.
• Clomiphene (Clomid): Clomiphene can help you and your partner conceive by stimulating ovulation.
• Letrozole (Femara): Letrozole is typically used to treat breast cancer, but it can also stimulate ovulation.
• Vaniqa (Eflornithine): Vaniqa is a cream used to reduce unwanted hair growth in women. If you are planning on becoming pregnant, talk to your doctor before using Vaniqa.

What Are the Health Complications of PCOS?

PCOS can have effects on your health beyond your reproductive years and reproductive organs. PCOS can increase your risk for:

• Cardiovascular disease
• Depression
• Endometrial cancer
• Metabolic syndrome (a cluster of conditions that includes high blood pressure, high blood sugar, high cholesterol, and increased fat around the waist)
• Sleep apnea (a condition in which your breathing repeatedly stops and starts while you are sleeping)
• Type 2 diabetes

Although there is no cure for PCOS, treating the symptoms can help reduce your risk of complications. Managing your weight can help prevent type 2 diabetes, metabolic syndrome, and cardiovascular disease. You can use the Grocery Guidance to help you plan meals that align with your health goals.

Rosanna Sutherby is a freelance medical writer who has been a practicing pharmacist in her community for close to 20 years. She obtained her Doctor of Pharmacy from Nova Southeastern University in Ft. Lauderdale, FL. She utilizes her clinical training in the pharmacy, where she helps patients manage disease states such as asthma, diabetes, heart disease, hypertension, and many others. Dr. Sutherby reviews and recommends drug regimens based on patients' concurrent conditions and potential drug interactions.

References:

https://www.cdc.gov/diabetes/basics/pcos.html

https://www.wellrx.com/health-conditions/about/health-condition/female-infertility/~default/

https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos

https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome

https://www.wellrx.com/health-conditions/about/health-condition/type-2-diabetes/~default/

https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/causes/

https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443

https://www.acog.org/patient-resources/faqs/gynecologic-problems/polycystic-ovary-syndrome

https://www.wellrx.com/health-conditions/about/health-condition/insulin-resistance-syndrome/~default/