Reproductive Health Information
Polycystic Ovary Syndrome
Approximately seven to eight percent of women of childbearing age are affected by polycystic ovary syndrome (PCOS), which is one of the leading causes of infertility. It is believed to be a genetic disorder that runs in families, but the cause is still unknown.
PCOS results from a hormonal imbalance that leads to excess production of androgens by the ovary, which causes abnormal hair growth and can prevent or delay ovulation. In order for the ovary to function normally, it must receive the correct hormone signal. In PCOS, the hormones that signal the ovary, which include leuteinizing hormone (LH) and insulin, are out of balance. As a result, the ovary does not function normally.
Typical symptoms are menstrual irregularity and excess hair growth on the face, chest, and abdomen. The symptoms usually develop shortly after puberty. However, there is a lot of variation in this disorder and symptoms can range from mild menstrual irregularity to complete lack of menstrual periods and severe abnormal hair growth.
Polycystic ovaries have a white, thick, tough outer covering, and are two to five times larger in size than normal ovaries. The cysts present in the ovary are actually follicles containing eggs that have failed to grow to a mature size. They are typically 5 mm in size and do not need to be surgically removed.
The following symptoms could be a sign of PCOS:
- Irregular, scanty or absent menstrual periods
- Increased levels of male hormones
- Excess hair growth (hirsutism)
- Obesity or weight gain
- Asymptomatic ovarian cysts (usually seen on ultrasound)
- Insulin resistance
- High blood pressure (readings over 140/90)
- Male pattern baldness
- Dark patches of skin on back of neck, under arms, groin
There is no single test for PCOS because no exact cause has been established. PCOS is diagnosed by clinical history and a physical exam looking for menstrual irregularity, and excess, abnormal hair growth or acne. In addition, all other medical conditions that could also cause these symptoms must be excluded. A pelvic ultrasound can be helpful in identifying polycystic-appearing ovaries. Blood tests that can be helpful in diagnosing the condition include:
- TSH, Prolactin (to exclude these conditions as a cause of menstrual irregularity)
- HCG (to exclude pregnancy as a cause of menstrual irregularity)
- Total testosterone and free testosterone (to look for excess androgens)
- FSH, LH (to exclude premature menopause as a cause of menstrual irregularity)
Other blood tests that should be considered for women with PCOS include:
- Tests to evaluate for diabetes risk:
Women with PCOS have a greater chance of developing health problems such as:
- Endometrial hyperplasia
- Endometrial cancer
- Insulin resistance
- Type II diabetes
- High blood pressure
- High cholesterol
- Heart disease
To reduce the risk of developing endometrial hyperplasia or endometrial cancer, women with PCOS should use oral contraceptives (birth control), progesterone, or progestins which are synthetic progesterones, to induce regular periods and the shedding of the uterine lining. For those women attempting pregnancy, the use of fertility drugs should be sufficient.
Women with PCOS are at risk for developing diabetes.The risk is higher in women who are overweight, but thin women are also at risk. To help prevent or delay the onset of type II diabetes, overweight women should exercise and make careful food choices in order to lose weight. Regular screening for diabetes should be performed. Diet, exercise and weight loss can also help improve cholesterol and triglyceride levels, and lower blood pressure levels.
A 2005 study found that 35 percent of women with polycystic ovary syndrome also had depression. This case-controlled study of 206 women was performed by Anuja Dokras, MD, PhD, and Elizabeth Hollinrake, MD.
Its findings recommend that women with PCOS be routinely screened and adequately treated for depression.
Dr. Dokras noted that the results also show for the first time that depression in PCOS patients is significantly associated with both high body mass index (BMI) and insulin resistance. "Between 50 and 70 percent of women who are treated for depression recover completely, so this is an important target population that we should be both screening and treating," added Dr. Dokras.
Treatment of PCOS is directed at shutting down the ovary to prevent the symptoms of PCOS, or correcting the signal to the ovary to lead to normal function and ovulation.
Medications that shut down the ovary or prevent the symptoms of PCOS include oral contraceptives, spironolactone, and flutamide. These medications are used in women who are not trying to get pregnant and are successful in regulating menstrual cycles and controlling excess hair growth.
Weight reduction is an important factor in the treatment of PCOS. Maintaining good general health through careful food choices and exercise can help to eliminate the complications of obesity and diabetes in women with PCOS.
For those women with PCOS who desire pregnancy, the standard therapy includes using fertility drugs that stimulate ovulation. Clomiphene citrate, an oral medication that is taken for five days and has few side effects, is used to induce ovulation. The risk of having multiple gestations (twins, triplets, etc.) is low approximately 10 percent. Approximately 80 percent of patients will ovulate with clomiphene citrate.
Injectable fertility drugs can also be used to stimulate ovulation, typically if clomiphene citrate fails to work. These medications include FSH and combination FSH/LH. These medications have a higher rate of multiple gestation (20-40 percent) and should be used with careful monitoring.
In vitro fertilization is also a successful treatment for women with PCOS who would like to become pregnant. This treatment decreases the risk of multiple gestations that can occur with injectable fertility drugs.
Visit the Penn Polycystic Ovary Syndrome Center to learn more about our treatments of PCOS.
Need an appointment? Request one online 24 hours/day, 7 days/week or call 800-789-PENN (7366) to speak to a referral counselor.