PCOS (Polycystic Ovary Syndrome)

• Overview (jump to topic): PCOS is a common hormonal disorder in women causing excessive production of male hormones and sometimes resulting in many cysts to form on the ovaries. It affects as many as 10% of reproductive age women in the United States, with 70%-80% of PCOS cases involving infertility.
• Causes: The cause of polycystic ovary syndrome is unknown, but women with a family member with it are at higher risk of also having the disease.
• Symptoms: In addition to infertility, the hormonal imbalances due to this condition often cause irregular periods, weight gain, high blood pressure, excessive body hair growth, skin issues and diabetes.
• Diagnosis: Because PCOS is related to other medical conditions, it is difficult to diagnose with a single test so a series of exams and evaluations are necessary to rule out other conditions before a PCOS diagnosis.
• Treatments: PCOS has no cure, but lifestyle changes, medications and fertility treatments like oral ovulation induction or in vitro fertilization (IVF) can minimize its effects and improve chances of pregnancy.

What is PCOS?

Polycystic ovary syndrome (PCOS), also known as Stein-Leventhal syndrome or hyperandrogenic anovulation, is a common female disorder causing metabolic issues and elevated hormones such as testosterone, luteinizing hormone and insulin.

This hormone imbalance can disrupt normal ovulation and the menstrual cycle, leading to irregular or missed periods, the development of cysts on the ovaries and ultimately infertility in women.

PCOS affects up to 1 in 10 women.

PCOS is considered to be the most common hormonal imbalance disorder in reproductive-aged women. An estimated 70%-80% of PCOS cases will result in infertility, according to the National Institutes of Health.

With proper diagnosis and treatment, most women with fertility problems due to this disease are able to conceive.

Cause of PCOS and risk factors

The cause of PCOS isn’t known. Some experts suspect a genetic issue that may be related to a malfunction in regulating the insulin hormone. As such, the primary risk factor for the condition is having a family member who has had it.

African American and Hispanic women are also diagnosed with PCOS at higher rates. Hispanic women in particular may suffer from increased severity and rates of symptoms.

PCOS symptoms & signs

PCOS causes complex changes in a woman’s hormonal glands, with varying effects on her body, to her mental state or reproductive cycle. While women with PCOS will often experience different symptoms, some of the more common ones are:

• Pelvic pain.
• Excess body or facial hair (also known as hirsutism).
• Oily or dry skin.
• Weight gain, or trouble losing weight.
• Skin tags or discoloration.
• Decreased sex drive.
• Anxiety and depression.

Diagnosing PCOS

Polycystic ovary syndrome is often overlooked and undiagnosed in many women because its symptoms are complex, vary from patient to patient, and can sometimes appear to be unrelated to one another.

Because PCOS is related to other medical conditions, it is difficult to diagnose with a single test. As a result, the fertility specialist will perform a series of exams and evaluations to rule out other causes before diagnosis.

• Physical exam to assess thyroid, body mass index, blood pressure, body hair, acne and skin condition.
• Health assessment to understand the patient’s history of menstrual irregularities and other fertility-related issues.
• Pelvic exam to check for abnormal physical signs, such as an enlarged clitoris or swollen ovaries.
• Ultrasound (sonogram) to check for cysts on the ovaries and the lining of the uterus.
• Blood tests to measure hormone levels and indicators of conditions other than PCOS.

After a proper diagnosis, the treatment for PCOS will vary, depending on whether a woman is considering pregnancy, is menopausal, or does not want to conceive. Our specialists discuss with the patient all evaluations and her specific desires before arriving together at a course of action.

Patient education, empathy and expertise is our strategy for success. More about our approach to care.

PCOS treatment

For women who want to conceive, our specialists may suggest fertility treatments to work around the issues the condition presents. Often treatment can be as simple as weight management or exercise.

• Routine exercise can assist the body in regulating insulin and in keeping off excess weight.
• Eating well, staying active, and maintaining a healthy weight can improve symptoms.

For those who suffer from severe symptoms, more advanced interventions may also help women achieve pregnancy. This can include using medication, such as clomiphene citrate (brand name Clomid), letrozole and follicle-stimulating hormone (FSH), to help stimulate ovulation. Medication can also be combined with assisted reproductive technology procedures like intrauterine insemination (IUI) or in vitro fertilization (IVF).

While IVF has the highest success rate compared with other fertility treatments, it’s not our first line of treatment. We treat you, and that means considering all factors (from emotions to finances) in your path toward success.

For nonfertility related symptoms, lifestyle changes can help reduce obesity, high blood sugar and pre-diabetes. If there are significant signs of pre-diabetes or diabetes, we may also prescribe insulin-sensitizing agents such as the drug metformin.