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Polycystic Ovarian Syndrome

What is Polycystic Ovarian Syndrome (PCOS)?

Polycystic ovarian syndrome, also known as Stein-Leventhal Syndrome, is a health problem that affects a woman’s ovaries. It has the ability to affect a women’s menstrual cycle, hormones, their heart, and even the ability to bear children. Women with PCOS typically have missed or irregular menstrual periods, irregular ovulation, high levels of androgens (sometimes called male hormones), and cysts (fluid-filled sacs) that develop in their ovaries.

About 1 in 20 women who are of childbearing age have PCOS. It can happen to girls as young as 11 years old.

An estimated 5 million women in the US might be affected.

What are the Symptoms of Polycystic Ovarian Syndrome?

Signs or symptoms usually emerge during early adulthood or late adolescence. While not everyone will experience the same symptoms, most (if not all) women complain of menstrual problems or not being able to get pregnant.

Some common symptoms of PCOS are:
    Infertility – Many women aren’t aware that they have PCOS but go to the doctor because they are having trouble conceiving. A woman who is fertile should ovulate once during their menstrual cycle. An egg should be released into a woman’s uterus. This rarely happens or not at all for women with PCOS.

    Polycystic ovaries – This is when there are a bunch of little cysts that look like beads surround the edge of the ovaries. While these cysts don’t cause any real problems, it might be a sign that something else is wrong.

    Normally, when a woman ovulates, there are a number of eggs that develop inside each ovary. What happens is that eventually one “dominant” egg will be released during ovulation. All of the other eggs shrink down back into the ovary. For women with PCOS, the remains of dominant eggs that were never released are the bead-like cysts around the ovaries.

    However, this not the only symptom Dr. Golshani will be looking at for PCOS. For a proper diagnosis, a woman needs to have some signs of excessive androgen in the body, as well as irregular menstrual cycles.

  • Irregular or no menstrual periods
  • Hirsutism – This means excessive hair growth, typically on the back, chest, face or buttocks.
  • Hair loss – on a woman’s head
  • Pelvic pain
  • Dark skin patches – This is usually found on the back of the neck or other areas in the body. Too much insulin causes this symptom.
  • Acne

What Causes Polycystic Ovarian Syndrome?

The cause of PCOS is unknown. But most experts think that several factors, including genetics, could play a role. Women with PCOS are more likely to have a mother, sister, or other family relative with PCOS.

Causes include:

    Hormonal imbalance – This is a main underlying cause. Women with PCOS have ovaries that produce more than the normal amount of androgens (male hormones that females also produce). High levels of androgens can affect how eggs are released and developed during ovulation.

    While nobody is really sure why hormonal issues happen, some experts suggest that the problem started in the ovary itself, other glands in the body, or the part of the brain that maintains how hormones are produced.

    Types of hormonal balance include:

  • Low sex hormone binding globulin (SHBG) levels: They help to lower the effects of testosterone.
  • High testosterone: Even though it is a male hormone, females also produce small amounts of it.
  • High levels of prolactin: This hormone stimulates milk production during pregnancy in the breast glands.

  • Exposure to androgens while in the womb – Excessive exposure to this type of hormone might have permanent effects on gene expression. This means that it might make some genes not work like they are supposed to which may lead to PCOS later in life.

    Insulin resistance – Blood insulin can reach higher levels, which causes the ovaries to make too much androgens and testosterone hormones. This can lead to abnormal or no ovulation at all, because it affects the development of the follicles, which is the sacs in which the eggs develop.

    Genes – If a woman’s female relatives have had PCOS, they are most likely to develop it.

    High levels of Bisphenol A (BPA) – BPA is a very common material used in plastic products such as food and drink packaging. Being excessively exposed to BPA daily might increase your BPA levels. There have been associations between BPA in women with PCOS and male sex hormones.

How is Polycystic Ovarian Syndrome diagnosed?

While there is no single definitive test to determine if you have PCOS, your doctor will do the following to figure out if something else is causing your symptoms, or if you have PCOS.

Physical Exam – Dr. Golshani will do a routine checkup such as measuring your body mass index (BMI), blood pressure and waist size. Try to allow your hair to naturally grow out for a few days before you visit, as she will check areas of any increased hair growth.

Pelvic exam – You will get checked to see if your ovaries are swollen or enlarged by the number of small cysts you have.

Medical history – Dr. Golshani will review your files and ask you about any symptoms you have such as weight changes and menstrual cycles. She may ask about your family medical history.

Sonogram (vaginal ultrasound) – Dr. Golshani may want to conduct a test that utilizes sound waves to take photos of the pelvic area. This ultrasound can be used to look at your ovaries for cysts, as well as the lining of the womb (the endometrium). The lining can get thicker if you don’t have regular menstruation.

Blood test – Dr. Golshani uses this test to check sugar (glucose) or androgen hormone levels in your blood.

Will PCOS Change During Menopause?

Polycystic ovarian syndrome can affect numerous systems in a woman’s body. Many of the symptoms may still be there even though a woman nears menopause, when hormone levels and ovarian functions change. For example, a woman will still have excessive hair growth, and thinning hair will get worse after menopause. As well, there are more risks of health complications such as diabetes, stroke and heart attack when a woman gets older.

Can PCOS Affect Women When Pregnant?

During pregnancy, women with PCOS might have higher rates of gestational diabetes, premature delivery, preeclampsia (pregnancy-induced high blood pressure), and miscarriages.

As well, women with PCOS have babies that tend to have a higher chance of dying before, during or shortly after birth. They also have an increased chance that they’ll spend time in a neonatal intensive care unit. These problems tend to happen when giving birth to multiple babies, like twins.

There is research being conducted to determine on whether or not diabetes medicine Metformin might be able to reduce or prevent the chances of the baby having problems. This medicine helps to lower male hormone levels and can limit weight gain in obese women.

This medicine does not appear to cause any type of major birth defects in pregnant women. This is an FDA pregnancy category B drug, and can be passed through breast milk. Talk to your doctor about using Metformin if you are trying to or are already pregnant, or you are nursing.

What are the Treatment Options for People with PCOS?

If a woman has polycystic ovary syndrome, it is incurable, but there are a few ways it can be treated. It all depends on what the symptoms are.

Treatment includes:
  1. Contraceptive pills – This might work if you just want a regular menstrual cycle and aren’t aiming to conceive, then this might be a solution for you. It might also help you lessen the chances of getting endometrial cancer.

  2. Weight loss – Overweight or obese women can significantly reduce their long term health issues if they adopt a healthy lifestyle and lose weight. Losing weight also helps with lower testosterone levels since insulin levels also drop. Having lower testosterone levels reduces excessive hair growth and acne, and improves fertility.

  3. Clomifene – Taking this medication helps to fix hormone imbalances, which helps to increase your chances of ovulation.

  4. Gonadotrophins – This might be recommended to you if you haven’t responded to clomifene. Since this medication might overstimulate the ovary, there is a chance of multiple pregnancies, such as twins or triplets.

  5. Anti-male hormones – These types of medications can help to reduce the masculine effects of testosterone, such as excessive facial hair and hair loss on the head.

  6. Eflornithine – This is a cream applied on the skin to help slow down facial hair growth. It does not remove hair, so you’ll need to look at options such as laser hair removal for more permanent solutions.

  7. Metformin – Also called Glucophage, Metformin is a medication that can increase ovulation that is also used to treat diabetes. It can also help reduce issues caused by insulin resistance and help to regulate very high levels of male hormones.

  8. Surgery – Your doctor may recommend laparoscopic ovarian drilling (LOD), which entails using laser or heat to surgically treat the ovaries. It also destroys tissue that produces androgens. This surgery will correct hormonal imbalances, which in turn restores the normal function of the ovaries.

  9. Surgery will only be recommended if a patient has not responded well to clomifene.

Surgery will only be recommended if a patient has not responded well to clomifene.

Are There Any Complications?

There is a higher risk of developing certain conditions or diseases, particularly for overweight or obese women with PCOS.

Complications include:
  • Abnormal bleeding from the uterus
  • Gestational diabetes - diabetes during pregnancy
  • Metabolic syndrome
  • Blood cholesterol and lipid abnormalities
  • Pregnancy induced hypertension
  • Endometrial cancer
  • High levels of C-reactive protein
  • Severe liver inflammation (nonalcoholic steatohepatitis)
  • Sleep apnea

Is There Anything I Can Do To Prevent Complications?

If you can, try to treat your symptoms at an earlier age to help lessen chances of getting complications like diabetes and heart disease. Talk to Dr. Golshani about focusing on more than one part of PCOS and how you can treat all your symptoms. You should also get tested regularly for diabetes.

You can also healthy lifestyle choices such as exercising, eating a well-balanced diet, and not smoking.

Are There Any Emotional Effects of PCOS?

It could be emotionally taxing to have PCOS. You might constantly worry whether or not you can get pregnant, depressed or even embarrassed by your appearance.

Getting treatment can help to address some of the concerns and make you feel emotionally better. Another suggestion is to look for local support groups or online to help you cope with the emotional effects of PCOS.

The Art of Healing

Dr. Roya Golshani, a board certified primary care physician, has been practicing general internal medicine since 2002. She is a passionate internist who not only practices internal medicine, but specializes in Women’s Health as well. With her additional training in medical, developmental, and psychological issues, she is fully capable of working with you to solve your problems. Talk with her today to learn more about polycystic ovarian syndrome test and how you can successfully treat it.

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