OHSU

Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a condition that causes your ovaries to produce excessive amounts of androgens (male sex hormones). Your ovaries become enlarged and contain many small cysts. Many PCOS patients are also obese. Symptoms of PCOS include:

  • Hirsutism (excess hair growth on face and body)
  • Acne
  • Irregular, absent or heavy menstrual periods
  • Lack of ovulation and infertility

If you are diagnosed with PCOS, treatment will depend on your goals. Your main concern may be fertility.  Or you may be more concerned about menstrual cycle regulation, hirsutism or acne. Regardless of your primary goal, PCOS should be treated. It’s important to treat because of the long-term health risks such as heart disease, diabetes and endometrial cancer.

Early diagnosis and treatment of POS is important. It can help decrease some of your symptoms and reduce your risk for certain diseases and disorders down the line. If your main concern is fertility, please read the information below.

Ovulation Induction

If fertility is your immediate goal, ovulation may be induced with clomiphene citrate (Clomid). Fertility medications may increase the risk of multiple pregnancy. PCOS patients who are insulin resistant may ovulate when treated with metformin (Glucophage). This medication increases your body’s sensitivity to insulin.

If clomiphene does not bring about ovulation, or you do not get pregnant within six ovulatory cycles, your doctor may prescribe gonadotropins. Gonadotropins are more expensive and have a higher incidence of side effects. Side effect risks include hyperstimulation of your ovaries and higher risk of multiple pregnancy
If you are concerned that you may have PCOS, you can contact us for diagnosis and treatment.

Abnormal Menstrual Function

Excess luteinizing hormone (LH) or insulin may cause the ovaries to overproduce androgens. Ongoing high levels of androgens may result in the symptoms listed above.

Lack of follicle stimulating hormone (FSH) may weaken your ovarian follicle development and prevent ovulation. This process may cause infertility. Eventually, PCOS results from the many small cysts that form in your ovary. These cysts are the result of the follicles that failed to mature and ovulate.

Lack of ovulation in PCOS results in continuous high levels of estrogen and not enough progesterone. Unrestricted by progesterone, ongoing estrogen exposure may cause the endometrium (lining of the uterus) to become extremely thick. This can lead to heavy and/or irregular bleeding (dysfunctional uterine bleeding). Over many years, endometrial hyperplasia (extra cell growth) or cancer may result. These disorders are due to continuous stimulation by high levels of estrogen that are not restricted by progesterone.

Diagnosing PCOS

PCOS may be diagnosed by your medical history and physical examination alone. To confirm the diagnosis and exclude certain other conditions, your doctor may measure your blood hormone levels.

Early Diagnosis

If you have had irregular menstrual periods and/or progressive hirsutism (excess hair growth on face and body) since puberty, you should be evaluated for PCOS. There is a genetic tendency to inherit this syndrome. Early treatment of PCOS may decrease the development of acne and hirsutism.

Long-term Considerations

Women with PCOS, particularly those with insulin resistance, may be at an increased risk for diabetes, heart disease, cholesterol abnormalities and endometrial cancer. If you are diagnosed with PCOS, you and your doctor should discuss the long-term health consequences. You should also discuss any additional testing that should be done.

PCOS Treatment

If you are diagnosed with PCOS, treatment will depend upon your goals. Your main concern may be fertility.  Or you may be more concerned about menstrual cycle regulation, hirsutism or acne. Regardless of your primary goal, PCOS should be treated. It’s important to treat because of the long-term health risks such as heart disease and endometrial cancer.

Weight loss

Obesity is commonly associated with PCOS. Weight loss improves the hormonal condition of many PCOS patients. If you are overweight, ask your doctor to recommend a weight control plan or clinic. Area hospitals and support groups are also helpful. Increasing physical activity is an important step in any weight reduction program.

Hormonal Treatment

Hormonal treatment is frequently successful in temporarily correcting the problems associated with PCOS. If treatment is stopped, however, symptoms usually reappear. If you are not trying to conceive, birth control pills may be your best hormonal treatment. Birth control pills decrease ovarian hormone production and help reverse the effects of excessive androgen levels. However, birth control pills are not recommended if you smoke and are over age 35. If you also have hirsutism, your doctor may prescribe spironolactone, combined with birth control pills.

If you are not concerned with fertility or contraception, and hirsutism is not a problem, there is a good treatment option. You can take progesterone at regular intervals to regulate your menstrual cycles and prevent the endometrial problems associated with excessive estrogen exposure.

(Adapted from “Hirsutism and Polycystic Ovarian Syndrome. A Guide for Patients.” American Society for Reproductive Medicine, 2003).