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 DEFINITION: a condition characterized in many patients by "polycystic" ovaries(multiple tiny ovarian cysts), lack of normal ovulation (anovulation) and elevated amount of male hormones(androgens) manifesting in hirsutism(excessive hair growth), often associated with obesity and insulin resistance(affecting about 50% of women with PCOS). High insulin level(insulin resistance) triggers excess male hormone production by the ovaries, interfering with normal egg production and preventing pregnancy. |
Now that you have been diagnosed with polycystic ovary syndrome, you may ask yourself "what does it mean for me?"
Several conditions are associated with this diagnosis, including infertility(as a result of a lack of normal ovulation), bleeding problems, increased facial hair growth(hirsutism) and acne(due to increased male hormone levels), increased risk of uterine and possibly breast cancer and increased risk of obesity. Untreated women with PCOS, especially those with insulin resistance, have three times the risk of diabetes and seven times the risk of heart disease compared with women without PCOS. High insulin levels stimulate cell growth and since cancer cell have increased number of insulin receptors, increased level of insulin may accelerate the growth of cancer cells. High insulin also elevates "bad" cholesterols levels increasing the risk of blockage of arteries and cardiovascular disease. |
| Most patients with this condition present with infrequent or no periods, obesity and increased facial hair or acne. Your physician may perform a vaginal ultrasound which frequently demonstrates enlarged ovaries with multiple tiny cysts around the periphery of the ovary. In addition your physician may order blood tests (FSH, LH, E2, prolactin, TSH, total and free testosterone, DHEAS levels and fasting blood sugar and insulin levels) on the third day of your menstrual cycle. |
| Insulin resistance is increased in women who are overweight and non exercisers. While there is no real good test for insulin resistance, your doctor may order a fasting blood sugar and insulin levels, triglycerides, HDL cholesterol and measure your blood pressure. If two or more tests are abnormal, your doctor may suggest that you are insulin resistant. |
| In young women who do not wish to be, pregnant, treatment most often involves regulation of the menstrual cycle by utilizing oral contraceptive therapy in combination with testosterone blocking agent such as Aldactone if facial hirsutism or acne is also a problem. Your physician may also recommend using an insulin sensitizing agent such as metformin as a first-line therapy. Studies had shown that metformin treatment decreases male hormone levels, reduces weight and can result in spontaneous ovulation in PCOS patients. In addition, anti insulin medications, by lowering blood insulin level, may also lower the risk for heart disease and cancer. |
| WHICH TREATMENT IS RIGHT FOR ME IF I PLAN TO CONCEIVE? |
| 1. interestingly, studies have demonstrated that even only a 5-10% weight-loss can result in lower male hormone levels and resumption of normal ovulation. |
| 2. OVULATION INDUCING DRUGS : these medications can come in oral form (Clomid, Serophene, and Letrozole); the medications work by stimulating the pituitary to release follicle stimulating hormone which in turn stimulate the ovary to produce eggs resulting in ovulation. Most often, 50-100 milligrams of the medication are taken daily for five days. Development of the eggs can be monitored by ultrasound or detected by over-the-counter ovulation predictor tests. Most patients who respond to this treatment will do so with lower dosage although in some patients it may be necessary to increase the daily dose to 150 mg for five days. Patients who do not respond to this therapy are referred to as Clomiphene-resistant. Such patients often require injectable hormones (gonadotropins) to induce ovulation, or may benefit from the addition of insulin sensitizing agent (metformin) to either Clomid or injectable hormone therapy. |
| I SUFFER FROM FACIAL HAIR AND I DO NOT WANT TO CONCEIVE |
Since facial hair is most commonly caused by elevated male hormones, effective therapy is directed towards blocking the male hormone from reaching the hair follicle or by reducing the amount of male hormone in the blood stream; one commonly used androgen-receptor antagonist is spironolactone (Aldactone) given at a daily dose of 100-200 milligrams. Another medication used to treat excessive hair growth is finasteride given at a dose of 5 mg daily. Testosterone blocking medications are often given in combination with oral contraceptives which by themselves suppress ovarian male hormone production and provide contraception. Several months of medical therapy are needed before significant improvement in the symptoms is noted.
Medical therapy is best utilized in conjunction with weight loss and mechanical therapy such as electrolysis and laser for permanent hair removal.
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