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Polycystic ovary syndrome (PCOS) is a condition that causes irregular menstrual periods due to issue with monthly ovulation. This may result in elevation levels of androgens (male hormones) in women. The condition occurs in approximately 5 to 10 percent of women.
The elevated androgen levels can sometimes cause excessive facial hair growth, acne, and/or male-pattern scalp hair thinning. Many young women with PCOS struggle with their weight, and they are at higher-than-average risk of developing diabetes and obstructive sleep apnea. Although PCOS is not completely reversible, there are several treatments that can minimize its symptoms. With some attention, women with PCOS are able to lead normal lives.
While the changes of puberty itself mimic PCOS, we maintain a high index of suspicion in adolescent girls who are referred for irregular menses. When they are also found to have excess hair, obesity or persistent acne, in the absence of other causes, we will look for laboratory and sonographic finding of PCOS. The cause of polycystic ovary syndrome isn't well understood, but is thought to involve a combination of genetic and environmental factors.
PCOS is extremely common, affecting women of all races and ethnic backgrounds. It is the most common endocrinopathy in young woman, found in 10% of our patients. Symptoms most often appear in the teen years, but some women do not have symptoms until they are in their early to mid-20’s. Because hormonal changes vary from one woman to another, patients with PCOS may have mild to severe acne, facial hair growth, or scalp hair loss.
How is PCOS treated? The most common treatment is to take birth control pills. But there are other treatments than can help with symptoms, too.
- Birth control pills – This is the main treatment for PCOS. The pills don't cure the condition. But they can improve many of its symptoms, like irregular periods, acne, and facial hair. Birth control pills also lower your risk of cancer of the uterus.
- Anti-androgens – These medicines block hormones that cause some symptoms like acne and facial hair growth. spironolactone is the one that many doctors use.
- Progestin – This hormone can make periods regular, if you take it regularly. It also lowers the risk of cancer of the uterus. Most doctors use medroxyprogesterone or natural progesterone.
- Metformin – This medicine can help make your periods more regular. But it works only in about half of the people who try it. When used in people with diabetes, this medicine helps to lower blood sugar levels.
- Medicated skin lotion or antibiotics to treat acne.
- Laser therapy or electrolysis to remove extra hair.
Is there anything I can do on my own to treat the condition? Yes. If you are overweight or obese, losing weight can improve many of your symptoms. Losing just 5 percent of your body weight can help a lot. As an example, for a person who weighs 200 pounds, this would mean 10 pounds of weight loss.
Future Risks Facing PCOS Patients
In addition to the cosmetic problems of PCOS, it is associated with an increased future risk of:
- high cholesterol
- insulin resistance and diabetes
- central obesity
- endometrial cancer
- fertility problems
- metabolic syndrome
- possible cardiovascular disease
- sleep apnea
Some studies have shown women with irregular menstrual cycles are more likely to develop coronary artery disease at younger ages than women with regular cycles, even if the women were not identified as having PCOS.
- There is no single test for diagnosing PCOS. It is often a clinical diagnosis based on history of infrequent menses with no other cause, in the setting of a young woman with excess hair growth and/or acne.
- You may be diagnosed with PCOS based upon your symptoms, menstrual history,blood tests and pelvic sonogram.
- Blood tests are usually recommended to determine if another condition is the cause of your signs and/or symptoms. Tests for pregnancy, prolactin level, thyroid stimulating hormone (TSH), and follicle stimulating hormone (FSH) may be recommended.
- Diabetes & cholesterol screen: If PCOS is confirmed, a screening test for diabetes (2-hour glucose tolerance test) and cholesterol testing are usually performed at some point in the first 1-2 years after diagnosis.
- In women with moderate to severe hirsutism (excess hair growth), or acne, blood tests for other androgens may also be done.
All women who are diagnosed with PCOS should be monitored by a central physician (typically their gynecologist or endocrinologist) overseeing their syndrome over time.
Symptoms of PCOS may be minor and annoying and treatment may seem unnecessary. However, untreated PCOS can increase a woman's risk of serious, preventable, chronic health problems over time.
Weight Management Tips:
- We always recommend newly-diagnosed PCOS patients meet with a dedicated nutritionist to help guide her toward a healthy future.
- Choose nutritious, high-fiber carbohydrates instead of sugary or refined carbohydrates
- Balance carbohydrates with protein and healthy fats
- Eat small meals & snacks through the day instead of large meals
- Exercise regularly to help manage insulin levels and your weight
- Weight loss surgery may be an option for severely obese women with PCOS. Significant amounts of weight can be lost after surgery, which can restore normal menstrual cycles, reduce high androgen levels and hirsutism, and reduce the risk of type 2 diabetes.
- However, the side effects of the procedure must be carefully considered against the effort to lose weight.
Susan Malley, MD
Adolescent & Adult Gynecology
Northern Medical Group
Relocating to Carmel for now
Televisits now available
664 Stoneleigh Avenue, suite 100
Putnam Hospital Center
Carmel, New York 10512
"Courage doesn't always roar. Sometimes courage is the little voice at the end of the day that says I'll try again tomorrow." MA Radmacher