Polycystic ovarian syndrome (PCOS)
Polycystic ovarian syndrome is a condition of hormonal imbalance in the female. In this condition the ovaries tend to make more male hormones than usual.
The diagnosis is made when a women has two or more of the following:
- Excess hair growth especially around the face and lower abdomen, and/or acne (hirsutism)
- Excess male hormones measured in blood tests
- Irregular periods due to failure of ovulation
- Characteristic changes within the ovaries on ultrasound – polycystic looking ovaries.
- 11% of women have PCOS.
Doctors are uncertain why PCOs occurs but it does run in families.
Other conditions are associated with PCOs although they are not part of the official diagnosis.
- Insulin resistance – high levels of insulin are needed to maintain normal actions of glucose metabolism, unfortunately these high levels of insulin also increase the production of male hormones and add to the symptoms of excessive hair growth and acne.
- Infertility – due the lack of ovulation
- Weight gain especially around the tummy area
- Pre-diabetes or diabetes
- Abnormal blood fats
- Cardiovascular disease
- Precancerous changes of the uterus and cancer of the uterus (due excess estrogens)
Poor diet and lack of exercise may contribute to the worsening of PCOs especially by increasing the insulin resistance and contributing to the amount of excess male hormones.
Treatment options are individualized, depending on the primary symptoms.
All women will need to have a discussion about diet and weight management. Weight management helps to regulate blood sugar and insulin levels, control the level of male hormones, improve symptoms of excess male hormones and reduce the risk of heart disease and diabetes. In women who are overweight, weight loss can improve menstrual disturbances and trigger ovulation.
Medical management (with the pill or the Mirena intrauterine device) will improve menstrual irregularities, protect the endometrium from uterine cancer and improve hirsutism.
If a pregnancy is desired, your fertility doctor will complete a full history and examination including organizing some more specialized hormone studies. As mentioned above, weight management is usually the first line treatment. Should further treatment be necessary, fertility drugs may induce ovulation. Though rarely needed assisted reproduction is sometimes necessary.