PCOS In The Reproductive Age Woman

Polycystic Ovary Syndrome (PCOS) affects 1 and 10 women of reproductive age in the U.S. and has a negative impact on a woman's health, appearance, self-esteem and chances of becoming pregnant. It is a common cause of infertility in women.

Women with PCOS are more likely to be overweight and are at an increased risk of metabolic health complications such as high cholesterol, heart disease and diabetes.

What is Polycystic Ovary Syndrome (PCOS)?

• There are 3 criteria for diagnosis but the first two criteria are the most important.
  • Anovulation - Women with PCOS have irregular periods or no period, indicating that an egg is not being ovulated on a regular (predictable) basis each month
  • Hyperandrogenism - Women with PCOS have signs/symptoms that their ovaries are making too much testosterone. However, all women make some ovarian testosterone, but women with PCOS make a little bit too much.
    • Signs/symptoms of high testosterone:
      • Hirsutism - dark coarse hair growing on lips, chin, chest, belly button, buttocks
      • Acne
      • Hair loss, particularly from the crown or top of the head
      • Extra sweating
      • Bloodwork that shows testosterone above normal female range
  • Polycystic” ovaries on ultrasound - Women with PCOS do not ovulate regularly, so their ultrasound will show too many follicles or growing eggs.
• It is also important to exclude other disorders that could cause irregular periods and high testosterone.

What causes PCOS?

• PCOS is a spectrum of disease, symptoms range from mild to severe, depending on the individual patient. Different forms/ severities of PCOS may have different causes. Some causes may be inherited; some may be due to exposure/environment.
• PCOS may be genetic due to in utero exposure, or a family tendency towards insulin and blood sugar problems. Often, other family members will report issues with irregular periods, diabetes, cholesterol issues and cardiovascular disease.
• PCOS may result from years of untreated irregular cycles, which can lead to excess ovarian testosterone secretion. Menstrual cycles may become irregular from weight gain, lifestyle changes or other illness.
• PCOS is complex, and often requires a team of specialists to properly treat.

How is it Diagnosed?

• Menstrual history and physical exam
• Bloodwork
• Ultrasound
• Testing to exclude other disorders that could cause irregular periods and high testosterone.

Why do we care?

• We care for many reasons! We want to take care of the whole patient.
  • Fertility – women with PCOS will need help with ovulating. Often, this is achieved with an oral pill (Clomid, Femara.)
  • Cancer risk – women who do not ovulate regularly are at risk of uterine cancer
  • Body weight – Extra testosterone leads to problems with insulin and blood sugar and “pre diabetes.” This can lead to issues with weight loss, because your muscle and fat cells are not receiving sugar for energy.
  • Cardiovascular Health – In addition to having an increased risk of diabetes and obesity, women with PCOS often have high cholesterol. Without proper evaluation and management, this can lead to heart disease.
  • Cosmetic – In addition to struggling with excess body weight, women with PCOS must control acne and unwanted hair issues. There are medical and non-medical options for cosmetic issues.

How do you cure PCOS?

• There is no cure for PCOS, but it can often be managed until it is unnoticeable. Some women will even ovulate and have regular (predictable) menstrual cycles with weight loss and proper insulin/blood sugar regulation.
• A woman with PCOS will always have a higher risk for irregular cycles, weight gain, cosmetic issues related to high testosterone and cardiovascular problems.

How is it Managed?

• Lifestyle changes are important for every woman with PCOS. Because of the elevated cardiovascular/diabetes risk, women with PCOS will have to be very diligent about nutrition, exercise and weight management.
• Regular monitoring for diabetes, cholesterol issues, thyroid, liver and kidney disease.
  • Diabetes and cholesterol medications may be considered.
• For women who are trying to conceive: an evaluation with a fertility specialist will help to develop a plan for ovulation and pregnancy.
• For women who are not trying to conceive, uterine protection against cancer is essential. This can be achieved with oral contraceptive pills, which also help to control acne and excess hair growth. For women who cannot (or do not want to) take oral contraceptive pills, other options are available (progesterone-only methods, vaginal ring, patch.)
• Cosmetic issues with hair/acne may respond to oral contraceptive pills with/without anti-testosterone medicines.
  • For women who are trying to conceive, anti-testosterone medicines are not safe, so topical treatments and manual hair removal are the best options.

Who should treat a woman with PCOS?

• A multi-disciplinary approach is often the best solution:
  • Primary Care Provider (PCP)
  • General Ob/Gyn
  • Reproductive Endocrinology and Infertility Specialist (REI)
  • Medical Endocrinologist
  • Nutritionist
  • Exercise coach
  • Psychologist/Mental Health Provider

For more information about PCOS and conception, and to schedule an appointment with Dr. KAthryn C. Calhoun or any other of ACRM’s fertility experts, call 678-841-1089 or click here.