Polycystic Ovarian Syndrome (PCOS)
A common cause of irregular periods and infertility
Polycystic Ovarian Syndrome or PCOS affects up to 10% of women of reproductive age and is the most common cause of irregular periods in women. It is important to know about PCOS because it can affect not only your ability to conceive but your general health as well. How do you know if you have PCOS?
Some Common Symptoms of PCOS include:
- Amenorrhea (cessation of period) or infrequent periods (more than 35 days between the start of your cycle)
- Irregular bleeding
- Infrequent or no ovulation
- Increased levels of male hormone, like testosterone
- Increase in weight or obesity (many women with PCOS are overweight)
- Diabetes; over production and inefficient use of insulin by the body
- Lipid abnormalities (high or low cholesterol, high triglycerides)
- High blood pressure
- Excess facial and body hair growth
- Male-pattern baldness or thinning hair
- Acne, oily skin, or dandruff
- Dark-colored patches of thick skin on neck, groin, underarms or ski folds
- Skin tags in the armpits or neck
While there is no single test that will tell you that you have PCOS, women with this syndrome usually have irregular menses from the time they start having periods. Therefore, this is the most common and reliable symptom of PCOS. Irregular menses are classified as cycles that are longer than 35 days from the first day of bleeding to the day before the next bleed, or less than 8 cycles per year.
In response to this common symptom, many women with PCOS are given oral contraceptives to regulate their menses but are not formally diagnosed with PCOS. To obtain a diagnosis, the physician must rule out other possible causes for irregular menses. Usually this involves checking a pregnancy test, checking your thyroid function with a TSH (thyroid stimulating hormone) level, and checking a prolactin level as well. These are all simple blood tests. If your physician suspects PCOS, you may be given medroxyprogesterone acetate (brand name Provera) to see if it will induce a period. This can help differentiate PCOS from other causes of no menses such as ovarian failure and hypothalamic amenorrhea. Women with these conditions have low estrogen levels and usually will not bleed in response to Provera. Women with PCOS will have normal to slightly elevated estrogen levels and will usually have a full period after this medication.
How is PCOS treated? Because PCOS can affect many different aspects of a woman’s health, a multi–pronged treatment plan is often necessary. For women attempting to conceive, the first line of therapy is often clomiphene citrate, a pill that can induce ovulation in 80% of patients with PCOS. For women who do not respond to clomiphene citrate, more advanced treatment with insulin sensitizing agents and/or injectable gonadotropins may be recommended. These more advanced treatments should be monitored by a Reproductive Endocrinologist. While the cause for PCOS is unknown and there is no specific “cure” for this condition, with the proper diagnosis and the help of your physician you can successfully manage your symptoms to live a very healthy life with healthy pregnancies.