By Jennifer Kulp Makarov, MD
Published in Resolve for the journey and beyond, Winter 2011
Polycystic ovary syndrome (PCOS) is a very common disorder that many women first learn about while seeking the cause of their infertility. PCOS affects 5-10% of women of reproductive age, making it one of the most common hormonal disorders in this age group. The exact cause of PCOS is not known. It is likely that a combination of factors leads to the development of PCOS. PCOS is thought to be a genetic trait and may run in families. Environmental factors such as the diet that one consumes are also thought to play a role in the development of PCOS.
Women with PCOS have three characteristic symptoms. Women are diagnosed with PCOS when they have at least two of these three symptoms:
Women with PCOS may have irregular periods. They may have only 6 to 8 periods per year. They may get their period every month for a few months and then skip a month or two or they may go many months without having a period. Many women with PCOS will have infertility associated with their irregular menses. Also, when women with PCOS do become pregnant, they have an increased rate of miscarriage.
Another common symptom of PCOS is acne or oily skin. Acne may occur over the face but may also be found over the back or chest. This is due to relatively higher levels of testosterone circulating in the bloodstream. Testosterone is a hormone that is found in much higher levels in men. Women with PCOS do not have male levels of testosterone but the levels of testosterone may be higher than expected for females. These higher levels of circulating testosterone can also cause excess facial hair on the chin or upper lip or excess hair growth on the chest and abdomen. The hormone imbalances seen in PCOS can also cause a type of hair thinning which occurs at the front of the scalp. Sometimes blood tests can show excess levels of testosterone in women with PCOS but other times they do not.
The third common feature of PCOS is what is called polycystic ovaries. This can be seen on a transvaginal ultrasound. This is actually a misnomer as the ovaries of women are not really full of cysts but rather ovarian follicles that each contains an egg. All women have these follicles in their ovaries and each month a group of follicles start to develop, with one going on to be the dominant follicle that ovulates the egg. The ovaries of women with PCOS may contain many small follicles that do not go on to ovulate an egg each month. These follicles fail to develop normally because of the hormonal imbalances in PCOS. Because the ovaries do not grow and ovulate an egg each month, women with PCOS may also experience difficulty getting pregnant.
Obesity is also common in women with PCOS. Up to 50-60% of women with PCOS are obese. Symptoms of PCOS such as those described above can be worsened by obesity. The hormonal imbalances found in women with PCOS may cause them to be more likely to gain weight and become obese. Women with PCOS are also prone to developing insulin resistance in which the body produces excess amounts of insulin. This is thought to be a precursor to Type II diabetes. Women with PCOS are at greater risk of developing diabetes and therefore all women with PCOS should be screened for insulin resistance.
There are treatments available for women with PCOS. These treatments do not cure the disease but rather help improve the symptoms of PCOS. For women with PCOS who are obese, diet and exercise to maintain a normal body weight may alleviate many of the symptoms of PCOS. In fact, for obese women, losing even 5-10% of body weight may help. Oral contraceptive pills are often given to correct some of the hormonal imbalances found in PCOS and can help decrease acne and excess hair growth as well as regulate menstrual cycles. Acne can also be treated with topical ointments or antibiotic creams. Women with excess hair growth often find laser electrolysis helpful. Metformin is an oral medication that may be prescribed to women with PCOS who are insulin resistant.
Women who are having difficulties conceiving may take a medication called clomiphene citrate or clomid to help them ovulate regularly. In women with PCOS who take clomid, about 80% will ovulate in response to the medication and 30-40% will become pregnant. About half of women will ovulate when taking one pill a day (50 mg) on cycle days five through nine. The other 50% of women do not ovulate on this dose of clomid and may need a higher dose or another medication. Using clomid increases your chances of having a multiple pregnancy to 8-13%, with twins being the most common. If pregnancy does not occur after six cycles of clomid use, further evaluation or a change in therapy is recommended.
If you think you may be experiencing any or all of the symptoms of PCOS, it is important to see a doctor for diagnosis and treatment.
Dr. Jennifer Kulp Makarov practices at Genesis Fertility & Reproductive Medicine, both at Genesis’ main office as well as their new office, in Park Slope, Brooklyn, New York. Dr. Makarov graduated from Tufts University with a degree in Biology, earning her medical degree from the UMDNJ-Robert Wood Johnson Medical School. She completed her Obstetrics and Gynecology residency at Johns Hopkins University School of Medicine and her fellowship training in Reproductive Endocrinology and Infertility at Yale University School of Medicine. Dr. Makarov has a special interest in the care of patients with PCOS, those in need of PGD to prevent transmission of genetic disease and women desiring fertility preservation.