By Dr. Jose Pliego
While no one knows the exact cause of polycystic ovary syndrome (PCOS), an estimated 5 to 10 percent of women of childbearing age have it.
In women with PCOS, the ovary doesn’t make all of the hormones it needs for any of the eggs produced to fully mature. They may start to grow and accumulate fluid, but no one egg becomes dominant. Instead, some may remain as cysts.
Since no egg matures or is released, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman’s menstrual cycle is irregular or absent.
Also, the cysts produce male hormones, which continue to prevent ovulation and can lead to acne, excessive hair growth and weight gain.
An estimated 5 to 10 percent of women of childbearing age have PCOS.
Cause of PCOS
The cause of PCOS is not completely understood. It is likely that a genetics tendency is involved. Women with PCOS can have a wide spectrum of signs and symptoms from very mild to severe. They may include:
- Irregular or absent menstrual periods
- Heavy vaginal bleeding
- Oily skin and acne
- Acanthosis nigricans (darkening and thickening of certain areas of the skin, especially in skin folds)
- Excessive hair growth on the face, chest, abdomen or thighs
- Thinning of hair on the crown of the head
- Type 2 diabetes
- Obesity
- Cardiovascular problems, including high cholesterol
- Multiple tiny ovarian cysts; some women with PCOS have a large number of tiny follicle cysts (visible by ultrasound) on their ovaries
Diagnosis
The diagnosis of PCOS is made based on physical signs and symptoms. Blood tests can be used to confirm the diagnosis and direct management. Treatment depends on the particular patient’s signs and symptoms, as well as her goals. Treatment options include:
- For women who are not ready to become pregnant, birth control pills are an excellent way to replace progesterone, establish regular periods and lower androgen levels.
- If a woman wants to become pregnant, treatment is aimed at establishing regular ovulation.
- For women with PCOS and insulin resistance, medication to improve insulin sensitivity may be useful.
Treatment
Because there is no cure for PCOS, it needs to be properly managed by a physician. Treatments are based on the symptoms each patient has and whether she wants to conceive or needs contraception. Some of these treatments are as follows:
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- Birth control pills can help regulate the menstrual cycle and prevent endometrial problems.
- Diabetes medications can decrease the testosterone production, causing abnormal hair growth to slow down and ovulation to return.
- Medicine for increased hair growth or extra male hormones. If a woman is not trying to get pregnant, there are some other medicines that may reduce hair growth. Spironolactone is a blood pressure medicine that has been shown to decrease the male hormone’s effect on hair. Propecia, a medicine taken by men for hair loss, is another medication that blocks this effect. Both of these medicines can affect the development of a male fetus and should not be taken if pregnancy is possible. Other non-medical treatments such as electrolysis or laser hair removal are effective at getting rid of hair. A woman with PCOS can also take hormonal treatment to keep new hair from growing.
- Surgery. Although it is not recommended as the first course of treatment, surgery called ovarian drilling is available to induce ovulation. This surgery can temporarily lower male hormone levels and help with ovulation.
- A healthy weight will help the body lower glucose levels and use insulin more efficiently, and it may help restore a normal period.
While PCOS cannot be prevented or cured, it can be controlled with varying degrees of success and healthy lifestyle choices.
Jose Pliego, M.D., is a reproductive endocrinologist at Scott & White Hospital – Round Rock. For more information, call 512-509-0200.
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