Polycystic ovary syndrome (PCOS)

What is PCOS?

Polycystic Ovarian Syndrome (PCOS) is a spectrum of clinical disorders that currently affects up to 8% of reproductive-age females. The condition is associated with increased androgen production from the ovaries and insulin resistance. PCOS can present with a variety of symptoms, but is primarily characterized by ovulatory dysfunction and hyperandrogenism.

What are the signs and symptoms?

When a patient presents with irregular menstrual periods with (or without) signs of acne, obesity and/or hirsutism, clinicians will consider a workup to evaluate for PCOS. Hirsutism is a condition of unwanted, male-pattern hair growth. PCOS is also known to increase risk for another condition, called metabolic syndrome. The main features characterizing metabolic syndrome include high blood pressure, insulin resistance, high cholesterol and obesity.

How is PCOS diagnosed?

Usually, PCOS is diagnosed through an evaluation performed by your OB/GYN provider, who will note any signs of hirsutism, acne and/or menstrual irregularities. Next, laboratory evaluation is used to check for elevated testosterone/androgen levels and imbalanced gonadotropins. Laboratory evaluation is also used to rule out other conditions that can imitate PCOS, including thyroid issues, congenital adrenal hyperplasia and elevated prolactin levels. A pelvic ultrasound can sometimes be utilized when making a diagnosis, as enlarged ovarian volume and/or polycystic appearance of the ovaries might be present. Once the diagnosis is made, additional screening and monitoring for insulin resistance and metabolic syndrome might be warranted.

How is PCOS treated? 

Treatment for PCOS is initiated to reduce both short-term and long-term complications that could arise from this condition. Lifestyle modifications play an important role in PCOS management and some clinicians may consider this the first line treatment for PCOS. This often includes dietary adjustments and adequate exercise. Recent studies have shown that as little as a 5-7 percent reduction in weight can help improve regular menstrual function and decrease risks for cardiovascular complications and insulin resistance seen with metabolic syndrome. If insulin resistance is already present, the use of metformin might be needed to help prevent development of diabetes mellitus.

Medical therapy usually begins with hormones, which might include a skin patch, vaginal ring, IUD, sub-dermal implant or pills. The goal of hormone therapy is to prevent endometrial hyperplasia, which can place a patient at increased risk for endometrial (or uterine) cancer later down the road.

Other treatment options include oral medication and topical creams used to treat the symptoms of acne and hirsutism. Hormone therapy significantly aids in the treatment of these symptoms, including options such as the pill, skin patch and vaginal ring, which are the most effective due to the estrogen component of these options.

Can PCOS cause infertility?

PCOS can increase lifelong risk of infertility due to anovulation. However, with early diagnosis and management, patients might have a higher likelihood of conceiving in the future. Weight loss can be the best strategy for women wishing to conceive because it could help promote regular menstrual function. Some women might also benefit from ovulation induction medications, which have a relatively high success rate in PCOS patients.