Signs/Symptoms
1) Irregular ovulation and thus irregular periods, that are usually more than 40 days apart.
The ovaries are stubborn, and don’t easily respond to the messages from the brain to cause release an egg monthly.
2) Polycystic appearing ovaries on ultrasound. These are multiple small cysts that are not painful.
3) Signs of androgen hormone excess such as acne and excess coarse hair growth.
Facts
It is a common condition affecting 5-15% of women.
Heredity likely plays a role.
Symptoms may present differently for different women.
There is no diagnostic test for PCOS, but lab work and ultrasound may help to decide if PCOS is an issue.
PCOS often involves insulin resistance. The cells of the body do not respond easily to the message from insulin to let sugar from the blood stream into the cells. This results in elevated blood sugar, and puts women with PCOS at risk for diabetes later in life.
Fertility
Due to infrequent ovulation, it may be difficult for women with PCOS to conceive.
When someone with PCOS is having trouble getting pregnant, lifestyle change is often the first thing recommended. This includes weight loss. Even mild weight loss (10-15% of weight) can help the ovaries to start releasing eggs (ovulation). Women with PCOS often do well with limiting simple carbohydrates such as rice, pasta, bread, sweets, and sweet drinks. For exercise a combination of cardiovascular exercise and strength training can be helpful. Building muscle mass can help lower insulin resistance. If lifestyle changes and weight loss are not leading to pregnancy, women with PCOS may benefit from ovulation induction with medications such as clomiphene or letrazole. They may also benefit from lowering insulin resistance with a medication called metformin.
Managing Menstrual Cycles
For women who do not wish to conceive:
Oral contraceptives can provide regular withdrawal bleeding (predictable cycles). Oral contraceptives lower circulating androgen levels, and this can lead to less trouble with acne and unwanted hair growth (hirsutism).
Progestins (progesterone) taken for 7-10 days of every 3rd month with no period can help keep the endometrium thin and healthy. This helps prevent endometrial cancer later in life.
Mirena or Kyleena IUD placed within the endometrial cavity will keep the endometrium thin enough to allow for absent or light periods.
Hair Growth (Hirsutism)
Waxing, shaving, depilatory
Laser hair removal, electrolysis
Oral contraceptives
Spironolactone - oral medication that lowers androgen levels (need to have potassium levels in blood monitored). Can not be taken if pregnancy is planned or possible.
Acne
Oral contraceptives, spironolactone, Differin products, salicylic acid
Resources
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