PCOS – Polycystic Ovarian Syndrome
What are the symptoms of PCOS ?
The symptoms of PCOS can vary from woman to woman and may include excessive weight gain, irregular or completely absent periods, ovarian cysts, excessive facial or body hair known as hirsutism, male pattern hair loss, obesity, acne, skin tags, high cholesterol levels, exhaustion or lack of mental alertness, depression, anxiety, decreased sex drive, excess male hormones and infertility.
Q. What tests do I have to do to determine whether I have PCOS ?
The diagnostic criteria are not definitive for PCOS. There are a few tests that help confirm insulin resistance such as a fasting insulin blood test and cholesterol panels [specifically triglycerides]. Testosterone, cortisol and DHEA should also be tested.
A pelvic scan of the ovaries should be done for knowing the number of visible cysts. The non-appearance of cysts does not confirm that one does not have PCOS. Treatment is usually ineffective pharmaceutically and lifestyle and reduced insulin strategies are more effective.
Q. Can surgery treat PCOS?
The removal of ovarian cysts is not an effective way to treat PCOS. Cysts on the ovaries are the result of hormone imbalance that begins with the production of too much insulin. This over-abundance of insulin causes an increase in male hormones, which eventually create the cysts. As a result, removing the cyst does not remove the problem, just a symptom.
Q. How is polycystic ovarian syndrome treated?
Because there is no cure for PCOS, it needs to be managed to prevent problems. Treatment goals are based on your symptoms, whether or not you want to become pregnant and to lower your chances of getting heart disease and diabetes. Many women will need a combination of treatments to meet these goals.
- Birth Control Pills: For women who do not want to be pregnant and still control menstrual cycles, reduce male hormone levels and help clear acne. However symptoms return once the pill is stopped.
- Diabetes medications: Metformin [Glucophage] helps women with PCOS symptoms, it lowers testosterone production, controls blood glucose, abnormal hair growth will slow down, ovulation may return after a few months use, it will also decrease body mass index [BMI] and improve cholesterol levels.
- Fertility medications: Lack of ovulation is usually seen in PCOS. This can be treated with the use of clomiphene citrate. Clomiphene citrate + Metformin is also used for ovulation stimulation. Another option is IVF with Gonadotropins treatment.
- Surgery: Ovarian drilling is a surgery that brings on ovulation. it is used on some women who do not respond to fertility medicines. Laparoscopy is also another option.
- Lifestyle modifications: Many Women with PCOS are overweight or obese. Keeping a healthy weight by eating healthy foods and exercising is another way woman can manage PCOS. Even a 10 percent loss in body weight can restore a normal period and make a women’s cycle more regular.
- Does PCOS put women at risk for other health problems?
Women with PCOS have greater chances of developing several serious, life-threatening diseases, including type 2 diabetes, cardiovascular disease [CVD] and cancer. Getting your symptoms under control at an early stage can help to reduce the above complications.
Q. How are PCOS and infertility related?
PCOS is sometimes associated with infertility. In PCOS, there is an elevated LH reversal of the LH/FSH ratio as LH becomes higher than FSH. The low levels of FSH allow many follicles to develop but without ever maturing even one follicle. Thus, numerous follicles are present in ovaries and once they become ataractic they form cysts, hence the ovaries appear as polycystic. Since the follicles do not mature, they do not release the egg. Hence, lack of ovulation is seen. The most likely cause of infertility is anovulation or lack of ovulation. Ovulation can be induced with ovulation drugs [clomid & metformin], by gonadotropins or correction of insulin resistance. The final option for achieving pregnancy in patients with PCOS related infertility is IVF i.e Invitro Fertilization with Gonadotropins.