This syndrome is considered to be one of the most common hormonal disorders, affecting 5-10% of women depending on the population studied.
It is called a syndrome because it involves a collection of different disorders, signs or symptoms happening at the same time. These issues can appear in the ovaries, causing chronic anovulation (incapacity to ovulate), elevated androgens (male hormones) and can be associated to insulin resistance, which is why PCOS women have higher risks of developing type II diabetes.
In order for a diagnosis of PCOS to be established, we need to identify at least two different symptoms. This is the reason why we have to combine medical history taking (questions like irregularity of menstrual cycle indicating anovulation, acne or presence of abnormally increase facial hair, etc.); blood tests looking for higher levels of male hormones (hyperandrogenemia); and an ultrasound looking for the typically enlarged ovarian structure with multiple small follicles that give name to this disorder (polycystic).
We generally find women complaining of irregular or absent menses, increased weight, increased facial hair (hirsutism), acne (also a sign of increased male hormones), and infertility due to an incapacity to ovulate. We may also find high blood sugar and cholesterol levels.
The lack of ovulation can expose these women to long periods of oestrogenic exposure without progesterone (hormone produced after ovulation). This exposure to oestrogens without progesterone is a risk factor for irregular uterine bleeding and with time precancerous changes in the endometrium (the lining covering the inside of the uterus). This lack of ovulation will, of course, make it difficult for these patients to achieve a pregnancy.
The “metabolic syndrome” is also common amongst this cohert of patients. This syndrome includes being overweight, having high cholesterol, high blood pressure, and insulin resistance/diabetes. The combination of these issues can put patients at higher risks of having heart problems.
As explained before, PCOS is a complexity of issues arising in many areas. Good weight control is essential for reducing most of the risks associated to it. Weight reduction can help these women start ovulating again reducing the difficulties in getting pregnant and also reducing the risks associated with the “metabolic syndrome”.
Infertility is usually treated with ovulation inductors. The most commonly used one is Clomiphene (Clomid), although newer studies are pointing towards a better drug called Letrozol. These are drugs that are taken orally and have good results. When these drugs fail then we have injectable drugs and a wide scope of possibilities to achieve pregnancy. All these drugs should be used by a specialized health care professional as there is a high of multiple pregnancy (twins, triplets) associated with their usage.
As mentioned before, keeping a strict weight regime is paramount for the control of the symptoms and complications of PCOS. Metformin is an insulin sensitizer that can be used to reduce the insulin resistance and the risks of metabolic syndrome.
When fertility is not desired, hormonal treatments are the best choice. The oral contraceptive pill can be used to treat abnormal uterine bleeding as well as excess male hormones and the symptoms associated to them (excess hair, acne). When these don’t work, laser treatment for excess hair is always an option.
PCOS is a very common endocrinological and metabolic disease that can be associated with infertility. As with most common diseases, the treatment options that are open to doctors are vast. Fertility treatments usually enjoy very high pregnancy rates in patients with PCOS so there is no need to allow this diagnosis to frighten you.
If you have further questions, get in touch with us today.
Dr Hans Arce
Medical Director - ReproMed Ireland