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Could You Have PCOS?

Polycystic Ovarian Syndrome (PCOS) is one of the most common hormonal disorders in women. It is estimated that 4-12 percent of premenopausal women in the United States have PCOS. Although the cause of PCOS is not known, there does seem to be some genetic link. Many women with PCOS have a family member (mother or sister) with the disorder.

Women with PCOS are at increased risk for several serious health conditions. More than 50 percent of women with PCOS will develop pre-diabetes or diabetes before the age of 40. The risk of heart attack is 4 to 7 times higher compared to women of the same age without PCOS.

Women with PCOS are also at increased risk for high blood pressure, high cholesterol, sleep apnea, anxiety and depression. Symptoms of PCOS may include infertility, infrequent menses, excessive hair growth, dark patches of skin, multiple ovarian cysts, obesity, male pattern baldness, insulin resistance, and sleep apnea. Women with PCOS may have a pearshaped appearance.

Diagnosis of PCOS is made through blood tests, ultrasound, and physical examination. Women who think they may have PCOS should talk to their OB/GYN. Although there is no cure for PCOS, there are ways to treat the symptoms.

PCOS can affect a woman’s menstrual cycle and her ability to have children. Although all women make androgens (male hormones such as testosterone) in their ovaries, women with PCOS make excessive amounts of androgens. Higher androgen levels cause problems with the development and release of eggs during ovulation.

Women with PCOS tend to be overweight. Lifestyle changes can go a long way in treating the symptoms of PCOS. Eating a healthy diet of fruits, vegetables and lean meats, while avoiding processed, high sugar foods and drinks are important. Exercising for at least one hour, three to four times per week can help weight loss. Even a 10 percent loss in body weight can help to restore regular ovulation. Reaching a healthy weight before attempting pregnancy may help prevent complications during pregnancy.

Women with PCOS may not ovulate on a regular basis, resulting in difficulty getting pregnant. In fact, PCOS is the number one cause of female infertility. Women with PCOS should consider seeing a REI (reproductive endocrinology and infertility) specialist when trying to get pregnant. The REI will be able to determine if there are other causes of infertility before treatment begins.

Treatment for infertility is ovulation induction, which helps the ovaries make and release eggs. The most common medication used is clomiphene citrate (Clomid). Clomid is a pill taken early in a women’s menstrual cycle. Other types of treatmentstreatments may include injectable fertility medications and invitro- fertilization. Pregnant patients are at a higher risk for miscarriage, gestational diabetes, gestational high blood pressure, and premature delivery.

Cycle regulation is important for women with PCOS who are not attempting pregnancy. Going long periods of time without a period can increase a women’s risk of developing cancer in the uterus. Birth control pills may be given to decrease androgen levels, improve acne, and decrease the risk of endometrial cancer. Sometimes other medications that decrease the amount of androgens produced by the body are used along with birth control pills. It is important for patients to realize that these types of medications should not be used in women attempting pregnancy.

About 40 percent of the women with PCOS have insulin resistance. This is typically diagnosed with a simple blood test. High insulin levels increase androgen production in the ovaries. Treatment to lower insulin levels may include medication, diet and exercise. Some women with insulin resistance may begin to ovulate on their own once insulin levels reach a normal level.

When other therapies are unsuccessful, women with PCOS may consider surgery. During the surgery, the ovaries are entered with a needle carrying an electrical current that is meant to destroy a small piece of the ovary in an attempt to help decrease androgen levels and restore ovulation. It is important to discuss surgical risks with your physician prior to surgery.

Experts agree that the best way to treat PCOS and prevent complications is to treat all of the symptoms at the same time. Talk to your OB/GYN about your condition or symptoms you may be experiencing; get regular checkups, including testing for high blood pressure, diabetes and high cholesterol. Exercise regularly, don’t smoke, and eat a healthy diet. If you are having difficulty getting pregnant, see an REI (reproductive endocrinology and infertility) specialist.

WENDY SCHILLIGNS, MD, FACOG

Dr. Schillings is a board certified reproductive endocrinologist, obstetrician and gynecologist. She leads all aspects of patient care at RMAPA. In addition, she formerly led the medical team at RE & I Specialist with the Lehigh Valley Physician Group. Dr. Schillings is chief of the Division of Reproductive Endocrinology and Infertility at Lehigh Valley Hospital Health Network and Clinical Associate Professor of Obstetrics and Gynecology at Penn State College of Medicine.