POLYCYSTIC OVARIAN SYNDROME

Polycystic ovarian syndrome (PCOS) is an extremely common endocrine disorder. The prevalence of PCOS is conservatively estimated to occur in 5-10% of reproductive-aged women. This disease has been recognized since at least the 1930's. While a clinical diagnosis of PCOS may encompass several distinct subsets of patients, most experts in the field agree that there are some common clinical and laboratory aspects of this common disorder

One common feature of PCOS is increased body weight. Women with PCOS tend to be heavy and have trouble losing weight. One underlying mechanism behind the ovulatory irregularity and the obesity is probably insulin resistance. This means that the cells of women with PCOS do not respond as well to their bodies' own insulin as those of someone without PCOS. This puts women with PCOS at higher risk for developing diabetes during pregnancy or later in life.

Treatment for PCOS depends largely on an individual woman's fertility desires. For those women not desiring immediate pregnancy, there are basically two options to help regulate menstrual cyclicity and prevent endometrial hyperplasia. The most common option is the use of oral contraceptives (birth control pills; BCPs). BCPs will give most women normal bleeding patterns and prevent hyperplasia. Since ovulation can occur unpredictably in women with PCOS, BCPs also provide adequate contraception. The hormones in BCPs will also help reduce acne and facial hair in most patients with PCOS. In women who do not require oral contraception, progesterone given for 10-12 days every 30-60 days will induce a reliable menses.

In women for whom unwanted hair growth is particularly bothersome, significant improvement can be obtained with a combination of medications. As already mentioned, BCPs are extremely useful in this regard. Other medications may include drugs that reduce the secretion of androgen hormones or interfere with their action in the skin and hair cells.

Alternatively, for women with PCOS who desire pregnancy, ovulation induction is often necessary. This involves medical treatment in order to help the ovaries release an egg each month in a reliable fashion. For many women this involves simple and relatively inexpensive oral medication. Others may require more intensive and expensive therapies utilizing injectable medications. For full coverage of ovulation inducing agents go to the section on ovulation drugs.

Finally, there are some new therapeutic options available for women with PCOS. As already mentioned, insulin resistance may represent the underlying problem for a lot of PCOS patients. A relatively new class of drugs that help sensitize the cells to the action of insulin, thereby reducing insulin resistance, has recently been shown to help induce ovulation in women with PCOS who failed previous simple therapies. Certain of these agents may also help women with PCOS to lose weight. Some of the more common drugs are: Metformin (Glucophage) and Actos.  Glucophage is much simpler to administer and is frequently associated with weight loss.  It is a general goal to obtain a weight loss of at least 10%.  Many studies have shown that a weight loss of 10% leads to a 30% pregnancy rate.  Although weight loss is difficult to achieve and the idea of dieting is stressful for almost anyone, we have had much recent success with a variety of approaches.  The first is the Atkins type protein based diet.  This low carbohydrate diet helps to reduce insulin secretion and encourage weight loss.  Other options include the sugar buster diet or formal weight loss systems such as Weight Watchers.  Also please remember the first week of any dietary change is the worst.   If you can hang in there with week one, any diet will seem more natural.

In women who cannot tolerate or don't conceive with oral medications such as Glucophage or Clomid other options are available. These include injectable ovulation medications such as Gonal-F or Follistim. also in vitro fertilization is available with excellent results.

PCOS is a common readily treatable disorder. The challenge is for the doctor to meet the specific needs of the patient during her entire life span.