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Irregular Periods? It Might Be Polycystic Ovary Syndrome (PCOS) |
Polycystic ovary syndrome (PCOS) is the most common hormonal disorder
in women, affecting 5-10% of the female population. It is characterized
by irregular menstrual periods and infertility due to a lack of
ovulation (release of an egg), and by signs of excess male hormones
overproduced by the ovaries. Unwanted facial hair is sometimes a sign of
excess male hormones. The symptoms usually start in adolescence, but
can appear in her 20’s or 30’s. Many patients with PCOS are overweight.
The ovaries are usually enlarged and contain multiple small cysts seen
on an ultrasound exam. The small cysts are actually follicles (the small
fluid sacs that house the eggs) that have not grown large enough to
release their egg.
The actual cause of PCOS is unknown. It appears that women are
genetically prone to this disorder. Female relatives of a patient with
PCOS have a 50% chance of having it themselves. Certain lifestyle
factors such as a high calorie, high carbohydrate diet and inadequate
exercise may worsen many of the symptoms. PCOS causes a woman not to
ovulate reliably. By not ripening an egg fully, her body fails to make
an important female hormone, progesterone. Progesterone protects the
uterine lining from overgrowth and from potentially cancerous changes.
A woman with PCOS is not necessarily going to exhibit all of the
aspects of the syndrome. Some may be lean and others may not have any
unwanted hair growth. The treatment for a woman with PCOS is directed
toward alleviating her particular symptoms and limiting their risk for
developing cancer of the uterus. The most common treatment for irregular
periods is the birth control pill. “The pill” provides both estrogen
and progesterone to regulate the menstrual periods and to protect the
lining of the uterus from getting too thick. This effect allows for
lighter periods and a reduced risk of cancerous changes to the lining.
Another hormonal option is to give progesterone alone for 10-12 days
each month, though this option doesn’t prevent unintended pregnancies.
The polycystic ovary makes more testosterone than usual. High
testosterone levels can lead to excess facial hair and acne. One
effective treatment is the birth control pill, which lowers testosterone
levels so as to slow the formation of new thick hair follicles and
lessen acne. It takes several months to see the improvement. Other
medicines that block testosterone production such as spironolactone
(Aldactone) can be prescribed. A prescription facial cream called Vaniqa
is also available to help slow facial hair growth. Electrolysis and
laser hair removal can also be used to temporarily remove the hair, once
the testosterone levels are suppressed.
Many women with PCOS are relatively resistant to their own body’s
insulin. The resulting high levels of insulin promote the storage of
fat, making it hard to lose weight. A vicious cycle is created because
overweight women make even more insulin and become even more resistant
to it. Women with PCOS, particularly those who are overweight, are at an
increased risk of diabetes and benefit most from losing weight.
Changing her diet and exercising more are the usual recommendations for
such a woman to lessen her symptoms and lessen her risks. Medications
can be tried to possibly help control insulin and help with weight loss.
One such medication is metformin (Glucophage), which can result in more
regular menstrual cycles, ovulation, and pregnancy.
Infertility problems occur with PCOS because of the lack of
ovulation. The most common treatment for inducing ovulation is to give
the fertility pill clomiphene citrate (Clomid,). Eighty percent of
patients will ovulate and half of those who ovulate will ultimately
conceive within several attempts. There is a modest increase in the risk
of having twins (7%) with clomiphene. Some patients do not respond to
clomiphene and may require other therapies. One option is metformin to
help the ovaries ovulate. Another option is to use fertility shots that
contain follicle stimulating hormone (FSH). These shots directly
stimulate the ovaries, but must be used with care because patients with
PCOS can have an excessive response to these medicines and make too many
eggs, increasing the risk of multiple pregnancies including the
possibility of triplets or higher-order pregnancies. Therefore, these
medicines must be monitored carefully by a trained Fertility Specialist
(Reproductive Endocrinologist). Some patients will benefit from in Vitro
Fertilization (IVF), where eggs are removed from the ovaries after
stimulation with fertility shots and then introduced to sperm in a
laboratory dish to create embryos. One or more embryos then can be
placed into the uterus. Any remaining embryos can be frozen, if desired,
to limit the risk if higher order multiple pregnancies (triplets or
more) and for use in future fertility attempts.
In summary, there is hope for women affected by this common syndrome
called PCOS to regulate their periods or to conceive a baby.
For more information, please call South Jersey Fertility Center at
(856) 596-2233 or visit www.sjfert.com.
