Polycystic Ovary Syndrome – PCOS

Basics of PCOS Treatment


Polycystic ovary syndrome (PCOS) is a health condition that affects the menstrual cycle and ability to have children. Women with PCOS have high levels of androgens (male hormones), as well as multiple cysts on the ovaries. Around 1 out of every 15 women of childbearing age has PCOS, which is approximately 5 million women in the U.S.


What causes PCOS?

Experts do not fully understand the cause of PCOS, but they believe genetics and other factors play a role. The main problem with this condition is hormonal imbalance, and the ovaries tend to produce excess androgens. High levels of androgen hormones alter egg development, egg release, and ovulation. Women with PCOS also have high insulin levels. The hormone insulin controls the conversion of starches, sugars, and other foods into energy for the body. Too much insulin leads to excessive production of androgen.


What are the symptoms of PCOS?

The symptoms of PCOS vary from person to person. The common symptoms include:

  • Hirsutism – Excessive hair growth on the face and body.
  • Infertility – Inability to ovulate causes problems with infertility.
  • Menstrual irregularity – Includes absence, infrequent, heavy, and/or irregular menstrual periods.
  • Weight gain
  • Acne
  • Ovarian cysts
  • Pelvic pain
  • Thinning hair or baldness


How does PCOS affect fertility?

The ovaries are where eggs develop in individual follicles (fluid-filled sacs). As the eggs mature and grow, fluid builds up. Once the follicle breaks open, at ovulation, the egg is released and the egg migrates up the fallopian tube to the uterus. Fertilization occurs in the fallopian tube for most women. Women with PCOS do not have all the hormones necessary for the egg to fully develop. Because of excess androgens, ovulation does not occur. The follicles often accumulate fluid, which remain as cysts.


How is PCOS diagnosed?

If the fertility specialist suspects PCOS, the workup will include:

  • Medical history – Asking you questions regarding weight changes, menstrual periods, and other symptoms.
  • Physical exam – The fertility doctor will measure your body mass index, waist size, and blood pressure, as well as assess for increased hair growth.
  • Pelvic exam – This is done to assess the ovaries and reproductive tract.
  • Laboratory tests – Androgen and insulin levels are checked, along with glucose (blood sugar).
  • Ultrasound – This test assesses for cysts on the ovaries, as well as checks the thickness of the endometrial linin


How is PCOS treated?

Treatment is aimed at correcting the hormone imbalance so the woman can become pregnant, as well as decreasing the risk for diabetes and heart disease. Treatment involves:


  • Lifestyle modifications – To lose weight, you can limit processed foods, fatty foods, and excess calories. Eat a diet of fruits, vegetables, whole-grain products, and lean meats. To regulate the menstrual cycle, most women need to lose at least 10 percent of total body weight.
  • Birth control – Oral contraceptives are used to reduce androgens, control menstrual cycles, and clear acne.
  • Medications – Metformin can control insulin resistance and prevent diabetes, which in turn, lowers testosterone production. This drug decreases growth of abnormal hair and restores ovulation. Clomid is also used to stimulate ovulation in women with PCOS.
  • Ovarian drilling – This is a surgical procedure performed by laparoscopy. The surgeon makes a small incision below the navel and inserts a small scope into the abdomen. A small needle with electric current is used to destroy a portion of the ovary.