What is PCOS ?(Polycystic Ovarian Syndrome)

Polycystic ovary syndrome (PCOS) is a reproductive endocrine disorder that affects approximately 5-10% of reproductive age women. While years of research have been conducted to try to determine the etiology of this syndrome, it continues to remain an enigma. To our best knowledge right now, PCOS may have a multifactorial etiology involving genetics, environmental factors as well as fetal and childhood exposures. While PCOS can have a wide spectrum of manifestations and symptoms, the common denominators are menstrual irregularity, increased male hormone actions, insulin resistance and a characteristic appearance of the ovaries on sonogram. While many women with PCOS are obese – and this may exacerbate the symptomatology – thin women can have PCOS as well.

What are the impacts of PCOS on fertility? Many women with PCOS suffer from infertility due to the chronic lack of ovulation. If a woman is not having regular periods then it can be assumed that she is not ovulating on a regular basis. There can be many causes for this and it is important to exclude other causes such as thyroid or pituitary issues before making the diagnosis of PCOS as the cause of the irregular periods. Due to the chronic anovulation, intercourse can be difficult to time and pregnancy hard to achieve. Treatment for infertility due to anovulation involves the use of medications such as clomiphene citrate(“clomid”) which help induce ovulation. Most pregnancies achieved with clomid occur within 3-4 ovulatory cycles. If you are not successful by that time then it would be prudent to seek care from a reproductive endocrinologist. If you are already seeing one, then it makes sense to move on to more aggressive treatment modalities. Not all women will respond to clomid, even at the higher doses, such as 200-250 mg. For these women, treatment options involve injections of the hormone FSH which help induce ovulation. The biggest “side effect” of treatment is multiple gestation. The risk of twins is estimated to be about 5-8% with clomid and 15-20% with injectables.

What are the long term impacts of PCOS? Since PCOS is an endocrine disorder associated with resistance to the action of insulin in the body, there can be long term metabolic impacts on the development of disorders such as diabetes and coronary artery disease. It is important for women with PCOS to have testing for glucose and lipid levels at least once every two years. This is done by checking a 2 hour glucose tolerance test and a fasting lipid panel. Often women with glucose intolerance can benefit from medications such as metformin which help improve the action of insulin in the body . The development of the “metabolic syndrome”, which involves high triglyceride levels, abnormal glucose levels, hypertension, and an increased waist to hip ratio, can have significant cardiovascular impact and is therefore important to look for. Maintaining a healthy diet and weight is very important to slow or prevent the onset of type 2 diabetes, lipid disorders, metabolic syndrome and ultimately coronary artery disease.

Another important aspect of chronic anovulation is its effect on the endometrium, which is the lining of the uterus. If a woman goes for long periods of time without having menses, then she can be prone to developing hyperplasia (precancerous abnormal growth) of the endometrium. This significantly raises her risk of developing endometrial cancer. For this reason, it is important to protect the endometrium either by using a progesterone containing contraceptive or by inducing a period every couple of months by taking a course of Provera or other such progesterone.

Ultimately, while PCOS is a disorder that has no definitive cure, many of its manifestations can be controlled with the right lifestyle modifications, medications and of course fertility treatments in those desiring pregnancy.