BaiBoo

After more than a year of not being able to get pregnant, Pamela finally went to her doctor for help. She was surprised to get a diagnosis of polycystic ovary syndrome, or PCOS. “I knew nothing about it,” she said. “Once I learned more, a lot of things started to make sense, like all the weight I’d gained, the embarrassing body hair, the hit-or-miss periods.”

Many people have never heard of PCOS, but it’s the most common hormone disorder in women of childbearing age. It is also one of the main causes of infertility.

It’s important to get diagnosed and treated if you have PCOS. Left untreated, PCOS raises your risk for type 2 diabetes, high blood pressure, high cholesterol and uterine cancer. Treatment doesn’t cure PCOS, but it can ease your symptoms and lower your risk of serious complications.

What are the symptoms?
PCOS can cause a variety of symptoms. Some common ones include:

• Irregular or missing menstrual periods
• Male-type dark, coarse hair on the face and body (hirsutism)
• Hair thinning or male-pattern baldness
• Acne
• Weight gain, usually around the waist, and trouble losing weight
• Inability to get pregnant (infertility)
• Pelvic pain
• Patches of thickened dark skin on the neck, groin, underarms and skin folds
• Skin tags in the armpits or neck area

Symptoms usually start around puberty, but they may start in adulthood. The symptoms may be mild enough that they aren’t noticed. Infertility is sometimes the first clue to PCOS.

Not all women with PCOS are overweight, but most are. Symptoms are worse in women who are overweight or obese.

What causes PCOS?
The ovaries normally release one egg every month (ovulation). For this to occur it requires the orderly release of a series of different hormones, including estrogen, progesterone and androgens. (Androgens are called male hormones, but women make small amounts of them, too.)

In PCOS, the level of androgens is too high. The eggs develop in small fluid-filled bubbles on the ovaries, but they aren’t released because the hormones are out of balance. This is what causes the multiple ovarian cysts that give the syndrome its name.

Doctors are not sure what causes the hormone imbalances in PCOS, but they may be caused by a buildup of insulin in the blood. This in turn triggers the release of higher than normal levels of androgens.

PCOS seems to run in families, so it may be partly a genetic problem.

How is PCOS diagnosed?
No single test can be used to diagnose PCOS. Your doctor will take your medical history and do a physical exam to look for symptoms of PCOS. You may also have blood tests to check hormone levels, and an ultrasound to check the ovaries for cysts. Other tests may be done to rule out other causes of your symptoms.

Your doctor may diagnose PCOS if you have:

• Irregular periods caused by not ovulating or irregular ovulation
• Elevated androgen levels as shown by blood tests or symptoms such as excess body or facial hair, balding or acne
• No other causes of elevated androgens or irregular periods

How is it treated?
Good diet and exercise habits can help with the symptoms of PCOS, and they are an important first step in treating this problem.

• A healthy diet includes whole grains, beans, fruits, vegetables and lean protein. Eating a few small meals rather than three big ones may help even out blood sugar levels.
• Exercise can help you lose weight and keep it off. It also helps your body use insulin, so it can lower your diabetes risk. Aim for 30 minutes or more a day of activity, such as brisk walking. Talk to your doctor before you start or increase your activity.
• Weight loss is key in treating PCOS. Losing even 5 percent to 10 percent of your weight can help restart ovulation, lessen your symptoms and lower your risk of diabetes. Diet and exercise can help you lose weight.

Your doctor may prescribe medications to help with your symptoms.

• Birth control pills can help regulate your periods and reduce hormone-related symptoms such as acne, hair loss and excess facial and body hair. They won’t be used if you’re trying to get pregnant.
• Anti-androgen medication such as spironolactone may be used along with birth control pills. It can help reduce unwanted hair growth and acne. It should not be taken during pregnancy.
• Metformin, a diabetes medication, can help restore ovulation and control your insulin and blood sugar levels. It’s often used to help increase fertility in PCOS, and it may be used along with infertility drugs for this purpose. It may also help with weight loss.
• Infertility drugs such as clomiphene may help if you’re trying to get pregnant. Gonadotropins may be tried if clomiphene doesn’t work. Losing some weight may help these treatments work better.      (MyOptumHealth,  Dec 2009)