by Lori L. Arnold, M.D., Scripps Memorial Hospital La Jolla
What do acne, an irregular menstrual cycle, obesity, excess hair growth and infertility have in common? While these diverse symptoms may seem unrelated, they are all potential indicators of a condition known as Polycystic Ovarian Syndrome (PCOS). And it’s much more common than you may think.
PCOS, also known as Stein-Leventhal Syndrome or Polycystic Ovary Disease (PCOD), is a hormone imbalance that upsets the normal process of ovulation. When a woman has PCOS, the ovaries do not produce the hormones necessary for ovulation. Her eggs do not fully mature and may remain as multiple (“poly”) cysts. Because ovulation is not completed, the woman’s body does not produce the hormone progesterone, which is needed for regular menstruation.
In addition to causing irregular menstrual cycles, PCOS can affect weight, skin, insulin levels and a number of other functions and is a leading cause of infertility.
Who Gets PCOS—And Why?
PCOS is believed to affect 3-11 percent of women of childbearing age, and many of those affected aren’t even aware that they have it (or that such a condition exists). We’re not sure what causes it, although the risk seems to be higher in women who have a mother or sister with PCOS.
There may also be a link between PCOS and insulin production. Insulin is a hormone that helps the body use carbohydrates for energy. Women who have a family history of type 2 diabetes, which is related to the body’s inability to use insulin properly, may be more likely to develop PCOS.
PCOS symptoms can vary widely from woman to woman, and may develop suddenly or over time. In addition to ovarian cysts, the most common symptoms include:
- Irregular menstrual periods (or no periods)
- Excess hair on the face and body
- Male-pattern baldness
- Insulin resistance or diabetes
- Weight gain or obesity, especially around the abdomen
Women with PCOS may have a higher risk of other health problems such as diabetes and heart disease. Due to the lack of regular menstrual periods, cancer of the uterus may be another concern. Early control of symptoms can help reduce these risks.
Diagnosis & Treatment
There is no single test to determine whether or not you have PCOS. Several other conditions can be quite similar, so the first step is to make an appointment with your physician. He or she will discuss your symptoms, take a medical history and do a physical examination. If your doctor suspects PCOS, you may also have blood tests to check your hormones and to rule out insulin resistance or diabetes. A vaginal ultrasound exam can reveal whether your ovaries are enlarged by the growth of cysts.
There is no cure for PCOS, but a number of treatments are available to manage your symptoms and prevent complications. If you are concerned about infertility, your doctor may prescribe medication to help stimulate ovulation. If you don’t want to become pregnant, birth control pills can help regulate your menstrual cycle and reduce the levels of male hormones that can cause acne and excess hair growth.
Metformin, a medication used to treat type 2 diabetes, may also help treat PCOS by regulating insulin and the menstrual cycle. It can be taken with fertility medications to reduce the amount of fertility medication required to produce ovulation. In some cases these patients are resistant to medications that induce ovulation, and Metformin can help improve their responsiveness.
Lori L. Arnold, M.D., is a reproductive endocrinologist and infertility specialist with Scripps Memorial Hospital La Jolla. For more information on staying healthy or for physician referral, call 1-800-SCRIPPS (1-800-727-4777).