September is Polycystic Ovary Syndrome Awareness Month.  Did you know that nearly 15% of women of reproductive age have it?  Some women have not ever even heard about PCOS and there are other women, right now that are being diagnosed with it.  

What is Polycystic Ovary Syndrome?

Polycystic ovarian syndrome (PCOS) is a hormonal imbalance caused by the ovaries that are creating excess male hormones. If you have PCOS, your ovaries are producing an unusual amount of the hormones called androgens. This also causes your reproductive hormones to become imbalanced. The result of having PCOS is that you often experience erratic menstrual cycles, missed periods, and unpredictable ovulation. You may develop small cysts on your ovaries (fluid-filled sacs) due to a lack of ovulation (anovulation). However, despite the name “polycystic,” you do not necessarily need to have cysts on your ovaries to have PCOS.

PCOS is one of the most common causes of infertility in females. Not only can it affect your fertility it can also increase your risk for other health conditions. Your healthcare provider can treat PCOS based on the symptoms you are experiencing.  If you have plans of having children, be sure to discuss this with your healthcare provider to decide what treatment options may be best for you.

Who can get PCOS?

Women can get PCOS at any time after puberty. Often, women are diagnosed in their 20s or 30s when they are trying to get pregnant. You may have a higher chance of getting PCOS if you are overweight or have obesity, or if other people in your family have PCOS.

What are the symptoms of polycystic ovarian syndrome?

Common symptoms:

• Irregular periods – This involves missing periods or not having a period at all. You may also experience heavy bleeding during periods.
• Abnormal hair growth – An excess amount of facial hair and heavy hair growth on the arms, chest, and abdomen. This can affect up to 70% of women with PCOS.
• Acne – PCOS may also cause acne, especially on the back, chest, and face. This type of acne may continue past your teenage years and can be difficult to treat.
• Obesity –  Approximately 80% of women with PCOS are overweight or have obesity, and have difficulty losing weight.
• Darkening of the skin – Dark skin, especially in the folds of your neck, armpits, groin (between the legs), and under the breasts. This is known as acanthosis nigricans.
• Cysts – Small pockets of fluid in your ovaries.
• Skin tags – These are little flaps of extra skin – often found in the armpits or on the neck in women with PCOS.
• Thinning hair – Some experience thinning hair or start to go bald.
• Infertility – PCOS is the most common cause of infertility in females. There is a decreased frequency or lack of ovulation that can result in not being able to conceive.

How is PCOS diagnosed?

Your healthcare provider will be able to diagnose PCOS after an examination. They may also order blood tests or perform an ultrasound to help with this diagnosis.

What to expect during your appointment.  Your healthcare provider may…

• Talk to you about your symptoms and medical history.
• Ask you about your family’s medical history.
• Take your weight and blood pressure.
• Perform a physical exam.  This may include looking for excess facial hair, hair loss, acne, discolored skin, and skin tags.
• Perform a pelvic exam.  Check to see if you have swollen ovaries or other growths in your uterus.
• Order blood tests to check hormone levels and glucose levels.
• Perform a pelvic ultrasound.  This is to look for cysts in your ovaries and check the thickness of the lining of your uterus.

Typically, if you have at least two of the following you could be diagnosed with PCOS:

• Irregular or missed periods. As well as, very heavy bleeding when you do have a period.
• Signs of excess androgen such as acne or excessive hair growth. Along with a blood test confirming excess androgen levels.
• Cysts presenting on one or both ovaries. However, many people don’t develop cysts.

Treatment?

Your symptoms will determine your treatment options along with your medical history and other health conditions.  If you want to get pregnant in the future that will factor into your treatment plan. Treatments often include medications, lifestyle changes, or a combination of both.

If you are not planning on becoming pregnant your treatment options may include:

• Hormonal birth control – Options include birth control pills, patches, shots, a vaginal ring, or an intrauterine device (IUD). Hormonal birth control can help to regulate your menstrual cycle, improve acne and help with excess hair growth.
• Insulin-sensitizing medicine – Metformin works by helping your body process insulin. In some cases, once insulin is controlled, those with PCOS may see improvements in their menstrual cycles.
• Medications to block androgens – Some drugs can block the effect of androgens. This helps control acne or hair growth caused by PCOS. Ask your healthcare provider if this may be right for you.
• Lifestyle changes – If it is a matter of your weight – losing weight and eating a healthy diet can have a positive effect on insulin levels.

If you are planning on becoming pregnant now or in the near future, treatment options may include:

• Drugs to induce ovulation (releasing an egg) – Certain drugs have been proven to induce ovulation in women with PCOS. In this case, those medications include clomiphene and letrozole; they are taken orally, while gonadotropins are given by injection.
• Surgery – There is a surgical procedure called ovarian drilling, that can trigger ovulation by removing tissues in the ovaries that are producing androgen hormones. However, with newer medications available, surgeons now rarely perform this procedure.
• In vitro fertilization (IVF) – In this scenario, your egg is fertilized with your partner’s sperm in a lab and then transferred to your uterus. This is a good option for women with PCOS when medication doesn’t help with ovulation.

It is possible to have PCOS without any symptoms.  Unfortunately, some women do not realize that they have this condition until they try to get pregnant or they start gaining weight for unknown reasons.  

If you think you are experiencing any of these symptoms we discussed, be sure to share this with your healthcare provider.  Also, it is very important to keep up to date with your Well Woman Exams.  Contact us for more information or to schedule an appointment.