Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age. PCOS causes 75 percent of all cases of anovulatory infertility. Symptoms of PCOS include irregular menstrual cycles, increased amounts of body hair, a tendency to gain weight easily, and difficulty getting pregnant.
Many women with PCOS produce too much insulin and or are found to have insulin resistance. This is one reason why women with PCOS tend to gain weight or have a hard time losing weight. They also have an increased risk of diabetes (a condition in which levels of sugar in the blood are too high), high blood pressure, and heart disease.
To diagnose PCOS, blood tests are taken to determine if you have hormonal irregularities, such as elevated testosterone and insulin blood hormone levels. An ultrasound exam may be done to look for small cysts on the ovary which often occurs with PCOS.
Women with PCOS who don’t want to get pregnant are usually treated with birth control pills or medication, inducing a period each month. This will prevent the development of abnormal cells in the uterine lining, which can occur with irregular menstrual cycles. Clomid® can also help correct some of the hormonal imbalances associated with PCOS.
If a woman with PCOS does want to get pregnant, she is treated with infertility medication that induces ovulation. Metformin (Glucophage) is used in women who are insulin resistant. Clomiphene citrate, or Clomid®, is the most common drug used for PCOS. Another option is injectable medications called gonadotropins. If these treatments fail, IVF is recommended.
If I get pregnant, will PCOS affect my pregnancy?
The rate of early miscarriage is higher in women with PCOS than in women without PCOS — as high as 30 to 40 percent — so your pregnancy will be monitored with blood hormone levels and early ultrasounds. Women with PCOS are also at increased risk of developing gestational diabetes and pregnancy-induced hypertension, so your obstetrician may wish to monitor your pregnancy more closely than usual.
What are the side effects of ovulation induction?
When undergoing ovulation induction, PCOS patients are at increased risk of multiple gestation pregnancy and hyperstimulation as compared to women without PCOS. We try to minimize the risk of multiple gestation pregnancy by using the smallest amount of medication possible in PCOS patients. Hyperstimulation is a side effect of the medication, associated with abdominal bloating, nausea, and discomfort. It is usually treated with hydration and rest. Because of these risks, it is very important that PCOS patients have their cycles monitored when taking fertility medications.
What does it mean if my insulin levels are elevated?
Many PCOS patients are also found to have insulin resistance. Elevated insulin levels can make weight loss very difficult for these patients. It is often associated with acne; excessive hair growth on the face, chest, abdomen and thighs; and thinning of scalp hair. The long-term consequences of untreated high insulin levels include an increased risk of diabetes (up to five times higher than normal), heart disease, endometrial cancer, and (in theory) breast cancer. For this reason, if your insulin levels are elevated, additional medication and a modified diet are prescribed. Finally, insulin resistance has also been shown to increase the “bad” cholesterol (LDL) levels and decrease the “good” cholesterol (HDL) levels. Your doctor may order a fasting lipid profile if this is suspected.
What medications are given for insulin resistance?
Metformin, or Glucophage, is an oral medication that can both facilitate weight loss and allow some patients to ovulate in response to Clomid® treatment, where they previously have been unable to do so. It is usually given two or three times per day. About half of all patients will initially experience diarrhea, bloating, or gas pain when first starting Metformin. These symptoms can be minimized by beginning with a smaller dose, taking the pills with meals, and avoiding meals high in carbohydrates. Avandia or rosiglitazone is another medication that can increase the sensitivity to insulin and also may restore ovulation. Usually, periodic liver function tests are done due to reports of extremely rare cases of liver inflammation.
Why should I follow a special diet? How long will I have to take medication or follow a diet?
It depends. Some women with PCOS and insulin resistance will return to normal hormonal function if they lose weight. Others may need to be treated for long periods of time. The lifetime risk of developing diabetes is five times higher for women with PCOS, so it is advisable to have laboratory testing repeated at least every few years. A diet relatively low in carbohydrate and high in protein usually helps insulin-resistant patients to lose weight and become more responsive to medication. We recommend a diet moderately low in carbohydrates (30 to 40 percent of total calories) and high in protein. Diets very low in carbohydrates can be dangerous and should be avoided. A diet high in fiber (20 to 30 grams per day) will also help to stabilize blood sugar levels and decrease insulin secretion. Finally, weight training has been shown to increase muscle mass and decrease insulin resistance. As little as 30 minutes twice a week can significantly increase muscle mass and lower insulin levels.
How is excessive hair growth treated?
Unwanted dark, thick body hair can be treated medically and/or with various procedures that remove hair. Medications including spironolactone and birth control pills lighten the color and decrease thickness of the hair shaft, and help suppress development of new hair growth. These medications take up to six months to produce noticeable results. For immediate improvement, laser hair removal can be performed. The latest technology provides for painless removal that, depending on the extent of hair removal necessary, is completed in three to six sittings and results in permanent removal of the hair shafts treated in this manner.