PCOS, Polycystic ovary syndrome is the most common diagnosis when a woman is found to ovulate irregularly.
It affects between 5% and 10% of women of reproductive age. The syndrome is characterized by irregular menstrual patterns, increased facial and body hair, elevated androgens (“male hormones”) in the blood, and infertility. Oftentimes, the ovary has a characteristic appearance at the time of ultrasound. Many small follicles are seen scattered along the periphery of the ovary (“string of pearls” appearance). This sonographic pattern, however, is not required for diagnosis. There are some other conditions that must be excluded when deciding on the diagnosis. An underactive thyroid gland is one example. PCOS is a complex disorder whose root cause is unknown. There is a genetic component as it is more likely to cluster in families. There is wide variation in the number of symptoms a patient may have and the severity of them.
Women with PCOS are more likely to be overweight or obese. Many women with PCOS also exhibit resistance to the action of insulin (hormone produced by the body for energy storage). The body then compensates and increases the production of insulin (leading to “hyperinsulinemia”). These elevated levels of insulin further contribute to the increasing levels of androgens. Lifestyle modifications that lead to weight loss such as an improved diet and increased exercise are the best initial approach. Certain medication may be used in conjunction with that approach. Metformin is a type of diabetes medication that has been shown to be helpful for some patients with PCOS. It improves the way the body uses insulin. Not all patients with PCOS will respond to Metformin and not all will be able to tolerate some common side effects (most often gastrointestinal).
For women with PCOS who desire fertility, ovulation induction medications are often required. Clomiphene citrate (CC) is the most common medication for that purpose. It is available in generic form and has been used safely for many decades. Obese women with PCOS often need higher doses, prolonged treatment, and multiple courses to achieve ovulation with CC. A significant proportion of women with PCOS fail to ovulate on standard dosages of CC and are termed clomiphene resistant. Injectable medications (called gonadotropins) may be added in that case. Use of those injections, however, significantly increases the cost, the frequency of visits, and the risk (for twins and triplets).
Beyond reproduction, PCOS has life-long implications. These patients have increased risk for prediabetes, diabetes, and cardiovascular disease. Obesity will further exacerbate all those outcomes. Fasting lipid profiles and a screen for diabetes should be checked by their healthcare providers.