Polycystic Ovary Syndrome Awareness Month
Article written by Dr Carlo
Polycystic ovary syndrome (PCOS) is a common condition with three main features:
Menstrual cycle problems, such as irregular periods or having no periods (meaning the ovaries do not release eggs)
High levels of "male" hormones – hirsutism (excessive hair growth) or elevated testosterone
Polycystic ovaries – the ovaries contain many fluid-filled sacs (follicles) that surround the eggs.
Being overweight worsens the clinical features of PCOS.
These clinical features include reproductive issues such as irregular menstrual cycles reduced frequency of ovulation, reduced fertility, polycystic ovaries on ultrasound and high levels of male hormones such as testosterone.
The elevated hormone levels can cause unwanted facial or body hair growth and acne.
PCOS is also associated with metabolic features, with risk factors for diabetes and cardiovascular disease including high levels of insulin or insulin resistance and abnormal cholesterol levels.
PCOS affects quality of life and can worsen anxiety and depression either due to its symptoms or due to the diagnosis of a chronic disease.
People with PCOS are more likely to have other health conditions including:
· type 2 diabetes
· hypertension (high blood pressure)
· high cholesterol
· heart disease
· endometrial cancer (cancer of the inner lining of the uterus)
PCOS can also cause anxiety, depression and a negative body image. Some symptoms such as infertility, obesity and unwanted hair growth can lead to social stigma. This can affect other life areas such as family, relationships, work and involvement in the community.
There is no cure for PCOS, but symptoms can be treated.
Treatment
PCOS treatment focuses on managing the things that are concerning you. This could include infertility, hirsutism, acne or obesity. Specific treatment might involve lifestyle changes or medication.
Lifestyle changes
Medications
Combination birth control pills. Pills that contain both estrogen and progestin decrease androgen production and regulate estrogen. Regulating your hormones can lower your risk of endometrial cancer and correct irregular bleeding, excess hair growth and acne.
Progestin therapy. Taking progestin for 10 to 14 days every 1 to 2 months can regulate your periods and protect against endometrial cancer. This progestin therapy doesn't improve androgen levels and won't prevent pregnancy. The progestin-only minipill or progestin-containing intrauterine device is a better choice if you also wish to avoid pregnancy.
To help you ovulate so that you can become pregnant, your health care provider might recommend:
Clomiphene. This oral anti-estrogen medication is taken during the first part of your menstrual cycle.
Letrozole (Femara). This breast cancer treatment can work to stimulate the ovaries.
Metformin. This medicine for type 2 diabetes that you take by mouth improves insulin resistance and lowers insulin levels. If you don't become pregnant using clomiphene, your provider might recommend adding metformin to help you ovulate. If you have prediabetes, metformin can slow the progression to type 2 diabetes and help with weight loss.
Gonadotropins. These hormone medications are given by injection.
If needed, talk with your health care provider about procedures that may help you become pregnant. For example, in vitro fertilization may be an option.
To reduce excessive hair growth or improve acne, your health care provider might recommend:
Birth control pills. These pills decrease androgen production that can cause excessive hair growth and acne.
Spironolactone (Aldactone). This medication blocks the effects of androgen on the skin, including excessive hair growth and acne. Spironolactone can cause birth defects, so effective birth control is needed while taking this medication. This medication isn't recommended if you're pregnant or planning to become pregnant.
Eflornithine (Vaniqa). This cream can slow facial hair growth.
Hair removal. Electrolysis and laser hair removal are two options for removing hair. Electrolysis uses a tiny needle inserted into each hair follicle. The needle sends out a pulse of electric current. The current damages and then destroys the follicle. Laser hair removal is a medical procedure that uses a concentrated beam of light to remove unwanted hair. You might need multiple treatments of electrolysis or laser hair removal. Shaving, plucking or using creams that dissolve unwanted hair may be other options. But these are temporary, and hair may thicken when it grows back.
Acne treatments. Medications, including pills and topical creams or gels, may help improve acne. Talk to your health care provider about options.