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Endocrine

PreDiabetes

Polycystic ovary syndrome (PCOS) is a health problem that affects one in 10 women of childbearing age. Women with PCOS have a hormonal imbalance and metabolism problems that may affect their overall health and appearance. PCOS is also a common and treatable cause of infertility

What is PCOS?

Polycystic ovary syndrome (PCOS), also known as polycystic ovarian syndrome, is a common health problem caused by an imbalance of reproductive hormones. The hormonal imbalance creates problems in the ovaries. The ovaries make the egg that is released each month as part of a healthy menstrual cycle. With PCOS, the egg may not develop as it should or it may not be released during ovulation as it should be.

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PCOS can cause missed or irregular menstrual periods. Irregular periods can lead to:

  • Infertility (inability to get pregnant). In fact, PCOS is one of the most common causes of female infertility.

  • Development of cysts (small fluid-filled sacs) in the ovaries

What Causes PCOS?

The exact cause of PCOS is not known. Most experts think that several factors, including genetics, play a role:

  • High levels of androgens. Androgens are sometimes called "male hormones," although all women make small amounts of androgens. Androgens control the development of male traits, such as male-pattern baldness. Women with PCOS have more androgens than normal. Estrogens are also called "female hormones." Higher than normal androgen levels in women can prevent the ovaries from releasing an egg (ovulation) during each menstrual cycle, and can cause extra hair growth and acne, two signs of PCOS.

  • High levels of insulin. Insulin is a hormone that controls how the food you eat is changed into energy. Insulin resistance is when the body's cells do not respond normally to insulin. As a result, your insulin blood levels become higher than normal. Many women with PCOS have insulin resistance, especially those who are overweight or obese, have unhealthy eating habits, do not get enough physical activity, and have a family history of diabetes (usually type 2 diabetes). Over time, insulin resistance can lead to type 2 diabetes.

Symptoms

Some of the symptoms of PCOS include:

  • Irregular menstrual cycle. Women with PCOS may miss periods or have fewer periods (fewer than eight in a year). Or, their periods may come every 21 days or more often. Some women with PCOS stop having menstrual periods.

  • Too much hair on the face, chin, or parts of the body where men usually have hair. This is called "hirsutism." Hirsutism affects up to 70% of women with PCOS.3

  • Acne on the face, chest, and upper back

  • Thinning hair or hair loss on the scalp; male-pattern baldness

  • Weight gain or difficulty losing weight

  • Darkening of skin, particularly along neck creases, in the groin, and underneath breasts

  • Skin tags, which are small excess flaps of skin in the armpits or neck area

Test and Diagnosis

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There is no single test to diagnose PCOS. To help diagnose PCOS and rule out other causes of your symptoms, your doctor may talk to you about your medical history and do a physical exam and different tests:

  • Physical exam. Your doctor will measure your blood pressure, body mass index (BMI), and waist size. He or she will also look at your skin for extra hair on your face, chest or back, acne, or skin discoloration. Your doctor may look for any hair loss or signs of other health conditions (such as an enlarged thyroid gland).

  • Pelvic exam. Your doctor may do a pelvic exam for signs of extra male hormones (for example, an enlarged clitoris) and check to see if your ovaries are enlarged or swollen.

  • Pelvic ultrasound (sonogram). This test uses soundwaves to examine your ovaries for cysts and check the endometrium (lining of the uterus or womb).

  • Blood tests. Blood tests check your androgen hormone levels, sometimes called "male hormones." Your doctor will also check for other hormones related to other common health problems that can be mistaken for PCOS, such as thyroid disease. Your doctor may also test your cholesterol levels and test you for diabetes.

 

Once other conditions are ruled out, you may be diagnosed with PCOS if you have at least two of the following symptoms:5

  • Irregular periods, including periods that come too often, not often enough, or not at all

  • Signs that you have high levels of androgens:

    • Extra hair growth on your face, chin, and body (hirsutism)

    • Acne

    • Thinning of scalp hair

  • Higher than normal blood levels of androgens

  • Multiple cysts on one or both ovaries

Treatment

There is no cure for PCOS, but you can manage the symptoms of PCOS. You and your doctor will work on a treatment plan based on your symptoms, your plans for children, and your risk for long-term health problems such as diabetes and heart disease. Many women will need a combination of treatments, including:

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You can take steps at home to help your PCOS symptoms, including:

  • Losing weight. Healthy eating habits and regular physical activity can help relieve PCOS-related symptoms. Losing weight may help to lower your blood glucose levels, improve the way your body uses insulin, and help your hormones reach normal levels. Even a 10% loss in body weight (for example, a 150-pound woman losing 15 pounds) can help make your menstrual cycle more regular and improve your chances of getting pregnant.3 Learn more about fitness and nutrition.

  • Removing hair. You can try facial hair removal creams, laser hair removal, or electrolysis to remove excess hair. You can find hair removal creams and products at drugstores. Procedures like laser hair removal or electrolysis must be done by a doctor and may not be covered by health insurance.

  • Slowing hair growth. A prescription skin treatment (eflornithine HCl cream) can help slow down the growth rate of new hair in unwanted places.

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The types of medicines that treat PCOS and its symptoms include:

  • Hormonal birth control, including the pill, patch, shot, vaginal ring, and hormone intrauterine device (IUD). For women who don't want to get pregnant, hormonal birth control can:

    • Make your menstrual cycle more regular

    • Lower your risk of endometrial cancer

    • Help improve acne and reduce extra hair on the face and body (Ask your doctor about birth control with both estrogen and progesterone.)

  • Anti-androgen medicines. These medicines block the effect of androgens and can help reduce scalp hair loss, facial and body hair growth, and acne. They are not approved by the Food and Drug Administration (FDA) to treat PCOS symptoms. These medicines can also cause problems during pregnancy.

  • Metformin. Metformin is often used to treat type 2 diabetes and may help some women with PCOS symptoms. It is not approved by the FDA to treat PCOS symptoms. Metformin improves insulin's ability to lower your blood sugar and can lower both insulin and androgen levels. After a few months of use, metformin may help restart ovulation, but it usually has little effect on acne and extra hair on the face or body. Recent research shows that metformin may have other positive effects, including lowering body mass and improving cholesterol levels.

For more information visit diabetes.org or call 1-800-DIABETES

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