Polycystic Ovarian Syndrome (PCOS)
Polycystic Ovarian Syndrome (PCOS) is an endocrine (hormonal) disorder that affects 5-10% of all women. PCOS can affect women of all races and ethnic backgrounds. Symptoms most often appear in the teen years, but some women do not have symptoms until they are in their early to mid-20’s. Some of the most frequent symptoms that bring a teen to our clinic may include:
1) Excessive facial or body hair (Hirsutism)
3) Irregular periods
Women with PCOS may have symptoms of acne, hair growth and menstrual problems. At this time there is no cure for PCOS, but there are ways to treat the symptoms and their causes. Every woman with PCOS is unique. Some women may have only a couple of symptoms while others may have more. Many women with PCOS have metabolic syndrome which must be treated. Symptoms can include high blood pressure, high cholesterol, glucose intolerance or diabetes.
Mo menstrual period (amenorrhea) or infrequent periods (oligomenorrhea)- The time between menstrual bleeding can be greater than six weeks, with eight or fewer periods per year. Irregular bleeding may occur. Periods may be lengthy, light, or heavy. Frequent spotting may also occur.
Cystic Ovaries- The sacs on the ovary which normally contain the egg that is released with each menstrual cycle can turn into cysts and no egg is released. Although the condition is called PCOS, only some girls and women with PCOS have cystic ovaries. Most girls and women with PCOS have normal ovaries.
Infertility- Infertility is not being able to get pregnant within six to twelve months of unprotected sex (depending on your age). In the case of PCOS, this is often due to no eggs or few eggs being released from the ovary. Teenagers with PCOS may still get pregnant, so they should not have unprotected sex.
Increased blood levels of androgens (hyperandrogenism)- The hormones testosterone, adrostenedione, and DHEAS are androgens. Making too many of these hormones can cause excess body and facial hair, as well as oily skin. The ovaries and adrenal glands produce these hormones.
Excessive hair growth (hirsutism)- The hair growth mostly occurs on the face, chest, abdomen, back, or toes. This can be a response to the body making too many androgens.
Flaking skin on the scalp (Acne/Oily Skin/Seborrhea)- All of these are a result of the skin making too much oil. This can be in response to the body making too many androgens.
Obesity or Weight Gain- Weight gain tends to occur around the middle, causing an “apple” shaped figure. Weight gain can worsen insulin resistance and heart disease risk factors, such as high cholesterol and high blood pressure.
Insulin Resistance and Hyperinsulinemia - Insulin resistance occurs when the body does not use insulin very well to change sugar from food into energy. The body then has to produce higher than normal levels of insulin (hyperinsulinemia) to try to keep the blood sugars under control.
Abnormal lipids (dyslipidemia)- Lipids are fats in the blood. In PCOS, the bad lipids or cholesterols (LDL & triglycerides) become high and the good one (HDL) becomes low.
High blood pressure (hypertension)- Blood pressure for a young woman should be around 120/80. High blood pressure is a reading of 130/80 or greater. High blood pressure is a risk factor for heart disease.
Dark patches on the skin (Acanthosis Nigricans)- This most often occurs around the neck, but can also occur in the skin creases under the arms, breasts, knuckles, and between the thighs. The patch can feel smooth and ranges in color from tan to dark brown. These skin changes reflect high insulin levels.
The exact cause of PCOS is not known at this time. It is diagnosed based on the symptoms that you have, an exam, and blood tests. Blood tests are done both to rule out other problems and confirm that you have PCOS. These results will also be used to help regulate menstrual cycles. In most cases, a pelvic exam is not done at the first exam and is only done at return visits in certain cases. An ovarian ultrasound may also be done.
Birth control pills (Oral Contraceptives)- Birth control pills contain hormones to make periods regular. They will also decrease the androgens produced by the ovaries and help control symptoms such as increased hair growth and acne. Girls and women with a history of blood clots should not use birth control pills.
Anti-androgen Drugs- These drugs block the effect of the hormones that cause unwanted hair growth (on the body and face) and acne. Spironolactone (Aldactone®) is one of the drugs we often prescribe to decrease acne and facial and body hair growth. This drug may take up to 24 weeks for full results to be seen. This drug cannot be taken during pregnancy.
Insulin Sensitizers- These drugs make the body more sensitive to insulin. This then lowers the amount of insulin produced by the pancreas. Metformin (Glucophage) is the most commonly used drug for this situation. This drug can also help you to lose weight, regulate your cycles, and help improve your cholesterol levels.
Weight Loss - Losing weight can be hard for women with PCOS because of the insulin resistance. Although some drugs can help, a healthy diet and exercise will be crucial for weight loss. Our dietician can help you create a food plan and set goals. Weight loss can also decrease the risks of heart disease and type 2 diabetes.
Excessive Hair Growth- Vaniqa® is a skin cream that can be used along with anti-androgen drugs to help reduce new growth of facial hair. The cream must be used twice a day for 6-8 weeks to see results. Old hair must be removed by plucking, shaving, or waxing. If the cream is not used as prescribed, the hair growth will return. Other methods of hair removal such as electrolysis or laser treatments can work well to achieve more permanent hair removal. These techniques are performed by a licensed dermatologist or plastic surgeon and can be costly.
Long Term Health Risks
Endometrial (lining of the uterus) Cancer - Each month, a lining builds up in the uterus. If a woman does not become pregnant, the lining is shed through menstruation. Women with PCOS do have a monthly build up of the lining, but the lining is not fully shed due to rare or absent periods. This build up of the lining over time can increase the chance of endometrial cancer if it is not treated.
Type 2 Diabetes - Insulin resistance and obesity both increase a woman’s risk of having type 2 diabetes. Women with PCOS who have family members with diabetes appear to be at the highest risk for also getting diabetes. Forty percent of women with PCOS have either diabetes or are not able to process glucose the right way (glucose intolerance or pre-diabetes) by the age of 40.
Heart Disease - Women with PCOS have an increased risk of heart disease. Symptoms such as high blood pressure, high cholesterol, obesity, and hyperinsulinemia increase a woman’s risk of heart disease.
Polycystic Ovarian Syndrome Association, website: http://www.pcosupport.org
- Polycystic Ovarian Syndrome Association, website: http://www.pcosupport.org
- University of Chicago Center for Polycystic Ovarian Syndrome, website: http://centerforpcos.bsd.uchicago.edu
- Center for Young Women’s Health, website: www.youngwomenshealth.org
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 07/01/2013
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