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eptember is Polycystic Ovarian Syndrome Awareness Month. While this disorder of ovulation is extremely common, affecting 5 to 10 percent of women of childbearing age, many women have not heard of it. While multiple ovarian cysts (polycystic ovaries) can be part of the syndrome, they are actually not its cause, and are not even always present. Despite its name, the central issue in polycystic ovary syndrome, or PCOS, is disordered hormone levels, which tend to be associated with a cluster of particular symptoms: irregular (or absent) menstrual periods, abnormal body hair growth and infertility.
How is polycystic ovarian syndrome diagnosed?
Diagnosing PCOS generally requires two of three criteria: decreased frequency (or absence) of ovulation, evidence of elevated male hormone levels, and/or polycystic ovaries. Other medical conditions involving hormonal disorders need to be excluded in order to confirm a diagnosis of PCOS. Normal ovulation occurs like clockwork: an ovary releases an egg about once per month, at a predictable time, and a menstrual period typically occurs about two weeks thereafter if the egg does not become fertilized. Regular, monthly periods indicate normal, regular ovulation. Ovulating infrequently, or not at all, can cause irregular or absent periods, or frequent, heavy and/or prolonged vaginal bleeding. While disordered ovulation can have other causes, this can be a sign of PCOS. Elevated male hormone (androgen) levels commonly cause increased male-pattern facial and/or body hair. PCOS criteria can be met by these physical findings alone, by labwork showing abnormal levels, or both. Polycystic ovaries are diagnosed by pelvic ultrasound, showing multiple small follicles (which look like tiny cysts) in the ovaries. These follicles are not a risk or problem in themselves but are a sign of the hormonal dysregulation that is PCOS. While it initially obtained its name from this classic appearance of the ovary, PCOS can be diagnosed in women who do not have these cysts. (Ovarian cysts are also very common and usually benign - having just two or three ovarian cysts does not mean that you have PCOS!) Adolescents can develop PCOS, but the diagnosis may not be as straightforward. Recent updated guidance recommends excluding polycystic ovaries from the criteria for adolescents, and stresses that irregular periods are normal within the first year after a girl’s first period.
Why is PCOS a problem?
Infrequent, or absent, ovulation can lead to frustratingly unpredictable bleeding patterns. Frequent or heavy vaginal bleeding can lead to anemia. Also, absent periods in a woman who is not yet SEPTEM BER 2021
menopausal can, over time, be a risk factor for endometrial cancer (cancer of the lining of the uterus). Disordered ovulation also can cause infertility. If a woman is ovulating less frequently, there are fewer chances to become pregnant, and fertile time periods are unpredictable. And if a woman is not ovulating at all, she cannot become pregnant naturally. Elevated androgen levels can also cause acne and unwanted facial and body hair, which can be minimal or can be very significant, and can be distressing to some women. PCOS is also frequently associated with other medical problems, particularly obesity, diabetes, and abnormal lipid/cholesterol levels; these can, in turn, be risk factors for cardiovascular disease.
How is PCOS treated?
For women with polycystic ovary syndrome who are overweight, losing weight is one of the most effective ways to restore normal, regular ovulation and menstrual periods. Restoration of regular cycles may restore normal fertility, as well. In overweight or obese women who are seeking pregnancy, this is a primary recommended treatment, as it also decreases the pregnancy risks associated with obesity. For the woman who is not seeking pregnancy, some hormonal contraceptives can regulate menstrual periods and lower androgen levels, which can decrease acne and stop unwanted hair growth. Women who cannot, or do not want to, take hormonal contraceptives can instead take a hormone called progestin at least every three months to trigger a menstrual period. This reduces the risk of endometrial cancer in women who have infrequent or absent periods. There are also medications which can slow unwanted body and facial hair growth (spironolactone) or help reduce existing hair (topical eflornithine). In some women, metformin may also be beneficial. This is a medication used to treat diabetes, but it can also help improve ovulation and thereby help regulate menstrual periods and may aid with weight loss. It can also have modest benefit in infertility. In women with PCOS who actively desire pregnancy, fertility medications which trigger ovulation are more effective than metformin. If you suspect you may have polycystic ovarian syndrome, talk to your primary care provider, gynecological provider, or endocrinologist. Diagnosis is important in order to watch for, and help avoid, associated conditions like diabetes, cardiovascular disease and endometrial cancer. More information can be found with the American College of Obstetricians and Gynecologists (ACOG) at www.acog.org , the PCOS Awareness Association at www.pcosaa.org/, and PCOS Challenge at www.pcoschallenge.com/. SWM Lisa Sousou is a physician’s assistant at the Centers for Reproductive Health at Oswego County Opportunities, Inc. H E ALTHY AGI N G EDITION
