Polycystic Ovarian Syndrome

By J. Ron Eaker, M.D.

I was vegetating recently whimsically considering my next column topic and I decided to take a populist bent and find out what people are interested in. I did what any 21st century computer geek would do and researched what was trending on social media as it applied to women’s health. I was surprised to discover that PCOS or polycystic ovarian syndrome was sitting at the top of searches on the InterWeb. A bit more research stoked my curiosity as I realized that one out of 10 reproductive-age women will experience PCOS sometime in their lifetime. As a practicing gynecologist I see this issue commonly, but honestly didn’t grasp the magnitude of its reach.

Disrupted or Absent Ovulation

PCOS is an umbrella term that encompasses a variety of symptoms that all have one thing in common: they generally arise from an ovulation disorder. Regular ovulation (shooting out an egg from an ovary) results from a delicate balance of hormones that can be disrupted from a variety of sources. Anything that blocks or delays ovulation can set up a cascade of events that leads to many of the symptoms commonly associated with PCOS. These annoyances, irregular periods, unwanted hair growth, weight gain, skin pigmentations and insulin insensitivity, all result from the hormone free-for-all that comes from a lack of ovulation.

There are a number of conditions that may predispose a woman to have ovulation troubles. Because the menstrual cycle is a rather delicate balance of intertwining hormones, any disruption in one may trigger a corresponding imbalance in another. For example, women who suffer from either to much thyroid hormone (hyperthyroid) or to little (hypothyroid) can see a breakdown in the normal period regularity and thus develop many of the symptoms associated with PCOS. Other common causes of ovulation disorders are gaining or losing a significant amount of weight, an elevation in a pituitary hormone called prolactin, stress, other medications, low percent body fat, autoimmune disease and perimenopause. A thorough exam along with some specific blood tests can usually identify any of these common causes, and a significant number of women will have no identifiable cause.

In addition to some of the previously mentioned symptoms, many women with PCOS have difficulty getting pregnant. Going back to the original cause, absent or irregular ovulation, it makes sense that if you don’t produce a viable egg on a regular basis the likelihood of getting pregnant declines rather dramatically. Additional symptoms may arise such as male pattern hair loss, acne and excessively oily skin.  Some women will also experience multiple cysts on their ovaries (thus its name). However, multi-cystic ovaries are not necessary for the diagnosis.

Cause Determines Treatment

The treatment of PCOS is largely dependent on whether an underlying cause can be identified. For example, in women with thyroid disease, correcting the thyroid hormone will often result in more regular ovulation and a resolution of the corresponding symptoms. 

If no specific cause for not ovulating is pinpointed, then treatment is largely dependent on a woman’s current fertility desires. If she wants to become pregnant, then often a physician will prescribe a medication that stimulates ovulation. In addition, some studies indicate that adding a second medicine, traditionally used for diabetics, enhances the rate of ovulation in PCOS patients. This highlights another aspect of PCOS that can have health effects throughout the body. Women with PCOS tend to exhibit insulin resistance and may have a problem with elevated blood sugars. This is similar to the situation experienced by folks suffering from adult-onset diabetes, although the underlying mechanisms may be somewhat different. The end result is a need to monitor blood sugar levels and keep them in a safe range.

If a woman is dealing with PCOS and doesn’t want to get pregnant, one of the best solutions is to suppress the ovaries with a birth control pill. It may seem a bit counterintuitive to use something that blocks ovulation to treat an ovulation disorder, but a pill “balances” the female hormones by taking over for the ovaries, thus counteracting some of the changes that occur when an ovary doesn’t ovulate. In addition, a birth control pill can reduce the effect that excess testosterone has on the body. This elevation in testosterone results from not ovulating regularly and is responsible for many of the symptoms of PCOS (hair growth, acne, weight gain, etc.)

Obviously if an ovulation disorder is secondary to weight gain, a healthy program to lose weight can normalize things. There have been several alternative methods promoted to treat PCOS and underlying ovulation disorders yet many have little more than anecdotal evidence to support their use.

PCOS is a common but treatable disorder and the most critical step in curbing problems is getting properly diagnosed.