Polycystic Ovarian Syndrome (PCOS)

Polycystic ovarian syndrome (PCOS) is a common hormonal disorder that is poorly understood and clinically characterized by the following symptoms:

• Irregular menstrual cycles
• Lack of regular ovulation
• Abnormal facial hair growth
• Acne
• Infertility
• Polycystic ovaries (enlarged, cystic ovaries)

PCOS occurs in approximately 6% of women and is the clinical result of ovarian tissue over-producing male hormones, particularly testosterone. In a 1998 study of teenagers with menstrual disorders, 24% of those with irregular cycles and 44% with oligomenorrhea had PCOS.

PCOS Symptoms

In PCOS, increased male hormone production produces high LH levels and low FSH levels (hormones secreted from the pituitary). These altered hormone concentrations only allow egg development to an immature stage and therefore polycystic ovaries develop with immature eggs and ovulation does not occur. Without ovulation, the follicles swell with fluid and form very small cysts several millimeters in size. Every time an egg is trapped within the follicle, another cyst forms, so the ovary swells, sometimes reaching the size of a large orange. Without ovulation, progesterone is no longer produced, whereas estrogen levels remain normal.

The elevated male hormone levels (hyperandrogenism) can cause obesity, facial hair, and acne, although not all women with PCOS have such symptoms. Other male characteristics, such as deepening voice and clitoral enlargement, are rare.

PCOS and Insulin Resistance

Recent evidence indicates that PCOS is a metabolic disorder characterized by insulin resistance and a compensatory elevated insulin level, which are found in both the overweight and non-overweight women with the syndrome. High insulin resistance is also associated with type 2 diabetes, in which insulin levels are normal or high but the body cannot use this hormone efficiently. About half of all PCOS patients will develop diabetes in their lifetime.

Treatment of PCOS

Infertility due to PCOS is due to lack of ovulation. Based upon the new understanding of insulin resistance, PCOS medications which lower insulin levels are typically used in combination with ovulation induction medications such as letrozole and/or injectable gonadotropins. Together, the medications help with ovulation along with intrauterine insemination to insure appropriate timing dramatically improve your chances of conception.