What is PCOS and How Can I Deal With It? 

Polycystic ovary syndrome (PCOS), is an endocrine disorder that is a commonly cited cause of infertility in women, affecting one out of every eight women. When a woman suffers from PCOS, her reproductive hormones are abnormal, which often leads to irregular or no ovulation. 
 
Women who suffer from PCOS often have polycystic ovaries, which means they are riddled with a number of tiny, painless and benign cysts.  Ultrasound exams of the tiny cysts resemble a string of pearls. Polycystic ovaries do not always point to PCOS, however. Studies have found that some women have polycystic ovaries, normal ovulation, and no other signs of an endocrine disorder like PCOS.
 
Commonly, PCOS is accompanied by abnormally high levels of androgen hormones. Whereas androgen hormones are found in both men and women, they are considered primarily male hormones. High androgen levels often lead to some of the more visibly distressing symptoms of PCOS, including acne and abnormal hair growth.
 
Symptoms of Polycystic Ovary Syndrome
 
In addition to infertility, the most-cited symptoms of polycystic ovarian syndrome include any or all of the following:
 
•    Irregular or absent ovulation (anovulation)
•    The absence of a monthly menstrual cycle (amenorrhea) or irregular monthly menstrual cycles (oligomenorhhea)
•    Recurrent miscarriage
•    Abnormal hair growth on the upper lip, chin, around the nipples or on the abdomen (hirsutism)
•    Insulin resistance
•    Acne
•    Skin and hair that is more oily than normal
•    Male pattern baldness
•    Obesity (Less common; many women with PCOS remain at a normal weight)
•    The presence of polycystic ovaries during ultrasound examination
•    High levels of androgens (hyperandrogenism)
•    Elevated levels of the hormone LH
 
Not everyone diagnosed with PCOS has every one of these symptoms. In fact, PCOS presents differently with every woman. Many women with PCOS are at a healthy weight and have no abnormal hair growth. Some women with PCOS have normal menstrual cycles. PCOS is usually diagnosed by looking at the larger picture, and by excluding other potential diseases and conditions that can cause similar symptoms. That is why it's vitally important to see your doctor for an accurate diagnosis as soon as you suspect something. 
 
How PCOS Causes Infertility 
 
It is believed that the abnormal hormone levels associated with PCOS lead to ovulation problems, and these problems are the primary cause of infertility. In addition to infertility, PCOS is also associated with a higher risk of early miscarriage, which some research indicating miscarriage rates as high as 20-40 percent, which is more than double the miscarriage rate of the population as a whole. 
 
While it's not entirely clear why miscarriage is more common in women with PCOS, there are a number of theories, including the possibility that PCOS produces poor egg quality, or that the abnormal hormone levels produce an unfavorable environment for an embryo to implant in the uterine lining, or that PCOS causes insulin resistance, which leads to infertility.  
 
Diagnosing PCOS
 
While there is no solid agreement on all criteria used to diagnose PCOS, and its definition has been changed over the years, there are some commonly used diagnostic criteria that most doctors follow. Diagnosis of PCOS currently requires that two out of three of the following must be present:
 
•    Irregular or absent menstrual cycles, caused by chronic anovulation
•    High levels of androgens, which can be confirmed using either blood test confirmation or outward signs (abnormal hair growth or acne) of high levels of androgens
•    The presence of polycystic ovaries, seen during the ultrasound examination
 
In addition, the diagnosing doctor must be able to eliminate other potential causes of anovulation or high androgen levels. In most cases, they will test for a number of other potential problems, including congenital adrenal hyperplasia or androgen secreting tumors, among others. The doctor will also run blood work, to check hormone and blood sugar levels, and they may also order a transvaginal ultrasound to see if the ovaries appear polycystic. 
 
Your doctor will also take a detailed history as part of your PCOS diagnosis. Your doctor will want to know about how regular your menstrual cycles are and they will ask about unwanted hair growth. You may feel embarrassment, but it is important that you answer all of your doctor's questions completely and honestly, to get an accurate diagnosis. 
 
Potential Treatments for PCOS
 

Treatment for PCOS can vary widely, depending on whether you're trying to get pregnant. If pregnancy is not a priority, the doctor may prescribe birth control pills as a way to regulate your cycles and help reduce symptoms like unwanted hair growth and acne.  While some women try to avoid birth control pills because they could harm their fertility, the research has never found that to be the case. 
 
However, it's important to understand that the purpose of the birth control pills isn't to "cure" PCOS. Your cycles may become more regular while on the pill. These are artificially created. Once you stop taking the pill, if your cycles were irregular before, they will likely be irregular again. 
 
If you have any questions regarding PCOS or any other aspect of your vaginal health, please call South Bay Ob/Gyn at 631-203-8893 to schedule an appointment with us today.

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