Polycystic Ovary Syndrome

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KEY POINTS

• Polycystic ovary syndrome (PCOS) is a hormone disorder that may increase your risk of uterine cancer, diabetes, and heart disease.
• Treatment is important to prevent further problems. The kind of treatment depends on how severe your symptoms are and whether you are trying to get pregnant.
• Make sure you know when you should come back for all of your follow-up appointments. Make sure you have a pelvic exam as often as recommended by your healthcare provider.

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What is polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS) is a hormone disorder. It may cause women to have:

• Too much male hormone
• Problems with ovulation (the release of eggs from the ovaries)
• Small fluid-filled sacs called cysts form in the ovaries

The 2 ovaries are part of the female reproductive system. They produce eggs and the female hormones estrogen and progesterone.

Normally, during your reproductive years, your ovaries release an egg before every period. PCOS keeps your ovaries from releasing eggs and can cause you to have irregular menstrual periods and missed periods. PCOS is most common in women less than 30 years old and can occur in girls as young as 11 years old.

PCOS increases your risk of uterine cancer, diabetes, and heart disease. If you have PCOS, it is important for you to be checked regularly by your healthcare provider and to get treatment to help prevent these problems.

What is the cause?

The exact cause of PCOS is not known. Some of the symptoms of PCOS are caused by the way your body makes and uses male hormones (androgens). Too much male hormone can affect the development and release of eggs during ovulation and can make your periods irregular. It can also make it hard for you to get pregnant.

PCOS also appears to be related to problems with insulin. Insulin is made by the pancreas, which is an organ in your upper belly. Your body uses insulin to help move sugar from the blood into the cells. Many women with PCOS have too much insulin in their bodies because they have problems using insulin. The extra insulin may cause your body to make more male hormone.

Some medicines may cause or worsen the symptoms of PCOS. Be sure to tell your healthcare provider about all of the medicines you are taking, including prescription and nonprescription drugs, supplements, and herbal remedies.

What are the symptoms?

Symptoms may include:

• Changes in your periods, like missed periods or no periods at all, or very light or very heavy bleeding
• Trouble getting pregnant
• More hair on your face, chest, belly, or upper thighs
• Balding in some women
• Obesity
• Oily skin, acne, or other changes in the skin

Many young women with PCOS start having menstrual periods at a normal age. But then, after a few years of regular periods, the periods may get quite irregular and then infrequent.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

• Blood tests
• An ultrasound scan, which uses sound waves to show pictures of the ovaries

Your healthcare provider may measure insulin and blood sugar levels in your blood.

How is it treated?

There is no cure for PCOS, but treatment is important to prevent further problems. The treatment depends on how severe your symptoms are and whether you are trying to get pregnant.

If you are not trying to get pregnant, you may be treated with hormones, usually birth control pills. This treatment can:

• Help make your menstrual cycles more regular
• Help lower your risk for uterine cancer
• Lower the amount of male hormone your body makes

When you take birth control pills, you should start having less unwanted hair growth and acne. Your healthcare provider may prescribe other treatments as well to help with these problems.

If you are trying to get pregnant, your healthcare provider may first recommend losing weight. A next step may be taking fertility drugs, which may be combined with another medicine to help increase your chances of getting pregnant.

Your provider may prescribe diabetes medicine to help keep your insulin at normal levels. The medicine can help you have normal menstrual cycles again and improve your chances of getting pregnant.

In rare cases, you may have surgery to remove a wedge of ovarian tissue. This sometimes results in regular menstrual cycles for at least a while.

If your symptoms are very severe, your healthcare provider may recommend removing both ovaries and taking hormone replacement therapy. If both ovaries are removed, you cannot get pregnant.

Your symptoms may improve with treatment, but there is no cure for PCOS. You may keep having PCOS until your ovaries stop making hormones when you go through menopause. In rare cases some women stop having PCOS after they have a baby.

How can I take care of myself?

Eat a healthy diet and try to keep a healthy weight. This may lessen the symptoms of PCOS.

Exercise regularly. It can help you lose weight. It also helps your body use insulin better and can lower blood sugar levels.

Follow your healthcare provider's instructions. Ask your provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all of your follow-up appointments. Make sure you have a pelvic exam as often as recommended by your healthcare provider. Pelvic exams can help your provider find some of the problems that might be caused by PCOS, like uterine cancer, so that they can be treated right away.