What is Polycystic Ovarian Syndrome?
Polycystic ovary syndrome (PCOS) is an ovulation disorder affecting up to 10% of reproductive-aged women. Notable symptoms of PCOS include disordered or lack of ovulation, elevated male hormones (androgens), and/or polycystic appearing ovaries on ultrasound. In addition women with PCOS may experience irregular or absent menses, excess facial and body hair growth, hair loss, acne, skin discoloration, obesity, diabetes, hypertension, and/or elevated cholesterol.
The pituitary gland in the brain plays an important role in the release of an oocyte from the ovary each month. Two hormones secreted by the pituitary gland are of importance:
- FSH (Follicle Stimulating Hormone) – stimulates a follicle to grow to maturity
- LH (Luteinizing Hormone) – causes a mature follicle to burst and to release the oocyte
PCOS occurs when there is an abnormality with the secretion of FSH and LH. This abnormality results in an underdeveloped follicle developing, subsequently not rupturing and thus the oocyte is not released. With time many underdeveloped follicles are formed in the ovaries, the result is abnormal hormonal levels, specifically the LH/FSH ratio as well as the ‘male hormones’ produced in the ovaries.
The fertility specialists as Medfem Fertility Clinic have extensive experience in treating women suffering from PCOS. We have undertaken extensive research on PCOS throughout the years and are dedicated to providing excellence in cutting-edge care to women with the disorder.
Symptoms of Polycystic Ovarian Syndrome
- Irregular menstrual cycles.
- Weight gain
- Excessive hair growth with a male sexual hair distribution e.g. on the upper lip, breasts or below the navel.
- Oily skin and acne.
Diagnosis of Polycystic Ovarian Syndrome
Making the correct diagnosis of PCOS is essential since there are multiple syndromes with similar signs and symptoms which can mimic the disorder but require different treatments. Therefore, PCOS can only be diagnosed after a comprehensive work-up has ruled-out other disease entities.
- Blood tests are conducted at the commencement of the cycle day 2 or day 3. The test should include FSH, LH and male hormones, androgen, DHEAS and testosterone.
- Further blood tests include a fasting insulin test and a further insulin level two hours after eating.
- On ultrasound the ovaries will have a multicystic appearance
Once the diagnosis is established a unique treatment protocol is designed for each patient based on her signs and symptoms. Patients experiencing infertility often undergo ovulation induction. Ovulation induction may be achieved with various orally ingested medications or, if needed, injectable hormones, with excellent results. In patients not seeking to conceive, various other treatments are available which may alleviate symptoms and simultaneously reduce the risk of developing future systemic illnesses, like diabetes and heart disease.
Treatment of Polycystic Ovarian Syndrome
- Abnormal insulin levels can be treated with medication metformin (glucophage) or more conservatively by correcting the diet.
- The first line of treatment is usually fertility drugs such as “Clomiphene citrate” or “Letrazole” (Femara) tablets. A word of warning though: patients with PCOS are very sensitive to these drugs and higher order multiple pregnancies are very common. This medication should be prescribed by an infertility specialist as ultrasonic monitoring of the ovarian response to the medication is essential. Ongoing monthly use has an adverse affect on the ovaries creating a ‘contraceptive effect’.
- Hormone injections containing FSH. These injections are very powerful and should only be administered by a specialist with a keen interest in infertility.
- Birth control pills, are aimed at restoring regular periods and reducing the risks of developing abnormal uterine lining. Some birth control pills and medications are used to reduce cosmetic effects of increased androgens (acne and increased body hair).
- Ovarian surgery. At laparoscopy a few of the small follicles are drained with a small needle to help stimulate ovulation. This is a highly specialised procedure and can damage the ovaries if not done correctly. Surgery is only performed if medical treatment fails.
In many women, losing as little as 10% of body weight and maintaining the weight loss can restore normal menstrual patterns. However, weight loss can be challenging for many obese women with PCOS. The treatment of infertility for overweight women should include lifestyle modifications in weight, physical activity and diet. These factors have general health benefits, and may result in a spontaneous return to normal ovulation, and/or better response to medications used to induce ovulation. Pre-pregnancy improvements in these factors will also optimise pregnancy progress and outcome.