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PCOS: A Mysterious Disease
Polycystic ovary syndrome (PCOS) is a hormone-related condition that affects millions of women, most without their knowledge. Estimates suggest that between 5 and 10 percent of the female reproductive population may have PCOS, and the number may actually be even higher among younger women because infertility is the primary clue that leads to most diagnoses. In fact, PCOS is the most common cause of infertility.

PCOS is the most prevalent hormone imbalance in women under the age of 50, yet nearly 70% of cases are presumed to be undiagnosed. If left untreated, PCOS can lead to more far reaching health concerns, such as diabetes, heart disease and endometrial cancer.

What Exactly is PCOS?

Even though the name implies that the predominant symptom is ovarian cysts, PCOS—also known as polycystic ovary disease (PCOD) or Stein-Leventhal syndrome (after the doctors who discovered it more than 70 years ago)—is really a hormone imbalance, especially characterized by an overabundance of androgens and insulin resistance.

PCOS typically starts during adolescence (or even prepuberty), but may not be detected until women are in their late 20s or 30s because it takes a long time for symptoms to develop, and those symptoms vary widely from one woman to the next. The more obvious symptoms of PCOS include menstrual abnormalities, acne outbreaks, unwanted facial hair (hirsutism), unexplained weight gain and infertility.

The name “polycystic ovary syndrome” is misleading because you can have PCOS with or without ovarian cysts and, if you do have ovarian cysts, it does not necessarily mean that you have PCOS. The cysts associated with PCOS are actually eggs that do not get released from the ovary because of abnormal hormone levels (see What Goes Wrong?). Tumors can also be associated with PCOS, but they are rare.

With the wide variations in the way this condition presents itself, there is much debate among medical professionals as to how to define and diagnose PCOS. The primary consensus seems to be that women with PCOS do not ovulate in a predictable manner, produce excessive quantities of androgens, particularly testosterone and/or DHEA, and they are insulin resistant.

What Are Androgens?

Androgens (from the Greek word andros, meaning masculine) are steroid hormones significant to our physical and sexual development. Androgens are secreted by the adrenal glands and the ovaries (in women), and are also produced by the nervous system, including nerve cells in the brain, spinal cord and peripheral nervous system (known as “neurosteroids”). They may also be produced by other tissues such as cells found in the liver, skin and hair.

Androgens affect every aspect of our bodies in some way. They are necessary for the functioning of the liver and blood cells, nourishing the bones, and creating muscle mass. Because they are used for muscle development, and muscles are our fat burners, androgens are also critical to weight management. One interesting paradox is that some women with PCOS retain fluids and hold body fat, while others are quite slender.

Women with PCOS typically have elevated levels of androgens, specifically testosterone, androstenedione, dehydroepiandrosterone (DHEA) and DHEA-sulfate (DHEA-S). Their estrone level also tends to be high, but their estradiol level is usually within the normal range. Further complicating their hormone balance, PCOS sufferers typically also have low thyroid and high or low cortisol levels, as well as high insulin levels.

What are the Symptoms?

While some women with PCOS do develop cysts on their ovaries, the most prevalent indicators of PCOS and other androgen disorders generally fall into one of three categories: changes in appearance, menstrual abnormalities and metabolic or systemic disorders.

acne and skin problems
hirsutism or excessive hair on the face, chest, abdomen, or other parts of the body
alopecia or hair loss, also referred to as male-pattern baldness
unexplained weight gain or fluid retention.
Menstrual abnormalities include:
severe menstrual pain
amenorrhea or absence of menstruation
oligomenorrhea or occasional periods (possibly coupled with infertility if the woman has tried to become pregnant).
Metabolic or systemic disorders linked with PCOS include:
infertility or reduced fertility
diabetes or insulin resistance
obesity
hypertension
heart disease
hyperlipidemia (elevated “bad” cholesterol)
endometrial cancer
ovarian cancer
breast cancer.
For many women, PCOS is a life-long disease. Symptoms typically begin to appear by adolescence, persisting through the reproductive years and into menopause. Symptoms tend to cluster according to life stages, as follows:

Prepuberty: weight gain, early puberty or menarche, acne, high blood pressure
Adolescence: irregular periods, obesity, acne, hirsutism
Reproductive years: infertility, gestational diabetes, preeclampsia
Perimenopause: diabetes, obesity, stroke, heart disease, cancer.
However, because sensitivities to excess androgen vary considerably, symptoms can vary dramatically from one woman to the next.

Unfortunately, many women who suffer from the symptoms of PCOS don’t seek medical treatment because they are too embarrassed, or because the symptoms seem trivial and unrelated. Many of the symptoms could be perceived as awkward phases of development, reactions to stress or lifestyle choices, or concerns with a less-than-perfect body. For those who do seek treatment, doctors often dismiss their complaints because they can be categorized as cosmetic (and therefore not covered by insurance), or as merely affecting a woman’s ability to get pregnant, or simply unexplained “female problems.”

One of the reasons that PCOS seems to be underdiagnosed is that many people (patients and doctors alike) do not consider aspects of our appearance to be important enough to address. However, as we all know, our appearance does affect our overall sense of well-being.

The mind/body relationship is a very important contributor to our health, and especially a woman’s reproductive health. Dr. Christiane Northrup notes that the cyclic release of hormones from the hypothalamus is different in women with PCOS. We do not yet know whether this difference is the cause or the result of ovarian problems, but it is clear that the mind and body are both affected.

What Causes PCOS?

The exact cause of PCOS is still a mystery. Research offers several possible theories, which may prove to be related, but there is no clear answer as of yet.

One theory suggests that PCOS may be due to an endocrine system defect, affecting the hypothalamus and/or pituitary glands. In this scenario, production of either gonadotropin-releasing hormone (GnRH) or luteinizing hormone (LH) is elevated. The ovaries then become overstimulated and result in androgen excess, which disrupts the normal menstrual cycle. (See What Goes Wrong?.)

Dr. Jeffrey Dach explains that PCOS is the end result of a self-perpetuating cycle of not ovulating. No ovulation means no progesterone is produced, which continuously feeds a vicious cycle of no ovulation, and leads to increased testosterone production by the ovary.

According to Dr. Jorge Flechas, PCOS is a scar tissue disease caused by a lack of iodine. He suggests that low iodine levels are responsible for the production of cysts, nodules, growths and scar tissue—no matter where they occur in the body.

Dr. John R. Lee’s theory points to xenobiotics, which are chemical compounds such as drugs, environmental pollutants, and carcinogens that are foreign to a living organism. Xenobiotics can disrupt hormone function, and can also alter the development of fetal tissue. During development of a female embryo, between 500 and 800 thousand follicles are created, each containing an immature ovum. Dr. Lee reports that studies show “the creation of ovarian follicles during this embryo stage is exquisitely sensitive to the toxicity of xenobiotics.” While the mother who is exposed to the chemicals may be unaffected, her baby “is far more susceptible, and these chemicals may damage a female embryo’s ovarian follicles and make them dysfunctional; unable to complete ovulation or manufacture sufficient progesterone.” As noted earlier, this damage may not be apparent until after puberty, and may then exhibit a wide variety of symptoms.

Another theory is that insulin resistance may set off a chain reaction that throws the hormones out of balance. Medical research suggests that when insulin levels in the blood are high, the ovaries may be stimulated to produce more testosterone. However, there appears to be something unique about PCOS in that the excessively high insulin production is coupled with insulin resistance, independent of body weight.

Drs. Quintana and Dunaif hypothesize that “polycystic ovarian changes may be a prerequisite for the insulin effects, because insulin does not alter androgen secretions in normal women.” They suggest that PCOS may be a major contributor to the number of women with non insulin-dependent diabetes mellitus (NIDDM), both pre- and post-menopause.

Dr. Sara Gottfried concurs that there is an insulin connection with PCOS, noting that the risk of Type II diabetes rises by approximately 80% if cysts are present (whereas it increases by only 50% with just high androgen levels). In The Hormone Cure, she explains that high insulin levels cause the ovaries to produce excessive amounts of androgens, and also cause the liver to produce less SHBG, resulting in even more free testosterone. She also notes that insulin resistance increases aromatase, which converts testosterone to estradiol, thereby setting the stage for estrogen dominance and a lack of ovulation.

Dr. Gottfried suggests that genetics, chronic stress resulting in an excess of DHEA, and excess body fat (especially around the mid-section) may all contribute to PCOS, as well as obesity, which typically causes insulin levels to rise, in and of itself. Approximately 50 percent of the women with PCOS have excess body fat, and women with apple-shaped figures (i.e., a high hip-to-waist ratio) are more likely to have some ovarian dysfunction. Other research suggests that there is some type of synergistic relationship between impaired glucose tolerance and obesity in women with PCOS.

Researchers at The University of Chicago Medicine Center for Polycystic Ovary Syndrome are exploring a possible hereditary basis for PCOS and its association with diabetes. They report that approximately 30% of the women with PCOS will have an abnormal glucose tolerance test, and that 10% will be diabetic by the time they reach 40 years of age. In addition, Dr. Dunaif found that about 50 percent of the sisters of women with PCOS exhibit similar symptoms. These findings strongly suggest that if you or one of your sisters is diagnosed with PCOS, the other women in your immediate family should also be checked.

What Goes Wrong?

When functioning normally, the hypothalamus gland acts as a control center in the brain, monitoring hormone levels and regulating the menstrual cycle. During a normal menstrual cycle, the hypothalamus secretes gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH). In proper proportions, these hormones act on the ovaries to start producing estrogen (mostly estradiol), and stimulate the maturation of eggs.

In a normal ovary, a single egg is released each cycle. The first follicle that ovulates releases its egg into the fallopian tube and quickly changes into the corpus luteum. The corpus luteum produces a surge of progesterone, which simultaneously puts the uterine lining in its ripening phase and turns off further ovulation. If fertilization does not occur, the ovary stops its production of both estrogen and progesterone, and the sudden decrease in the concentrations of these hormones causes the blood-rich uterine lining to slough off, resulting in menstrual bleeding.

But what happens if a follicle does not release the egg for some reason?

If the ovary is not functioning properly and the egg is not released, the follicle may become a cyst and the normal progesterone surge does not occur. The lack of progesterone is detected by the hypothalamus, which continues to try to stimulate the ovary by increasing its production of GnRH, which in turn increases the pituitary production of LH.

An increase in pituitary hormones stimulates the ovary to produce more estrogen and androgens, which stimulates even more follicles to ovulate. If these additional follicles are also unable to release an egg and produce progesterone, the menstrual cycle is dominated by increased estrogen and androgen production, without progesterone, and multiple cysts may develop.

How is PCOS Diagnosed?

There is currently no single, simple test for diagnosing PCOS. Your healthcare practitioner may perform an endoscopic exam or use a diagnostic tool such as ultrasound to determine if your ovaries are enlarged or have cysts. If something similar to “a string of pearls” is evident in the ultrasound, chances are that a diagnosis of PCOS is likely; if not, PCOS may or may not be present.

Hormone testing may also be used to determine if you have an elevated testosterone level, an elevated luteinizing hormone (LH) level, a normal to low follicle-stimulating hormone (FSH) level and elevated prolactin level. High LH tends to be a good marker for PCOS. For PCOS patients, Dr. Gottfried also suggests checking progesterone, glucose, fasting insulin and the “hunger hormone” leptin.

During diagnosis, your healthcare practitioner will try to rule out other possible causes for your symptoms. Possibilities include Cushing’s syndrome (a complex hormone condition that is characterized by an excess of cortisol and affects many areas of the body) and other disorders associated with the pituitary or adrenal glands, such as congenital adrenal hyperplasia (CAH), which is an underlying genetic defect that can lead to androgen imbalances.

What Treatments Are Available?

The typical approach to treating PCOS has been some form of temporary “chemical castration” using oral contraceptives, androgen suppressors, synthetic estrogens, or other drugs that block hormone production, especially LH.

However, these conventional approaches simply suppress symptoms and perpetuate the problem—they do not address the underlying cause.
In fact, Drs. Quintana and Dunaif report that oral contraceptives “can produce substantial insulin resistance in normal women and may worsen the insulin resistance of those with [PCOS].”

Many practitioners, including Dr. Jeffrey Dach, Dr. Jerilynn Prior, Dr. Allen Warshowsky and Dr. John Lee (among others), believe that a cyclic regimen of progesterone therapy is an obvious starting point to treating PCOS.

Dr. Lee treated his PCOS patients with a bioidentical progesterone supplement, in conjunction with attention to proper diet, adequate exercise and stress management. Dr. Lee claimed that “If progesterone levels rise each month … as they are supposed to do, this maintains the normal synchronal pattern … and PCOS rarely, if ever, occurs.”

Bioidentical progesterone has also proven to be effective for inducing fertility when there appears to be some sort of ovulatory dysfunction. Evidence indicates that bioidentical progesterone therapy poses no risk, is likely to benefit those wishing to become pregnant, and may help maintain a pregnancy through the early months.

Another approach for treating PCOS is insulin-lowering medications. For women with PCOS, it is especially important to regulate insulin production such that the ovaries have a chance to function normally. Studies demonstrate a significant decline in ovarian androgen levels in PCOS patients while taking these medications.

An insulin-based treatment works best when coupled with a healthy diet and proper exercise. Many healthcare professionals recognize that metabolic aspects influence the reproductive and dermatologic health of their patients, especially patients with PCOS. For PCOS patients who are overweight, reducing their body weight by as little as 15% can significantly improve insulin sensitivity, restore ovulatory function, and reduce the effects of excess androgen.

In addition to progesterone therapy and insulin-based treatments, Dr. Gottfried believes that a more holistic approach is the key to successfully treating PCOS, including:

decreasing stress by practicing yoga
eating low glycemic and high fiber foods (fiber prevents recirculation of hormones from the gut and increases testosterone excretion)
other dietary and lifestyle changes, such as omitting sugar, avoiding dairy products, eating more protein and using more omega 3 oils
supplementing with zinc and vitamin D.
Results from studies of a supplement called D-chiro-inositol (DCI) are promising for the treatment of PCOS and other conditions. Based on inositol (a nutrient found in a wide variety of fruits and vegetables, and known to affect nerve function), DCI may play a role in the cellular function that mediates the action of insulin.

Obviously, we still have much more to learn about PCOS, what causes it, and how to treat it. As more women become aware of PCOS and its symptoms, and bring those concerns to their doctors and other healthcare practitioners, the medical profession will continue to enhance its understanding of PCOS.

What You Can Do Now

In the meantime, become more proactive about your own health and start practicing self-love with better eating habits, as well as proper exercise and sleep. Be advised of the symptoms and issues identified in this newsletter, and do your part to address health concerns that may contribute to PCOS, such as reducing stress and improving your diet.

As part of your normal health-related routine, monitor and document any changes to your appearance (especially your skin and hair), as well as any unexplained weight gain and menstrual irregularity. Speak with your healthcare practitioner about any and all symptoms that could be related to PCOS.

If you have an adolescent sister, daughter or niece, pay special attention to changes in her that may be more than simply “awkward stages” of development. She may need the help of an informed advocate to get her on a path to proper treatment.

References

The following resources were used in researching this newsletter:

“PCOS Polycystic Ovary Syndrome – Anovulatory Androgen Excess” by Jeffrey Dach, MD; posted at jeffreydachmd.com/pcos-part-one/; April 2013.
A presentation by Jorge Flechas, MD; AAOT annual meeting; Dallas, TX; 2013.
The University of Chicago Medicine Center for Polycystic Ovary Syndrome: http://www.uchospitals.edu/specialties/pcos/pcos.html; April 2013.
“Polycystic Ovary Syndrome (PCOS): A New Epidemic that Causes Infertility, Excess Hair, Acne and More” by Dr. John R. Lee; The John R. Lee Medical Letter; July 1999.
“How Insulin Resistance Is Linked to Polycystic Ovary Syndrome” by Benjamin Quintana, MD, and Andrea Dunaif, MD; Contemporary OB/GYN; July 1994.
The Hormone Cureby Sara Gottfried, MD; Scribner Books; New York, NY; March 2013.
“What Makes Your Ovaries Tick: Insights about ovulation, fertility, PCOS and more,” an interview with Jerilynn C. Prior, MD, FRCPC; http://www.virginiahopkinstestkits.com/priorovaries.html; April 2013.
“What is PCOS and Why Talk About It?,” a presentation by Dr. Allen Warshowsky at the 2013 Integrative Healthcare Symposium, New York, NY.
Polycystic Ovary Syndrome Association, Inc., an all-volunteer non-profit support group: http://www.pcosupport.org; March 2013.

What is polycystic ovary syndrome (PCOS)?

Polycystic (pah-lee-SIS-tik) ovary syndrome (PCOS) is a health problem that can affect a woman’s:

Menstrual cycle
Ability to have children
Hormones
Heart
Blood vessels
Appearance
With PCOS, women typically have:

High levels of androgens (AN-druh-junz). These are sometimes called male hormones, though females also make them.
Missed or irregular periods (monthly bleeding)
Many small cysts (sists) (fluid-filled sacs) in their ovaries
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How many women have PCOS?

Between 1 in 10 and 1 in 20 women of childbearing age has PCOS. As many as 5 million women in the United States may be affected. It can occur in girls as young as 11 years old.

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What causes PCOS?

The cause of PCOS is unknown. But most experts think that several factors, including genetics, could play a role. Women with PCOS are more likely to have a mother or sister with PCOS.

A main underlying problem with PCOS is a hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. Androgens are male hormones that females also make. High levels of these hormones affect the development and release of eggs during ovulation.

Researchers also think insulin may be linked to PCOS. Insulin is a hormone that controls the change of sugar, starches, and other food into energy for the body to use or store. Many women with PCOS have too much insulin in their bodies because they have problems using it. Excess insulin appears to increase production of androgen. High androgen levels can lead to:

Acne
Excessive hair growth
Weight gain
Problems with ovulation
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What are the symptoms of PCOS?

The symptoms of PCOS can vary from woman to woman. Some of the symptoms of PCOS include:

Infertility (not able to get pregnant) because of not ovulating. In fact, PCOS is the most common cause of female infertility.
Infrequent, absent, and/or irregular menstrual periods
Hirsutism (HER-suh-tiz-um) — increased hair growth on the face, chest, stomach, back, thumbs, or toes
Cysts on the ovaries
Acne, oily skin, or dandruff
Weight gain or obesity, usually with extra weight around the waist
Male-pattern baldness or thinning hair
Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black
Skin tags — excess flaps of skin in the armpits or neck area
Pelvic pain
Anxiety or depression
Sleep apnea — when breathing stops for short periods of time while asleep
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Why do women with PCOS have trouble with their menstrual cycle and fertility?

The ovaries, where a woman’s eggs are produced, have tiny fluid-filled sacs called follicles or cysts. As the egg grows, the follicle builds up fluid. When the egg matures, the follicle breaks open, the egg is released, and the egg travels through the fallopian tube to the uterus (womb) for fertilization. This is called ovulation.

In women with PCOS, the ovary doesn’t make all of the hormones it needs for an egg to fully mature. The follicles may start to grow and build up fluid but ovulation does not occur. Instead, some follicles may remain as cysts. For these reasons, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman’s menstrual cycle is irregular or absent. Plus, the ovaries make male hormones, which also prevent ovulation.

Normal ovary and polycystic ovary
Normal Ovary and Polycystic Ovary
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Does PCOS change at menopause?

Yes and no. PCOS affects many systems in the body. So, many symptoms may persist even though ovarian function and hormone levels change as a woman nears menopause. For instance, excessive hair growth continues, and male-pattern baldness or thinning hair gets worse after menopause. Also, the risks of complications (health problems) from PCOS, such as heart attack, stroke, and diabetes, increase as a woman gets older.

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How do I know if I have PCOS?

There is no single test to diagnose PCOS. Your doctor will take the following steps to find out if you have PCOS or if something else is causing your symptoms.

Medical history. Your doctor will ask about your menstrual periods, weight changes, and other symptoms.

Physical exam. Your doctor will want to measure your blood pressure, body mass index (BMI), and waist size. He or she also will check the areas of increased hair growth. You should try to allow the natural hair to grow for a few days before the visit.

Pelvic exam. Your doctor might want to check to see if your ovaries are enlarged or swollen by the increased number of small cysts.

Blood tests. Your doctor may check the androgen hormone and glucose (sugar) levels in your blood.

Vaginal ultrasound (sonogram). Your doctor may perform a test that uses sound waves to take pictures of the pelvic area. It might be used to examine your ovaries for cysts and check the endometrium (en-do-MEE-tree-uhm) (lining of the womb). This lining may become thicker if your periods are not regular.

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How is PCOS treated?

Because there is no cure for PCOS, it needs to be managed to prevent problems. Treatment goals are based on your symptoms, whether or not you want to become pregnant, and lowering your chances of getting heart disease and diabetes. Many women will need a combination of treatments to meet these goals. Some treatments for PCOS include:

Lifestyle modification. Many women with PCOS are overweight or obese, which can cause health problems. You can help manage your PCOS by eating healthy and exercising to keep your weight at a healthy level. Healthy eating tips include:

Limiting processed foods and foods with added sugars
Adding more whole-grain products, fruits, vegetables, and lean meats to your diet
This helps to lower blood glucose (sugar) levels, improve the body’s use of insulin, and normalize hormone levels in your body. Even a 10 percent loss in body weight can restore a normal period and make your cycle more regular.

Birth control pills. For women who don’t want to get pregnant, birth control pills can:

Control menstrual cycles
Reduce male hormone levels
Help to clear acne
Keep in mind that the menstrual cycle will become abnormal again if the pill is stopped. Women may also think about taking a pill that only has progesterone (proh-JES-tuh-rohn), like Provera, to control the menstrual cycle and reduce the risk of endometrial cancer (See Does PCOS put women at risk for other health problems?). But, progesterone alone does not help reduce acne and hair growth.

Diabetes medications. The medicine metformin (Glucophage) is used to treat type 2 diabetes. It has also been found to help with PCOS symptoms, though it isn’t approved by the U.S Food and Drug Administration (FDA) for this use. Metformin affects the way insulin controls blood glucose (sugar) and lowers testosterone production. It slows the growth of abnormal hair and, after a few months of use, may help ovulation to return. Recent research has shown metformin to have other positive effects, such as decreased body mass and improved cholesterol levels. Metformin will not cause a person to become diabetic.

Fertility medications. Lack of ovulation is usually the reason for fertility problems in women with PCOS. Several medications that stimulate ovulation can help women with PCOS become pregnant. Even so, other reasons for infertility in both the woman and man should be ruled out before fertility medications are used. Also, some fertility medications increase the risk for multiple births (twins, triplets). Treatment options include:

Clomiphene (KLOHM-uh-feen) (Clomid, Serophene) — the first choice therapy to stimulate ovulation for most patients.
Metformin taken with clomiphene — may be tried if clomiphene alone fails. The combination may help women with PCOS ovulate on lower doses of medication.
Gonadotropins (goe-NAD-oh-troe-pins) — given as shots, but are more expensive and raise the risk of multiple births compared to clomiphene.
Another option is in vitro fertilization (IVF). IVF offers the best chance of becoming pregnant in any given cycle. It also gives doctors better control over the chance of multiple births. But, IVF is very costly.

Surgery. “Ovarian drilling” is a surgery that may increase the chance of ovulation. It’s sometimes used when a woman does not respond to fertility medicines. The doctor makes a very small cut above or below the navel (belly button) and inserts a small tool that acts like a telescope into the abdomen (stomach). This is called laparoscopy (lap-uh-RAHS-kuh-pee). The doctor then punctures the ovary with a small needle carrying an electric current to destroy a small portion of the ovary. This procedure carries a risk of developing scar tissue on the ovary. This surgery can lower male hormone levels and help with ovulation. But, these effects may only last a few months. This treatment doesn’t help with loss of scalp hair or increased hair growth on other parts of the body.

Medicine for increased hair growth or extra male hormones. Medicines called anti-androgens may reduce hair growth and clear acne. Spironolactone (speer-on-oh-LAK-tone) (Aldactone), first used to treat high blood pressure, has been shown to reduce the impact of male hormones on hair growth in women. Finasteride (fin-AST-uhr-yd) (Propecia), a medicine taken by men for hair loss, has the same effect. Anti-androgens are often combined with birth control pills. These medications should not be taken if you are trying to become pregnant.

Before taking Aldactone, tell your doctor if you are pregnant or plan to become pregnant. Do not breastfeed while taking this medicine. Women who may become pregnant should not handle Propecia.

Other options include:

Vaniqa (van-ik-uh) cream to reduce facial hair
Laser hair removal or electrolysis to remove hair
Hormonal treatment to keep new hair from growing
Other treatments. Some research has shown that bariatric (weight loss) surgery may be effective in resolving PCOS in morbidly obese women. Morbid obesity means having a BMI of more than 40, or a BMI of 35 to 40 with an obesity-related disease. The drug troglitazone (troh-GLIT-uh-zohn) was shown to help women with PCOS. But, it was taken off the market because it caused liver problems. Similar drugs without the same side effect are being tested in small trials.

Researchers continue to search for new ways to treat PCOS. To learn more about current PCOS treatment studies, visit ClinicalTrials.gov. Talk to your doctor about whether taking part in a clinical trial might be right for you. Return to top
How does PCOS affect a woman while pregnant?

Women with PCOS appear to have higher rates of:

Miscarriage
Gestational diabetes
Pregnancy-induced high blood pressure (preeclampsia)
Premature delivery
Babies born to women with PCOS have a higher risk of spending time in a neonatal intensive care unit or of dying before, during, or shortly after birth. Most of the time, these problems occur in multiple-birth babies (twins, triplets).

Researchers are studying whether the diabetes medicine metformin can prevent or reduce the chances of having problems while pregnant. Metformin also lowers male hormone levels and limits weight gain in women who are obese when they get pregnant.

Metformin is an FDA pregnancy category B drug. It does not appear to cause major birth defects or other problems in pregnant women. But, there have only been a few studies of metformin use in pregnant women to confirm its safety. Talk to your doctor about taking metformin if you are pregnant or are trying to become pregnant. Also, metformin is passed through breastmilk. Talk with your doctor about metformin use if you are a nursing mother.

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Does PCOS put women at risk for other health problems?

Women with PCOS have greater chances of developing several serious health conditions, including life-threatening diseases. Recent studies found that:

More than 50 percent of women with PCOS will have diabetes or pre-diabetes (impaired glucose tolerance) before the age of 40.
The risk of heart attack is 4 to 7 times higher in women with PCOS than women of the same age without PCOS.
Women with PCOS are at greater risk of having high blood pressure.
Women with PCOS have high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol.
Women with PCOS can develop sleep apnea. This is when breathing stops for short periods of time during sleep.
Women with PCOS may also develop anxiety and depression. It is important to talk to your doctor about treatment for these mental health conditions.

Women with PCOS are also at risk for endometrial cancer. Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Progesterone causes the endometrium (lining of the womb) to shed each month as a menstrual period. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia, when the lining grows too much, and cancer. Return to top
I have PCOS. What can I do to prevent complications?

If you have PCOS, get your symptoms under control at an earlier age to help reduce your chances of having complications like diabetes and heart disease. Talk to your doctor about treating all your symptoms, rather than focusing on just one aspect of your PCOS, such as problems getting pregnant. Also, talk to your doctor about getting tested for diabetes regularly. Other steps you can take to lower your chances of health problems include:

Eating right
Exercising
Not smoking
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How can I cope with the emotional effects of PCOS?

Having PCOS can be difficult. You may feel:

Embarrassed by your appearance
Worried about being able to get pregnant
Depressed
Getting treatment for PCOS can help with these concerns and help boost your self-esteem. You may also want to look for support groups in your area or online to help you deal with the emotional effects of PCOS. You are not alone and there are resources available for women with PCOS.

More information on polycystic ovary syndrome (PCOS)

For more information about polycystic ovary syndrome (PCOS), call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

American Association of Clinical Endocrinologists (AACE)
Phone: 904-353-7878
American College of Obstetricians and Gynecologists
Phone: 202-638-5577
American Society for Reproductive Medicine (ASRM)
Phone: 205-978-5000
InterNational Council on Infertility Information Dissemination, Inc. (INCIID)
Phone: 703-379-9178
Women’s Health Research, National Institute of Child Health and Human Development, NIH, HHS
Phone: 800-370-2943
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The information on our website is provided by the U.S. federal government and is in the public domain. This public information is not copyrighted and may be reproduced without permission, though citation of each source is appreciated.
Polycystic ovary syndrome (PCOS) fact sheet was reviewed by:

Esther Eisenberg, M.D., M.P.H.
Professor of Obstetrics and Gynecology, Vanderbilt University
Medical Officer, Reproductive Sciences Branch
The Eunice Kennedy Shriver National Institute of Child Health and Human Development
National Institutes of Health

Content last updated July 16, 2012.
Resources last updated March 17, 2010.

Polycystic Ovary Syndrome (PCOS) and Weight Gain

Most women at some point have to contend with weight gain. But for women with polycystic ovary syndrome (PCOS), losing weight can become a constant struggle.

PCOS occurs when the ovaries don’t make enough hormones for the eggs to fully mature. Instead of releasing a mature egg during ovulation, some of the follicles in the ovaries turn into fluid-filled sacs called cysts. More than six out of every 10 women who have PCOS are also overweight.

The good news is that women with PCOS can actually win the struggle against weight gain. If you have PCOS, certain lifestyle changes can help you shed pounds and reduce the disease’s severity.

Why does polycystic ovary syndrome cause weight gain?

PCOS makes it more difficult for the body to use the hormone insulin, which normally helps convert sugars and starches from foods into energy. This condition — called insulin resistance — can cause insulin and sugar — glucose — to build up in the bloodstream.

High insulin levels increase the production of male hormones called androgens. High androgen levels lead to symptoms such as body hair growth, acne, irregular periods — and weight gain. Because the weight gain is triggered by male hormones, it is typically in the abdomen. That is where men tend to carry weight. So, instead of having a pear shape, women with PCOS have more of an apple shape.

Abdominal fat is the most dangerous kind of fat. That’s because it is associated with an increased risk of heart disease and other health conditions.

What are the risks associated with PCOS-related weight gain?

No matter what the cause, weight gain can be detrimental to your health. Women with PCOS are more likely to develop many of the problems associated with weight gain and insulin resistance, including:

Type 2 diabetes
High cholesterol
High blood pressure
Sleep apnea
All of these conditions can lead to heart disease. In fact, women with PCOS are four to seven times more likely to have a heart attack than women of the same age without the condition.

Experts think weight gain also helps trigger PCOS symptoms, such as menstrual abnormalities and acne.

What can I do to lose weight if I have polycystic ovary syndrome?

Losing weight not only can help you look better — it can also make you feel better. When you have PCOS, shedding just 10% of your body weight can bring your periods back to normal. It can also help relieve some of the symptoms of polycystic ovary syndrome.

Weight loss can improve insulin sensitivity. That will reduce your risk of diabetes, heart disease, and other PCOS complications.

To lose weight, start with a visit to your doctor. The doctor will weigh you and check your waist size and body mass index. Body mass index is also called BMI, and it is the ratio of your height to your weight.

Polycystic Ovary Syndrome (PCOS) – Topic Overview
Polycystic ovary syndrome (say “pah-lee-SIS-tik OH-vuh-ree SIN-drohm”) is a problem in which a woman’s hormones are out of balance. It can cause problems with your periods and make it difficult to get pregnant. PCOS also may cause unwanted changes in the way you look. If it isn’t treated, over time it can lead to serious health problems, such as diabetes and heart disease.

Most women with PCOS grow many small cysts camera.gif on their ovaries. That is why it is called polycystic ovary syndrome. The cysts are not harmful but lead to hormone imbalances.

Early diagnosis and treatment can help control the symptoms and prevent long-term problems.

Hormones are chemical messengers that trigger many different processes, including growth and energy production. Often, the job of one hormone is to signal the release of another hormone.

For reasons that are not well understood, in PCOS the hormones get out of balance. One hormone change triggers another, which changes another. For example:

The sex hormones get out of balance. Normally, the ovaries make a tiny amount of male sex hormones (androgens). In PCOS, they start making slightly more androgens. This may cause you to stop ovulating, get acne, and grow extra facial and body hair.
The body may have a problem using insulin, called insulin resistance. When the body doesn’t use insulin well, blood sugar levels go up. Over time, this increases your chance of getting diabetes.
The cause of PCOS is not fully understood, but genetics may be a factor. PCOS seems to run in families, so your chance of having it is higher if other women in your family have it or have irregular periods or diabetes. PCOS can be passed down from either your mother’s or father’s side.

Symptoms tend to be mild at first. You may have only a few symptoms or a lot of them. The most common symptoms are:

Acne.
Weight gain and trouble losing weight.
Extra hair on the face and body. Often women get thicker and darker facial hair and more hair on the chest, belly, and back.
Thinning hair on the scalp.
Irregular periods. Often women with PCOS have fewer than nine periods a year. Some women have no periods. Others have very heavy bleeding.
Fertility problems. Many women who have PCOS have trouble getting pregnant (infertility).
Depression.
To diagnose PCOS, the doctor will:

Ask questions about your past health, symptoms, and menstrual cycles.
Do a physical exam to look for signs of PCOS, such as extra body hair and high blood pressure. The doctor will also check your height and weight to see if you have a healthy body mass index (BMI).
Do a number of lab tests to check your blood sugar, insulin, and other hormone levels. Hormone tests can help rule out thyroid or other gland problems that could cause similar symptoms.
You may also have a pelvic ultrasound to look for cysts on your ovaries. Your doctor may be able to tell you that you have PCOS without an ultrasound, but this test will help him or her rule out other problems.

Regular exercise, healthy foods, and weight control are the key treatments for PCOS. Treatment can reduce unpleasant symptoms and help prevent long-term health problems.

Try to fit in moderate activity and/or vigorous activity often. Walking is a great exercise that most people can do.
Eat heart-healthy foods. This includes lots of vegetables, fruits, nuts, beans, and whole grains. It limits foods that are high in saturated fat, such as meats, cheeses, and fried foods.
Most women who have PCOS can benefit from losing weight. Even losing 10 lb (4.5 kg) may help get your hormones in balance and regulate your menstrual cycle.
If you smoke, consider quitting. Women who smoke have higher androgen levels that may contribute to PCOS symptoms.1
Your doctor also may prescribe birth control pills to reduce symptoms, metformin to help you have regular menstrual cycles, or fertility medicines if you are having trouble getting pregnant.

It is important to see your doctor for follow-up to make sure that treatment is working and to adjust it if needed. You may also need regular tests to check for diabetes, high blood pressure, and other possible problems.

It may take a while for treatments to help with symptoms such as facial hair or acne. You can use over-the-counter or prescription medicines for acne.

It can be hard to deal with having PCOS. If you are feeling sad or depressed, it may help to talk to a counselor or to other women who have PCOS.

olycystic Ovary Syndrome (PCOS) – Treatment Overview
Regular exercise, a healthy diet, weight control, and not smoking are all important parts of treatment for polycystic ovary syndrome (PCOS). You may also take medicine to balance your hormones.

Treatments depend on your symptoms and whether you are planning a pregnancy.

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There is no cure for PCOS, but controlling it lowers your risks of infertility, miscarriages, diabetes, heart disease, and uterine cancer.

Healthy lifestyle
If you are overweight, weight loss may be all the treatment you need. A small amount of weight loss is likely to help balance your hormones and start up your menstrual cycle and ovulation.
Eat a balanced diet that includes lots of fruits, vegetables, whole grains, and low-fat dairy products.
Get regular exercise to help you control or lose weight and feel better.
If you smoke, consider quitting. Women who smoke have higher levels of androgens than women who don’t smoke.1
For more information, see Home Treatment.

Hormone therapy
If weight loss alone doesn’t start ovulation (or if you don’t need to lose weight), your doctor may have you try a medicine such as metformin or clomiphene to help you start to ovulate.

If you aren’t planning a pregnancy, you can also use hormone therapy to help control your ovary hormones. To correct menstrual cycle problems, birth control hormones keep your endometrial lining from building up for too long. This can prevent uterine cancer.

Hormone therapy also can help with male-type hair growth and acne. Birth control pills, patches, or vaginal rings are prescribed for hormone therapy. Androgen-lowering spironolactone (Aldactone) is often used with combined hormonal birth control. This helps with hair loss, acne, and male-pattern hair growth on the face and body (hirsutism).

You can use other methods to treat acne and remove excess hair. For more information, see Home Treatment.

Taking hormones doesn’t help with heart, blood pressure, cholesterol, and diabetes risks. This is why exercise and a healthy diet are key parts of your treatment.

To learn more about hormones, see Medications.

If weight loss and medicine don’t restart ovulation, you may want to try other treatments. For more information, see the topic Fertility Problems.

Regular checkups
Regular checkups are important for catching any PCOS complications, such as high blood pressure, high cholesterol, uterine cancer, heart disease, and diabetes.

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