Overview

Polycystic ovary syndrome (PCOS) is a common hormonal disorder in women of childbearing age. Women with PCOS may have infrequent or prolonged periods or have excessive levels of male hormones (androgens). The ovaries can develop many small collections of fluid (follicles) and not regularly release eggs.

The exact cause of PCOS is unknown. Early diagnosis and treatment as well as weight loss can reduce the risk of long-term complications such as type 2 diabetes and heart disease.

Symptoms

The signs and symptoms of PCOS often develop around the time of your first period during puberty. Sometimes PCOS develops later, for example, in response to substantial weight gain.

The signs and symptoms of PCOS vary. A diagnosis of PCOS is made when you experience two or more of these signs:

Irregular periods. Infrequent, irregular, or prolonged menstrual cycles are the most common sign of PCOS. For example, you may have less than nine periods per year, more than 35 days between periods, and unusually heavy periods.
Excess androgens. Elevated levels of male hormones can lead to physical signs, such as excess facial and body hair (hirsutism), and sometimes severe acne and male pattern baldness.
Polycystic ovaries. Your ovaries may be enlarged and contain follicles that surround the eggs. As a result, the ovaries may not function regularly.
The signs and symptoms of PCOS are usually more serious if you are obese

Causes

The exact cause of PCOS is unknown. Some of the factors that could play a role include:

Excess insulin. Insulin is the hormone made in the pancreas that enables cells to use sugar, your body’s primary energy source. When your cells become resistant to the effects of insulin, your blood sugar levels may rise and your body may make more insulin. Excess insulin can increase androgen production and cause difficulty ovulating.
Low inflammation. This term is used to describe the production of substances by white blood cells to fight infections. Research has shown that women with PCOS have a type of inflammatory disease that causes polycystic ovaries to produce androgens, which can lead to heart and blood vessel problems.
Inheritance. Research suggests that certain genes may be linked to PCOS.
Excess androgenic. The ovaries produce abnormally high levels of androgens, which leads to hirsutism and acne.

Types

There are four types of PCOS: insulin resistant PCOS, inflammatory PCOS, hidden cause PCOS, and pill-induced PCOS.
Insulin resistant PCOS. It is the most common type of PCOS. …
Pill-induced PCOS. This type is the second most common PCOS. …
FLAMMABLE PCOS. …
HIDDEN PCOS.

Treatment

PCOS treatment focuses on treating your individual problems such as infertility, hirsutism, acne, or obesity. Specific treatment may include lifestyle changes or medication.

Lifestyle changes
Your doctor may recommend weight loss through a low-calorie diet combined with moderate exercise. Even a slight weight reduction – for example, losing 5 percent of your body weight – can improve your condition. Losing weight can also increase the effectiveness of drugs your doctor recommends for PCOS and can help with infertility.

Medication
To help regulate your menstrual cycle, your doctor may recommend:

Combined birth control pills. Pills that contain estrogen and progestin decrease androgen production and regulate estrogen. Regulating your hormones can lower your risk of endometrial cancer and correct abnormal bleeding, excessive hair growth, and acne. Instead of pills, you can use a skin patch or vaginal ring that contains a combination of estrogen and progestin.
Progestin Therapy. Taking progestin for 10 to 14 days every one to two months can regulate your periods and protect against endometrial cancer. Progestin therapy does not improve androgen levels and does not prevent pregnancy. The progestin minipill or the progestin-containing intrauterine device is a better choice if you also want to avoid pregnancy.
To help you ovulate, your doctor may recommend:

Clomiphene. This oral anti-estrogen drug is taken during the first part of your menstrual cycle.
Letrozole (Femara). This breast cancer treatment can stimulate the ovaries.
Metformin. This oral drug for type 2 diabetes improves insulin resistance and lowers insulin levels. If you don’t get pregnant with clomiphene, your doctor may recommend adding metformin. If you have prediabetes, metformin can also slow the progression to type 2 diabetes and help you lose weight.
Gonadotropins. These hormonal drugs are given by injection.
To reduce excessive hair growth, your doctor may recommend:

Birth control pills. These pills decrease androgen production, which can cause excessive hair growth.
Spironolactones (Aldactones). This drug blocks the effects of androgen on the skin. Spironolactone can cause birth defects, so effective birth control is needed while taking this medication. It is not recommended if you are pregnant or planning to become pregnant.
Eflornithine (Vaniqa). This cream can slow down facial hair growth in women.
Electrolysis. A tiny needle is inserted into each hair follicle. The needle emits a pulse of electrical current to damage and eventually destroy the follicle. You may need multiple treatments.

Diagosis

There is no test to definitively diagnose PCOS. Your doctor will likely start with a discussion of your medical history, including your period and weight changes. A physical exam will include checking for signs of excessive hair growth, insulin resistance, and acne.

Your doctor may then recommend:

A pelvic exam. The doctor visually and manually inspects your reproductive organs for lumps, growths, or other abnormalities.
Blood tests. Your blood can be analyzed to measure hormone levels. This test can rule out possible causes of menstrual abnormalities or excess androgens that mimic PCOS. You may have additional blood tests to measure glucose tolerance and fasting cholesterol and triglyceride levels.
An ultrasound. Your doctor checks the appearance of your ovaries and the thickness of the lining of your uterus. A wand-shaped device (transducer) is placed in your vagina (transvaginal ultrasound). The transducer emits sound waves which are translated into images on a computer screen.
If you have a diagnosis of PCOS, your doctor might recommend additional testing for complications. These tests may include:

Periodic checks of blood pressure, glucose tolerance, cholesterol and triglyceride levels
Screening for Depression and Anxiety
Screening for obstructive sleep apnea

Risk factor

If you’ve been diagnosed with polycystic ovary syndrome (PCOS), it’s important to understand the long-term health risks associated with the disease, including:

Infertility or subfertility
Endometrial cancer
diabetes
Lipid abnormalities
Cardiovascular risks
Obstructive sleep apnea
Not all women with PCOS will develop these conditions, but PCOS increases your risk. Therefore, it is important that your health be regularly monitored by a doctor who has experience treating women with PCOS. Regular visits to the doctor should be planned during your reproductive years and continued after menopause, even if you no longer have irregular periods and other PCOS symptoms may decrease after menstruation has ended.

The internationally renowned doctors at the Center for Polycystic Ovarian Syndrome oversee the care of thousands of women with PCOS each year. UChicago Medicine is also home to cancer, heart disease, and other health care experts who can diagnose and treat these conditions as they develop.

Health factor

Infertility
Gestational diabetes or pregnancy-induced high blood pressure
Miscarriage or premature birth
Nonalcoholic steatohepatitis – a severe liver inflammation caused by fat accumulation in the liver
Metabolic syndrome – a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular disease
Type 2 diabetes or prediabetes
Sleep apnea
Depression, anxiety and eating disorders
Abnormal uterine bleeding
Cancer of the uterine lining (endometrial cancer)

When to see doctor

Contact your doctor if you have any concerns about your menstrual periods, if you suffer from infertility, or if you have signs of excessive androgen such as: B. worsening hirsutism, acne and male pattern baldness.

How much cost

A cycle with injectable gonadotropins typically costs between $ 1,500 and $ 6,000, depending on what is done and the injectable doses needed to stimulate follicle growth.

Duration

While IVF is more expensive and complex, it is far more successful. One cycle of IVF gives the same pregnancy rate as 6 months of clomid treatment.