Polycystic ovarian syndrome, or PCOS, is characterized by chronic lack of ovulation or extended periods of infrequent ovulation, also called oligo-ovulation. Common symptoms of PCOS include:
-oligomenorrhea (infrequent menstruation)
-amenorrhea (lack of menstruation)
-hirsutism (excessive increased hair growth in a male pattern distribution)
Though PCOS is the most common cause of androgen excess and hirsutism, the exact cause of PCOS remains unknown. Some experts believe that women may have polycystic ovarian syndrome as a result of a genetic predisposition, others may have PCOS as a result from obesity or other causes of lutenizing hormone (LH) excess. High amounts of LH contributes to a vicious cycle which results in increased ovarian androgen production.
The treatment of polycystic ovarian syndrome may include:
-Oral contraceptive pills
-Weight loss if a woman is overweight
Many women with PCOS are overweight. Obesity worsens symptoms of PCOS and contributes to abnormal hormonal levels. Many women with PCOS will resume regular ovulatory cycles with loss of excess weight alone. A weight reduction diet should be encouraged in all overweight women with polycystic ovarian syndrome.
Oral contraceptive pills:
Oral contraceptive pills can decrease the production of androgens. When the levels of androgens decrease acne will clear and new hair growth is prevented. The oral contraceptive pills will also prevent estrogen excess and thereby prevent endometrial hyperplasia. Endometrial hyperplasia is a known risk factor for endometrial cancer. An additional benefit for women on oral contraceptive pills, or OCP’s, is that they will have predictable menstrual bleeding episodes.
Decreased insulin sensitivity or even overt Type 2 Diabetes mellitus are common conditions associated with PCOS. Metformin will help sensitize a woman’s body to insulin. The administration of the insulin-sensitizing agent metformin will also reduce androgen levels and can help control weight in women with PCOS.
In some women with anovulatory polycystic ovarian syndrome, clomiphene citrate will be used to induce ovulation. The ability of Clomiphene citrate to induce ovulation is facilitated by weight loss. There is some suggestion that N-acetyl cysteine increases the efficacy of clomiphene citrate.
Of note, Hyperthecosis is a more severe form of polycystic ovarian syndrome. Hyperthecosis may cause virilization such as temporal balding, clitoral enlargement, deepening of the voice and remodeling of the limb-shoulder girdle.
Hyperthecosis is often resistant to treatment with oral contraceptives. It is also more difficult to induce ovulation in women with this severe form of PCOS.