Approximately 5 to 10 percent of women who are of reproductive age are affected by polycystic ovary syndrome (PCOS), making it a very common disorder. Women in certain ethnic populations also have a higher risk of developing PCOS and experiencing PCOS symptoms.
While it’s a common problem that I encounter on a regular basis, the encouraging news is that lifestyle modifications are often an incredibly effective means of treating PCOS. There are also a variety of medical PCOS treatments that may be appropriate for patients, depending on their goals and symptoms.
The term “polycystic” refers to the multiple, small fluid-filled sacs that form on an affected woman’s ovaries. Essentially, PCOS is an imbalance of hormones. When a woman has PCOS, her body produces an elevated number of male hormones called androgens, including testosterone. This hormone imbalance can cause irregular menstrual cycles and ovulation, and this often leads to infertility.
Infertility is undoubtedly one of the most concerning PCOS symptoms for many of my patients seeking treatment. Women with PCOS also may have weight gain, adult acne and excessive hair growth on the face, chest, arms or other areas of the body where it would not typically be found (known as hirsutism).
It is also worth noting that metabolic syndrome, a condition in which individuals have elevated cholesterol levels, heart disease, insulin resistance and diabetes, may be found at higher levels in women with PCOS.
How is a PCOS diagnosis made?
When evaluating a patient for PCOS, a physician may begin with a physical examination to determine whether there are increased amounts of hair on various parts of the body. The doctor might ask if the patient shaves or uses other hair removal/reduction techniques such as electrolysis or laser treatment.
The doctor may also conduct a blood test to assess whether there are increased levels of testosterone and other male hormones. Finally, because PCOS is associated with diabetes and insulin resistance, patients may be given a two-hour glucose (sugar) tolerance test.
During this test, blood sugar levels are measured while the patient is fasting and again two hours after ingesting a sugary solution. This test can help the doctor identify metabolic irregularities that often accompany PCOS.
Lifestyle changes can help manage PCOS symptoms
The most effective treatment for PCOS and PCOS symptoms, especially for women who are overweight or obese, is lifestyle modification that fosters maintaining a proper weight. A woman only needs to lose 5 to 10 percent of her body weight in order to improve the PCOS symptoms.
Specific lifestyle interventions are usually a combination of diet and exercise. In my experience, I have found that diet is the most effective approach for achieving the initial weight loss, and exercise is important to maintain the weight loss over time.
While these changes are truly effective PCOS treatment methods yielding long-term health benefits, lifestyle changes are often very difficult to achieve and maintain. As the saying goes, old habits die hard, and much of what we refer to as our “lifestyle” is simply a collection of habits that we’ve built over many years. Patients must make a firm and persistent commitment to alter their ingrained habits, but I can tell you that the payoff for doing so is very gratifying, especially if it results in a child.
Medical PCOS treatment
For women who are not trying to get pregnant
Medical treatment of PCOS and PCOS symptoms has a lot to do with a patient’s particular goals. If she is not trying to get pregnant, then regulation of her menstrual cycles in order to prevent the long-term side effects of irregular cycles becomes very important.
Over time, irregular cycles may lead to endometrial hyperplasia. This condition, which is an overgrowth of uterine lining, can develop into endometrial cancer if left untreated for many years.
Typically, PCOS patients who do not wish to get pregnant are offered oral contraceptive pills to regulate their cycle. As an added perk, birth control pills are also effective in reducing excess hair growth. Other oral medications that regulate hormones (antiandrogens) may be prescribed.
As an alternate option, a progesterone-containing IUD (intrauterine device) may be inserted in order to protect against endometrial hyperplasia. Progesterone works by lowering the hormones that produce excess hormones in the ovaries. This option is particularly beneficial for patients who have adverse side effects from birth control pills.
For women who are trying to get pregnant
If the patient wants to get pregnant, then the goal is to induce ovulation so that it becomes more reliable and effective. There are oral and injectable medications that aid in the ovulation process. The physician will walk through the benefits and risks of each treatment method, and advise the best approach for the specific patient.
When a woman affected by PCOS becomes pregnant, she is at a somewhat higher risk of preeclampsia, which is high blood pressure during pregnancy. Additionally, gestational diabetes is also seen at a higher level in women with PCOS during pregnancy.
Polycystic ovary syndrome is a condition that is very common and also has very effective treatment regimens. Ultimately, the best approach to treatment must be evaluated by a qualified physician. If you think you have PCOS or are displaying PCOS symptoms, you should contact a reproductive endocrinologist to start evaluation and explore treatment options.