Polycystic Ovary Syndrome (PCOS)

A metabolic disorder estimated to affect more than six million reproductive-age women in the United States. It is believed to raise a woman’s risk of Type 2 diabetes and cardiovascular disease.

The syndrome can manifest itself in a variety of ways, including irregular menstrual cycles, increased production of testosterone from the ovaries, infertility, elevated insulin levels, male-pattern hair loss, overweight or obesity, hirsutism (excessive hair growth), and acne. These signs and symptoms can occur in any combination and, in spite of the syndrome’s name, are not always accompanied by polycystic ovaries (ovaries that have developed numerous fluid-filled sacs containing eggs in various stages of development).

Because there are so many ways in which PCOS can present itself, there is no single test that is used for diagnosis. If PCOS is suspected, a physician will generally begin by asking about a woman’s medical and reproductive history, including questions about her menstrual cycle and any pregnancies. The doctor will likely also conduct physical and pelvic examinations, and he may carry out imaging of the ovaries, although this is not necessary. The final step in the diagnosis usually consists of a variety of blood tests, which check for high levels of cholesterol, triglycerides, insulin, and hormones such as testosterone.

A position statement published in 2005 by the American Association of Clinical Endocrinologists states that women with PCOS are at a greatly increased risk of developing Type 2 diabetes and cardiovascular disease. By the age of 40, over 50% of women with PCOS will have impaired glucose tolerance (also known as prediabetes) or Type 2 diabetes, and some studies have shown that up to 40% of these women have calcification of their coronary arteries by age 45. PCOS is also associated with an increased risk of health complications such as high blood pressure (hypertension) and high blood cholesterol and triglyceride levels.

Although PCOS cannot be cured, it can be managed. One of the first lines of therapy often considered is metformin (brand name Glucophage), a drug widely used to treat Type 2 diabetes. Use of metformin can correct some of the metabolic abnormalities that accompany PCOS, which may facilitate weight loss and regularize menstrual cycles. The use of birth control pills can also help to ameliorate some symptoms. Lifestyle modifications, including increasing physical activity, losing weight, and following a healthful diet, can also help counteract the effects of PCOS. Thiazolidinediones, which include pioglitazone (Actos) and rosiglitazone (Avandia), are sometimes recommended for women with PCOS who have impaired glucose tolerance or diabetes.

If you suspect you have PCOS, speak to your doctor. Early diagnosis and intervention can help decrease the possibility of complications later in life.