Polycystic Ovary Syndrome (PCOS)

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Infertility topics explained by Brian Acacio, M.D.. 
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Polycystic Ovary Syndrome, referred to as PCOS, is a common chronic life-long disorder that often leads to menstrual irregularities and infertility among women. This condition results in a hormone imbalance which in turn disrupts the ovulation process.

PCOS Symptoms

Some women with PCOS may exhibit only one of the listed symptoms while others may experience all symptoms.

  • acne – typically found on the face, chest and back
  • excessive hair growth (hirsutism) – face, legs, chest, back, abdomen, pubic area
  • weight gain –related to high levels of glucose and insulin
  • infertility – result of not ovulating
  • irregular (oligomenorrhea) or absent (amenorrhea) periods alternating with very heavy periods.
  • mood swings – resulting from hormone imbalances
  • skin problems – thickening and darkening of skin
  • thinning hair – similar to that of men and caused by higher levels of androgens

Symptoms can vary among different groups of ethnicity; some races may have higher incidences of a particular symptom while other races may not find a particular symptom significant in the diagnosis of PCOS.

Those Affected by PCOS

PCOS is considered the most common endocrine disorder and may affect anywhere from eight to ten percent of all women. That translates to five to ten million women in the United States alone. While PCOS occurs in women of all ages and races, there is a higher frequency rate in certain high-risk ethnic groups. These high-risk groups include:

  1. those who have had a premature pubarche (pubic hair before the age of eight)
  2. some Native American groups as well as groups of Latino or Mediterranean descent
  3. those with family histories involving: diabetes, insulin resistance, hyperinsulinemia (higher than normal amount of insulin), oligomenorrhea or amenorrhea, and cardiovascular disease

Causes of PCOS

In the past, PCOS has been attributed to having excessive levels of male hormones in the body which could inhibit ovaries from ovulating. Only recently has research shown the connection between PCOS and hyperinsulinemia, a condition in which the body has an elevated amount of insulin. Insulin resistance, which brings upon the onset of hyperinsulinemia, happens when the body cannot effectively break down sugar. The excess sugar, in the form of glucose, signals the pancreas to produce insulin to “process” the glucose as energy or for future use. These elevated levels of glucose and insulin in turn, bring about a hormone imbalance in which more male hormones are produced. PCOS can lead to infertility when the menstrual cycle is interrupted or halted. Regardless of fertility issues, if insulin resistance is undetected and untreated, type II diabetes may develop.

It is important to note that not all women with PCOS have insulin resistance. Some scientists believe that some women are born with a faulty gene that generates the excessive levels of male hormones. Genetics may also play a role in women with PCOS.

PCOS Treatment Options

Treating the root cause of PCOS would involve lowering elevated insulin levels. Insulin sensitizers help the body use and store excess glucose and have in the past, helped those with type II diabetes. These medications are being used to successfully treat women with PCOS and insulin resistance. Insulin sensitizers help return glucose and insulin levels to normal, restore the menstrual cycle, lower the risk of diabetes and cardiovascular disease, and mitigate symptoms like acne, weight-gain, excessive hair growth and hair thinning.

Metformin, an insulin sensitizer, has been approved for the treatment of diabetes but has not been approved for the treatment of PCOS. Metformin, marketed under the name of Glucophage, can be used to treat PCOS but has some considerable gastrointestinal side effects (abdominal bloating, diarrhea, flatulence, loss of appetite, nausea, and vomiting). It is recommended that new Glucophage patients seek the advice of a specialist to initiate therapy. D-Chiro-Inositol (DCI) is an over the counter supplement likely as effective as Metformin with no reported side effects.

PCOS and Infertility

For women with PCOS and insulin resistance, the use of metformin (or DCI) can restore normal menstrual cycles and reduce elevated levels of male hormones in the body. The ideal PCOS patient for treatment would be someone with:

  • elevated insulin levels or insulin resistance
  • irregular—but not absence of—menstrual periods
  • elevated testosterone levels
  • lutenizing hormone to follicle stimulating hormone (LH/FSH) ratio greater than 2:1

Past results from using metformin (for 3-6 months) + DCI to treat PCOS and infertility have shown that

  • 50% of those with oligomenorrhea and 25% of those with amenorrhea now have normal menstrual cycles
  • 25% have ovulation restored with 10% of these women conceiving naturally within half a year of treatment
  • 30% reduction of serum testosterone levels within half-a-year of treatment

Other treatment options for PCOS and infertility include weight reduction (for those who are over their ideal weight or are considered obese), utilizing additional hormone therapy with metformin, DCI, hormone therapy with insemination, and in some cases, IVF.

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