Written by Andrea Reh, M.D
PCOS Questions from Patients Answered by Dr. Andrea Reh
Polycystic ovary syndrome (PCOS) is the most common ovulatory disorder that’s caused by hormonal imbalances that prevent ovulation—the body’s process of producing and releasing an egg from the ovary. Even though it is a common disorder, there are many PCOS questions from women who think they have PCOS, or women who may have already been diagnosed. For answers to some of the concerns or common PCOS questions, Dr. Andrea Reh shares some insight:
What exactly is PCOS?
A key indicator of PCOS is an abnormal menstrual cycle. The cycles can be irregular, which is defined as occurring greater than 5 weeks apart or absent altogether. However, not every woman with irregular or absent menstrual cycles will have PCOS. It’s important that your physician rules out other causes of irregular menstrual cycles first, before giving the diagnosis of PCOS.
Aside from irregular menstrual cycles, other symptoms of PCOS might include high androgens—male hormones such as testosterone. Signs of high androgens can manifest as acne and/or excess facial or body hair. Some women with PCOS may be obese and some might not. There is no one size fits all for PCOS.
What are the causes of PCOS?
Another common PCOS question is “What are the causes?” The cause of PCOS is not entirely understood. There is a genetic component to this condition as women are more likely to develop the condition if her mother or sister has it. It is also known that PCOS is associated with abnormal insulin metabolism, such that women with PCOS have a higher risk of developing diabetes. The dysfunction in the body’s ability to process sugars can disrupt anovulation (lack of ovulation)—increasing the amount of male hormones and leading to obesity.
How do you know if you have PCOS?
A woman’s menstrual cycle is the best indicator to diagnosing PCOS. If you have irregular or absent menstrual cycles, then a physician would first test for other causes of irregular menstrual cycles by checking thyroid and prolactin levels and another common condition known as late onset congenital (present at birth) adrenal hyperplasia. A physician will then look at a ultrasound (sonogram) or physical symptoms such as acne or hair growth to make the diagnosis. There are, however, other conditions that may look similar on an ultrasound to PCOS, so there is no one single test that can confirm or exclude the diagnosis.
What is the treatment for PCOS?
Treatment for PCOS depends on whether you are trying to conceive. If you are trying to get pregnant, the first step is optimizing your health. If you are overweight, weight loss and dietary control is recommended to get to a normal body weight. For patients who are obese, weight loss may restore menstrual cycles and allow for ovulation to occur.
For patients with diabetes or pre-diabetes (borderline diabetes), getting your blood sugar under control is the first priority. This can help reduce PCOS and optimize your health before pregnancy. Adjunctive medications such as Metformin or glucophage can be helpful for glucose control and weight loss, and may restore ovulation for some patients.
Once these factors have been optimized, if cycles do not resume, then the next step would be to proceed with fertility medications to induce ovulation. Medications such as letrozole or clomiphine citrate (Clomid, Serophene) are pills taken for 5 days at the beginning of a cycle. Patients are then monitored closely to see if they are responding to the medications, which will allow physicians to estimate when they will ovulate. For most patients, oral medications are all that is needed to induce ovulation. However, if these do not work, then your physician may recommend moving on to daily subcutaneous (under the skin) injections to induce ovulation under close supervision.
It may take time to determine the right medication, but with the proper medication and monitoring, it will be possible to induce ovulation. Once we’re able to induce ovulation, you’ll have timed intercourse at home or undergo an intrauterine insemination (IUI) at the office. Assuming there are no other factors for the couple’s infertility, once ovulation is induced, most women are able to get pregnant within 3 to 6 cycles of treatment.
In vitro fertilization (IVF) is also an effective treatment for PCOS, but is usually only considered for those patients who have had failed attempts of these consecutive approaches, or if IVF is indicated for other unrelated reasons.
To learn more about diagnosing and treatment options for women and to learn more about the common PCOS questions, please speak with one of our New Patient Liaisons at 1-877-971-7755 or click to schedule an appointment.