The Basics

Polycystic ovary syndrome (PCOS) is caused by hormonal imbalances that curtail or prevent ovulation—the body’s process of producing and releasing eggs from the ovary. Essentially, women with PCOS have an inappropriate production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) that results in limited egg development and an increase in testosterone and other typically male hormones (androgens). Women with PCOS also have abnormal insulin metabolism, which worsens with anovulation (no ovulation), increases androgens, and leads to obesity.

Symptoms of PCOS

The hormonal imbalances experienced by women with PCOS can cause the following symptoms:

• Irregular menstrual cycles—those that are 3 to 5 days shorter or longer than a typical cycle (a normal cycle ranges between 21 and 35 days)
• Heavy or absent periods—some women with PCOS only menstruate one to two times a year
• Acne
• Excess facial and body hair

Causes of PCOS

The cause of PCOS is not completely understood. It is clear that there is a genetic basis to the condition, as a woman is more likely to develop the condition if her mother or sister has it. It is also known that disrupted signaling from the brain to the ovary affects ovarian hormone production, which further exacerbates, or worsens, the condition.

diagnostic tests for pcos

Your medical history and a pelvic exam are necessary for diagnosing PCOS. However, your physician may need other tests to confirm the diagnosis such as:

Blood hormone levels
Blood tests that reveal the levels of certain hormones in your blood, such as FSH, LH, estrogen (estradiol), and androgens

Ultrasound
A scan that uses high-frequency sound waves to identify the many small cysts in the ovaries

Endometrial biopsy
A procedure in which your physician obtains a sample of your endometrial tissue to help explain why your periods are irregular

treatment for secondary pcos

Your treatment will depend on your specific needs. Obesity may make the condition worse, so losing weight may help improve the hormonal imbalance. If your goal is to become pregnant, then your doctor may prescribe a medication to stimulate ovulation. Common fertility treatments include oral medications to help with ovulation such as clomiphene citrate (Clomid, Serophene) and letrozole. Your doctor may prescribe a second oral medicine, such as metformin, a diabetes drug, along with it that can help make the body more sensitive to insulin and lead to more regular ovulation.

Historically, Clomid has been the first line of treatment for PCOS; however, letrozole use has been increasing due to a possible increase in pregnancy rates. However, it is important to note that if you have not conceived after three to four cycles of Clomid, you should consider a different course of treatment, such as intrauterine insemination (IUI) or in vitro fertilization (IVF).

For women who may not be trying to become pregnant, medications such as hormones or insulin metabolism can improve irregular or heavy periods and other symptoms. Early diagnosis and treatment can reduce the development of acne and facial hair.

FAQ

Are there long-term risks associated with PCOS?
Long-term exposure to high levels of estrogen (and not enough progesterone) can lead to an increased risk of uterine cancer. Treatments such as birth control pills are available to reduce this risk. Since women who have PCOS may also be at increased risk for diabetes, your doctor may want you to have a screening test for this as well.