Polycystic Ovarian Syndrome (PCOS)

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Polycystic ovarian syndrome (PCOS) is an endocrine disorder that affects 10% of women in childbearing age. In PCOS, the ovaries produce excessive amounts of male hormones and develop many small cysts. PCOS is a common cause of infertility, menstrual irregularity and excessive hair growth.

How Does PCOS Cause Infertility?

PCOS is caused by hormonal imbalances that prevent ovulation. A woman with PCOS will not produce enough FSH (follicle stimulating hormone) to make the ovary mature and release eggs during a menstrual cycle. Instead, the ovary will make immature follicles that will develop into small cysts. Since no follicle becomes large enough and no egg matures or is released, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman’s menstrual cycle is irregular or absent, resulting in infertility.

At the same time, women with PCOS will produce too much LH (luteinizing hormone), which tells the body to produce too much estrogen and androgens (male hormones). High levels of estrogen can cause a thickening of the uterine lining which in turn leads to heavy and irregular periods. High levels of androgens can lead the body to develop acne and excessive hair growth and these male hormones also prevent ovulation.

What Are PCOS Symptoms?

Not all women with PCOS share the same symptoms. Some of the common symptoms include: infertility, infrequent or no menstrual periods, irregular bleeding, increased hair growth, acne, weight gain/obesity, diabetes, high cholesterol, high blood pressure, thinning hair and pelvic pain.

How is PCOS Diagnosed?

To diagnose PCOS, Dr. Zoneraich normally uses the following tests in addition to the presence of PCOS symptoms:

• Transvaginal Ultrasound – this is performed at the onset of a menstrual cycle (days 2 to 4) and gives Dr. Zoneraich the ability to evaluate the ovaries and see how many follicles are present and if they have a characteristic appearance of polycystic ovaries (many small cysts along the edge of the ovary in the “string of pearls” configuration). For a diagnosis of PCOS to be made, a woman MUST have polycystic appearing ovaries.
• Hormonal Blood Tests - to measure the levels and ratios of your key reproductive hormones.
  • FSH (follicle stimulating hormone), LH (luteinizing hormone), E2 (estradiol) – normal ratios of FSH:LH are 2:1 and reversal of this ratio with higher levels of LH suggests PCOS.
  • Androgens (testosterone and DHEAS) – male hormones are produced both by the ovaries and adrenal gland; excess amounts can be a contributor or result of PCOS like symptoms.
  • 17 Hydroxyprogesterone – a hormone level that serves as a screening test for congenital adrenal hyperplasia, a condition of the adrenal gland that can have other more severe consequences on health as well as contributing to PCOS like symptoms. If abnormal, further testing and treatment would be required by a medical endocrinologist.
• Glucose and Insulin Testing – In most cases, patients who are suspected to have PCOS will be required to undergo a 2 hour glucose tolerance test with insulin levels in order to determine if there is a problem with insulin absorption in the body. Abnormal insulin metabolism can lead to ovulatory issues, weight gain, and potential pre-diabetic conditions.

How is PCOS Treated?

If you are trying to get pregnant and you have PCOS, Dr. Zoneraich has many options available for you. Treatment plans will be based on your specific findings and needs, the severity of your PCOS, and any other infertility issues that you may face.

Common treatments for PCOS include fertility medications to help induce ovulation. These medications can be either oral medications or injectable medications. For women with documented insulin insensitivity, insulin sensitizing medication such as metformin (Glucophage) may be prescribed as well in hopes of resulting in more regular ovulation. If obesity is part of the PCOS, losing weight will also likely improve your symptoms, spontaneous ovulation, and overall chances for pregnancy. Take a few minutes to read more about weight & fertility.

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