PCOS: When Missed Periods and Infertility Are More Than A Gynecology Issue

Rhoda H. Cobin, MD, MACE, ECNU and Rachel Pessah-Pollack, MD, FACE

By Rhoda H. Cobin, MD, MACE, ECNU and Rachel Pessah-Pollack, MD, FACE

Polycystic (pah-lee-SIS-tik) ovary syndrome, commonly known as PCOS, is the most common endocrine condition in females of reproductive age, affecting as many as one out of 10 in the U.S.

Commonly known as PCOS, the syndrome was first discovered in 1935 by American gynecologists Dr. Irving Stein and Dr. Michael Leventhal, from whom its original clinical name of Stein-Leventhal syndrome was taken. But despite its prevalence, there is still a significant amount of misunderstanding and confusion surrounding PCOS.

Even though the name suggests that the ovaries are central to pathology of the disease, cysts are not a cause of PCOS, but rather a symptom. And it is not simply a gynecological disorder impacting a woman’s reproductive system. It can also affect hormones, sugar metabolism, lipids (blood fats) and blood vessels.

For some women, PCOS symptoms emerge shortly after they begin menstruating. Others may not show signs of the disorder until later in life, or after substantial weight gain. And many are unaware they have PCOS and don’t receive a diagnosis until they are struggling to get pregnant. In fact, PCOS is the most common cause of infertility in women of child-bearing age.

Although PCOS is believed to be genetic, the exact genes and patterns of inheritance are not clear.

There is currently no single, simple test for diagnosing PCOS. Physicians look for a variety of symptoms, some of which are manifested in appearance. Among the physical clues that PCOS may be present are excessive facial and/or body hair, a condition known as hirsutism; acne; patches of thick, darkened skin on the neck, groin, underarms, or skin folds (a condition called acanthosis nigrican); loss of scalp hair; skin tags, which are small, soft flaps of skin that resemble tiny, extended fingers; and weight gain, particularly around the middle section of the body.

Additional symptoms include irregular or absent menstrual periods, elevated cholesterol, high blood sugar and recurrening pregnancy loss.

If you are suspected of having PCOS, your physician may use a diagnostic tool such as an ultrasound to determine if your ovaries are enlarged and contain numerous small cysts (polystic) located along the outer edge of each ovary that often resemble a string of pearls. However, this test is not absolutely necessary, as the ovaries may not look abnormal, and having ovarian cysts does not mean that you have PCOS.

Hormone testing may also be used to determine if you have elevated levels of the male hormone testosterone; elevated luteinizing hormone, which stimulates ovulation and is involved in the production of estrogen; normal-to-low folliclestimulation hormone (FSH) levels; and an elevated level of prolactin, which can interfere with ovulation and decrease fertility. Testing cholesterol, triglycerides and blood sugar is also part of a thorough evaluation.

Not all women with PCOS have all of the medical problems associated with the syndrome. Each person may have a different combination of symptoms. In addition, other conditions may cause some of these health issues, which is why PCOS can sometimes be difficult to diagnose. Your doctor also will try rule out other possible causes for your symptoms.

PCOS cannot be cured, but it can be treated. Treatment depends on the patient’s age and the severity of symptoms. For teenagers concerned with the acne and facial hair that can accompany PCOS, medications such as birth control pills can decrease production of androgen hormones (which stimulate or control the development and maintenance of male characteristics), while others can reduce their impact. Women with irregular periods will be prescribed medication to help regulate their periods and help shedding of the uterus lining to prevent build up, which decreases the risk of uterine cancer. For women trying to conceive, medications to help ovulation will usually be needed, but not always. Women who are menopausal should discuss with their physician the benefits and risks of hormone replace treatment to treat the PCOS.

The condition can lead to an increased risk of some serious long-term health issues such as diabetes and cardiovascular disease, so it's important to get the right diagnosis and treatment. Diabetes is four times more likely to develop in a PCOS patient, especially is there is a family history of diabetes. Also, the risk of developing high blood pressure and certain lipid abnormalities—which increase the likelihood of a heart attack or stroke—require that blood pressure and cholesterol be routinely monitored.

A good first step after diagnosis is to lose weight, which can help restore hormone balance. With proper lifestyle changes and treatment, you can help improve most of your symptoms and reduce the chance of developing health issues related to PCOS.