Q: What is polycystic ovarian syndrome (PCOS)?
A: PCOS is a hormonal disorder linked to hyperandrogenism (high levels of androgens such as testosterone). Visible symptoms may include hirsutism (excess body and/or facial hair); irregular or infrequent periods; obesity; acne and/or oily skin (particularly severe acne in teenagers or acne that persists into adulthood); infertility; ovarian cysts; insulin resistance (also called impaired glucose tolerance, a frequent precursor to type II diabetes); hair loss or balding; Acanthosis nigricans (darkening of the skin, usually on the neck; AN is a sign of insulin problems as well); and skin tags, small pieces of excess skin in the armpit or neck area. Women with PCOS may also have, as the name suggests, ovarian cysts.
Q: How is PCOS diagnosed?
A: A health care professional will take a thorough history and physical, and may do a series of blood tests to check for hormone imbalances characteristic of PCOS, as well as ultrasound imaging of the ovaries. An essential criterion for the diagnosis of PCOS is irregular or absent menstrual periods.
Q: Which health care professional should I see?
A: Depending on your symptoms, your regular health care professional, gynecologist or dermatologist may be able to provide adequate treatment. More complex cases, however, or infertility cases, often require the expertise of an endocrinologist or reproductive endocrinologist.
Q: Should I try an insulin sensitizer to treat PCOS?
A: Certainly, if you have insulin resistance or type II diabetes, an insulin sensitizer would be an accepted approach to treatment. But health care professionals are undecided on whether these drugs should be used for PCOS in the absence of insulin resistance, diabetes or infertility treatment. Studies are under way that may provide a clearer answer. Meanwhile, based on successful small studies, many women are already asking for these medications and many health care professionals are prescribing them.
Q: What can I do if I can't conceive?
A: The first line of treatment is usually an ovulation-stimulating drug such as clomiphene citrate (Clomid). Potential side effects include hot flashes while the drug is taken, ovarian swelling that goes down with the onset of the period and an increase in the possibility of having twins. If clomiphene alone doesn't work, the next step may be injectable gonadotropin or, increasingly, an insulin-sensitizing drug in combination.
Q: Do I have to take birth control pills if I have PCOS?
A: No, although they are frequently prescribed to help the body back into regular menstrual cycles. You can take, instead, regular courses of progestogens (at least four times a year). Menstruation is essential, because it sloughs off the endometrial lining, helping to prevent uterine cancer.
Q: My ovaries have been removed. I can't possibly have PCOS, can I?
A: Yes. Polycystic ovarian syndrome is a rather misleading name for the syndrome, because it is really an endocrinological disorder that sometimes results (and sometimes doesn't) in small cysts on the ovaries.
Q: I've been taking medication as prescribed for weeks now and have seen no improvement. What should I do?
A: Stick with the program a while longer. It takes up to six months, for example, to begin to see effects with spironolactone. Insulin sensitizers, likewise, take two to three months to reach full effect. Consider adding a weight-reduction program as well if this is an issue.
Q: Do the symptoms of PCOS ever suggest anything more serious?
A: Yes, the possibilities include an androgen-producing tumor, Cushingâ€™s syndrome or hypothyroidism. A thorough diagnosis is important, especially if your levels of testosterone are above 200 mg/dl, or you have symptoms of â€œvirilizationâ€ such as facial beard, clitoromegaly (enlarged clitoris), balding at the temples, deepening voice or muscle enlargement.
Q: Should I be tested for diabetes if I have PCOS?
A: Yes. Due to the link between insulin abnormalities and insulin level and PCOS, every woman diagnosed with PCOS should have a fasting glucose and insulin test to check for insulin resistance and diabetes. If you have diabetes, it is important to begin treatment and monitoring early in order to avoid complications.