Question on Polycystic Ovary Syndrome

Dear Dr. Spence,
Could you please give me some information regarding polycystic ovary syndrome? I have been doing some research into my infertility and am concerned I may have it.
Signed,
Concerned

Dear Concerned,
Polycystic ovary syndrome, or PCOS, is a common endocrine disorder affecting approximately 6% of reproductive age women. I can empathize with your position – PCOS is the leading cause of infertility. Its cause is unknown, but seems related to the overproduction of hormones like testosterone. Afflicted women have a constellation of signs and symptoms including the infertility, but also menstrual abnormalities, obesity, acne, excessive hair growth and an increased tendency towards diabetes mellitus. Women tend towards enlarged ovaries with multiple cyst formation, thus the name. It should be noted that women with PCOS are three times more likely to develop uterine cancer. Lab evaluation can be helpful; often the diagnosis is clinical. Supporting labs include elevated luteinizing hormone (LH) with possible increases in testosterone, and elevated blood sugars, so-called insulin resistance. Treatment is directed at improving and/or controlling symptoms of the disease. To assist with fertilization efforts, as in your case, drugs like clomiphene are used. Clomiphene can improve ovulation rates to 70% though actual pregnancy rates may fall to 30-40%. Women with PCOS who desire fertility are generally referred to and managed by reproductive endocrinologists. Women with menstrual irregularities not concerned with conception often use low dose oral contraceptive pills or medroxyprogesterone (proevra) every day for 10 to 14 days each month. This decreases the likelihood of abnormal uterine cell growth which is a contributing factor in the development of endometrial (uterine cancer). Women with excessive hair growth may use oral contraceptive pills as well and will usually note improvement after six months of treatment. Other medications that may be used for this condition include spironolactone and flutamide – they work by inhibiting androgen production which has been implicated in the aforementioned symptoms of PCOS. Finally, insulin resistance and elevations in blood sugar may eventually result in overt diabetes mellitus. To combat this, many physicians may use metformin (glucophage) initially as a stabilizing medication, though it is unclear if it should be used in those with normal glucose levels Certainly, the most important factor with polycystic ovary syndrome is in making a diagnosis in the first place. Like many diseases, it is under recognized in a clinical setting unless certain telltale symptoms arise. Many times these develop late in the course of the disease itself, delaying diagnosis for years.

Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.