Polycystic Ovary Syndrome- From Initial Testing to Emotional Support
Eric Scott Sills, MD, Georgia Reproductive Specialists

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women, affecting an estimated five to ten million women of reproductive age. For women trying to conceive a child, PCOS is a serious, common cause of infertility - nearly half of all female factor infertility cases can be traced to PCOS. New medical insight into the disease has led to treatment options, including ovulation medication, dietary changes and surgery, which have proven successful and allow many women to overcome PCOS and conceive a child naturally. Women who undergo treatment for PCOS but are still unable to conceive naturally often turn to assisted reproductive technologies, including in vitro fertilization, and experience high pregnancy success rates.

Diagnosis

Women who have PCOS often have a number of apparently unrelated symptoms, including abnormal bleeding, infertility, obesity, excess hair growth, hair loss and acne. The condition likely has a genetic component and those affected often have both male and female relatives with adult-onset diabetes, obesity, high blood pressure and/or female relatives with infertility, excess hair growth and menstrual problems. Ultrasound reveals that polycystic-appearing ovaries are another common symptom among women with PCOS, but it is believed that PCOS may be present in women who don't fit the traditional medical profile.

Physicians have yet to come to an agreement on the preferred method for diagnosing PCOS. It is estimated that only 25 percent of women with PCOS have been diagnosed, largely due to the fact that doctors and researchers have only recently begun to understand the syndrome. Most physicians will consider a diagnosis of PCOS after ruling out other conditions such as Cushing's disease (overactive adrenal gland), thyroid problems, congenital adrenal hyperplasia or pituitary gland dysfunction.

Testing

After reviewing a patient's medical history, the physician will determine which tests are necessary, including male hormone, fasting insulin and glucose levels along with an ultrasound examination of the ovaries. If a patient has irregular or absent menstrual periods, physical exam clues will be factored in, including height and weight, increase in facial or body hair or loss of scalp hair, acne, discoloration of the skin under the arms, breasts and in the groin area. Additional testing including blood hormone levels, ultrasound and near-infrared absorptiometry may also be performed to confirm the PCOS diagnosis.

Women with PCOS are often at greater risk for other medical conditions, so testing for blood lipids, diabetes and abnormal blood clotting factors often follows the initial diagnosis in selected cases.

Treatment

Treatments for PCOS have traditionally been difficult and expensive, and have limited success when used alone. Today, through a combination of medicinal therapy and dietary changes, approximately 65 to 85 percent of patients with PCOS achieve a regular menstruation cycle. For those patients who are not trying to conceive a child but do want to get their PCOS under control, the use of anti-androgen medications such as birth control pills are successful in managing symptoms.

Many women with PCOS are able to conceive as a result of treatments, which may include dietary counseling, ovulation medications, ovarian drilling surgery and in vitro fertilization. During ovarian drilling surgery, a laser fibre or electrosurgical needle is used to puncture the ovary resulting in a dramatic lowering of male hormones within days. Typically, up to eighty percent of patients will benefit from ovarian drilling treatment. Women who have failed to ovulate with the use of ovulation induction medications, including clomiphene and Metformin, will respond to the medications when they are reintroduced to the system following ovarian drilling.

Through a combination of available treatments, many women are able to conceive. For couples that are still unable to conceive naturally following PCOS treatment, in vitro fertilization (IVF) is most often the next step. IVF success rates are higher and risk factors lower in patients who have their PCOS under control.

Support

The diagnosis of polycystic ovary syndrome can be overwhelming and confusing for many women. Your physician should be committed to working through the diagnosis and treatment plan step by step with you to put your mind at ease. In many cases, women are comforted by the opportunity to talk to other women who are going through the same thing they are. There are a number of Web sites dedicated to PCOS, including www.pcosupport.org and www.soulcysters.com, for the approximately five to ten million women in the United States who are affected by polycystic ovary syndrome.

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