PCOS Treatment in Long Island
Polycystic ovary syndrome is a common hormonal disorder that affects 5%-10% of women. The diagnosis of PCOS is made when a woman has at least two of the following three characteristics:
- Inability to release an egg from the ovaries on a regular monthly basis.
- Increased male hormone levels and/or an increase in hair in the midline of the body known as hyperandrogenism.
- Polycystic-appearing ovaries on ultrasound. In patients with PCOS, multiple small follicles develop in the ovaries that appear as cysts, hence the term “polycystic.” These small cysts are actually immature ovarian follicles that failed to mature and ovulate.
Ultrasound picture of a polycystic ovary
Because of the variable nature of PCOS, its diagnosis is based upon the combination of clinical, ultrasound, and laboratory features.
Other diseases must be excluded before the diagnosis of PCOS can be made:
- Unexplained hirsutism
- Ovarian or adrenal tumor (excessive production of androgens)
- Non-classical adrenal hyperplasia (excessive production of androgens by the adrenal gland)
- Cushing syndrome (excessive production of cortisol by the adrenal gland)
- Medications (anabolic steroids, danazol, phenytoin, minoxidil, and diazoxide.natural supplements such as DHEA and androstenedione)
Irregular Menstrual Periods
The ovulatory cycle is easily affected by hormonal abnormalities. Overproduction or underproduction of certain hormones can have devastating results. Excess LH or insulin may cause the ovaries to overproduce androgens. Insufficient FSH may impair ovarian follicle development and prevent ovulation, resulting in infertility. Eventually, the multiple small cysts formed in the ovary from follicles that failed to mature and ovulate result in the PCOS appearance on ultrasound. Not all women with PCOS have ovaries with this appearance. Lack of ovulation in PCOS results in continuous high levels of estrogen and insufficient progesterone. Unopposed by progesterone, ongoing estrogen exposure may cause the endometrium to become excessively thickened, which can lead to heavy and/or irregular bleeding. Over many years, endometrial cancer may result due to continuous stimulation by high levels of estrogen unopposed by progesterone.
Hirsutism (male pattern hair growth)
Hirsutism, or excessive hair growth, is a condition where women grow hair on their face and body, including on their back, belly, and chest due to excess male hormones (androgens). If you are diagnosed with hirsutism, your physician may perform blood tests, ultrasound, special x-rays, and hormone tests to evaluate the function of your ovaries and adrenal glands. After identifying the causes of hirsutism, your physician can recommend the appropriate treatment. Women develop hair in the following areas:
- Upper lip
- Beard area
- Lower abdomen
- Inner thighs
- Lower back
- Chest and sternum
- Upper abdomen
- Upper back
Obesity commonly is associated with PCOS. Fatty tissues produce excess estrogen, which in turn contributes to insufficient FSH secretion by the pituitary gland. Insufficient FSH prevents ovulation and may worsen PCOS. In addition, obesity is associated with the development or worsening of insulin resistance, which may further increase androgen production by the ovaries.
PCOS Diagnosis and Treatment
If you are diagnosed with PCOS, treatment will depend upon your goals. Some patients may be concerned primarily with fertility, while others are more concerned about menstrual cycle regulation, hirsutism, or acne. Regardless of your primary goal, PCOS should be treated because of the long-term health risks such as heart disease and endometrial cancer.
Diet and Exercise
Increasing physical activity is an important step in any weight reduction program. Start slowly with an aerobic activity such as walking or swimming. Increase speed and distance gradually. Regular activity improves the state of mind as well as aiding in weight reduction. Recommendations include:
- 3 to 4 exercise periods each week with at least 30 minutes of aerobic exercise
- Get a fit bit and walk 10,000 steps a day
- Eat a healthy and balanced diet
- Don’t skip breakfast!
Extreme cases of obesity, unresponsive to medical management and behavioral modification, may be treated with bariatric surgery. Surgical risks have decreased over time and many procedures are performed in a minimally invasive way.
Hormonal treatment frequently is successful in temporarily correcting the problems associated with PCOS. If treatment is stopped, however, symptoms usually reappear. If you are not trying to conceive, birth control pills may be your best hormonal treatment. Birth control pills decrease ovarian hormone production and help reverse the effects of excessive androgen levels. However, birth control pills are not recommended if you smoke and are over age 35. If you also have hirsutism, your physician may prescribe spironolactone, alone or combined with birth control pills. Rarely, GnRH analogs may be used to decrease ovarian androgen production. If you are not concerned with fertility or contraception, and hirsutism is not a problem, you can take progesterone at regular intervals to regulate your menstrual bleeding and prevent the endometrial problems associated with excessive estrogen exposure.
Medical Therapy for Hirsutism
There are a variety of specific medical and surgical treatments that your physician may recommend based on your diagnosis and severity of hirsutism (Table 3). Most medications used to treat hirsutism are approved by the US Food and Drug Administration (FDA) but not for this specific indication. Nevertheless, research has documented its effectiveness.
Commonly, women with PCOS do not ovulate regularly, which may cause infertility. Medications which can assist this are:
If fertility is your immediate goal, ovulation may be induced with clomiphene citrate. Clomiphene is simple to use, is relatively inexpensive, and works well to induce ovulation in many patients. Clomiphene causes the pituitary gland to increase FSH secretion. Sometimes increasing the dosage or the length of treatment is necessary. Approximately 10% of pregnancies with clomiphene are twins; triplets are more are rare. Your physician also may recommend a steroid drug designed to suppress the adrenal gland to supplement clomiphene therapy.
There are many types of gonadotropins used alone or in combination with ovulation induction. They include human menopausal gonadotropin (hMG), purified human follicle-stimulating hormone (hFSH), recombinant follicle-stimulating hormone (rFSH), and human chorionic gonadotropin (hCG). Gonadotropins are more expensive and have a higher incidence of side effects such as hyperstimulation (excessive swelling) of the ovaries and a higher rate of multiple pregnancies such as twins or triplets.
This medication is an insulin-sensitizing agent that helps to reduce circulating insulin and androgen levels and restores normal ovulation in some women with PCOS. It can also assist fertility medications to help with ovulation. Side effects can include gastrointestinal irritation, especially diarrhea, flatulence, and abdominal bloating. This can be improved with low carbohydrate diets. Metformin should be avoided in women with kidney, lung, liver, or heart disease. It should also be stopped when having radiology exams that use iodine (such as hysterosalpingograms or CT scans). Lactic acidosis is a rare but serious adverse effect of Metformin.
Psychological Aspects of Hirsutism and PCOS
Dealing with hirsutism and PCOS can be emotionally difficult. You may feel unfeminine, uncomfortable, or self-conscious about your excessive hair growth or weight, as well as worried about your ability to have children. Even though you may be embarrassed to share these feelings with other people, it is very important that you talk to your physician as soon as possible to explore the medical and cosmetic treatments available to treat these disorders. It also is important for you to realize that these are very common problems experienced by many women.
PCOS Specialists in New York
PCOS can cause hirsutism, acne, irregular or heavy menstrual periods, lack of ovulation, and infertility. It also is associated with an increased risk of diabetes, uterine cancer, high cholesterol, and heart disease. Despite questions surrounding the causes of PCOS, advances have been made in both understanding and treating the condition. If you are diagnosed with hirsutism or PCOS, it is best to seek a specialist in PCOS who can address your goals and concerns and discuss the best treatment option for you.