Understanding Polycystic Ovary Syndrome (PCOS) Video and Transcript
Margo S. Hudson, MD
Co-director, Polycystic Ovary Syndrome Program, Fish Center for Women’s Health, Brigham and Women’s Hospital
Instructor in Medicine, Harvard Medical School
Polycystic ovary syndrome (PCOS) is a constellation of symptoms rather than a specific disease. The cause or causes are not completely understood. Interestingly, the ovaries may develop cysts, but that is not necessary for the diagnosis of polycystic ovary syndrome. Many patients who have polycystic ovary syndrome or PCOS are overweight or obese and it is one of the most common hormonal problems in young women.
Menstrual Cycle Irregularities Associated with PCOS
In a normal menstrual cycle, the brain makes the hormone GnRH, which is released into a special circulation going to the pituitary gland. The pituitary gland then releases two hormones, FSH and LH, which travel in the bloodstream to the ovary, causing the ovary to produce an egg. The egg will then travel to the uterus and, if fertilized, will stay in the uterus. If the egg is not fertilized, it will be shed, and the woman will have a normal menstrual period.
We think one of the primary abnormalities in PCOS is the abnormal release of GnRH. Instead of being released in a regular cyclic manner, GnRH is released rapidly throughout the day. This disrupts the release of the LH and FSH in a way that LH is increased but FSH is decreased into the peripheral circulation. In response, the ovary makes more of the male hormone testosterone, an androgen, and ovulation is inhibited.
Women with PCOS may notice a constellation of symptoms. The most common are unpredictable and irregular periods. Acne is also common, as well as the development of coarse hair on many body parts. Depression and mood disorders are also extremely common in patients with PCOS.
Many of the symptoms of PCOS may not be noticed by the patient. In particular, blood sugar may increase because of insulin resistance and this can lead to a condition called pre-diabetes or even diabetes. Blood pressure can increase and women may develop high cholesterol levels and sleep apnea. Also, women with PCOS are at increased risk for certain cancers, such as uterine cancer.
The risks for some of these serious medical problems have just been quantified in a recent study. Women who were diagnosed with PCOS, compared to women of the same age without PCOS, had three times the risk of diabetes, stroke, and heart disease, twice the risk of anxiety, depression, and drug use and twice the risk of hospitalization for any cause. Women with PCOS were also found to have 10 times the risk of infertility.
A healthy lifestyle is the cornerstone of treatment for polycystic ovary syndrome. This includes maintaining a healthy weight, getting plenty of exercise and sleep, and, for women who smoke, making all efforts to discontinue smoking. There are also medical treatments available for polycystic ovary syndrome. Birth control pills will help cause regular periods and will also help lower testosterone levels. A medication called metformin will help lower insulin levels and improve insulin sensitivity. Spironolactone is available to help with excess hair growth. If spironolactone is not adequate for excess hair growth, laser therapy will remove unwanted hair.Nutrition education will help reduce excess weight, and psychological support can help reduce stress.
Because of the high risk for infertility, one question that women will often have is "Will I be able to get pregnant?" There are medications available to help correct ovarian dysfunction and lead to a normal pregnancy. Because some of these medications may lead to multiple births, they should be given by a specialist under close supervision. Once pregnant, a woman with PCOS should be closely monitored for the risk of diabetes in pregnancy or gestational diabetes.
Polycystic Ovary Syndrome Program at Brigham and Women’s Hospital
We offer a unique organizational structure to ensure coordination of care through our PCOS program coordinator. We also offer a full range of services including access to gynecology, dermatology, nutrition and weight management, metabolic and diabetes care and mental health referrals. If necessary, we can also refer for reproductive assistance.