UT Medical Group, Inc. - Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome (PCOS) affects about four percent of women, but many of them do not even know that they have the condition. Symptoms such as weight gain, irregular or no periods, excess hair growth, and infertility can be easily confused with other medical disorders.

The condition is usually diagnosed in women before the age of 30 and is more likely to develop in women who have a relative with the condition or who are obese.

Polycystic Ovarian Syndrome is characterized by enlarged ovaries with small cysts arranged around the surface of the ovary. (In a normal ovary, larger cysts occur in a random arrangement.) On a sonogram, these are visible as small cystic follicles--part of normal ovulation. These small cystic follicles (about 8 mm or 1/3" each) accumulate when the ovary does not ovulate.

Small cysts may be caused by stress, obesity, family genetics or other reasons. Once they start developing, they can create hormonal problems within the ovary, making the problem even worse.

Medications

For women who are not sexually active and who are not trying to become pregnant, progestin hormone pills for 10 to 14 days a month can be a useful therapy, says UT Medical Group reproductive endocrinologist Dr. Dan Martin.

"Birth control pills are preferable in those women desiring to avoid pregnancy at this time," he explains. "The progestin pills are similar to birth control pills but have less medicine. Progestin pills are not designed to prevent pregnancy but only to regulate periods. They are taken for 10 to 14 days a month whereas birth control pills are taken 21 or 28 days a month. A progestin shot may be useful in those women who have no desire for pregnancy, but the shot can sometimes take three to 12 months to wear off."

Dr. Martin says there are many medications used for those women with polycystic ovarian syndrome who are trying to get pregnant. These include:

Clomiphene (Clomid) is a fertility medication to increase ovulation.
Dexamethasone is similar to cortisone and Medrol. Dexamethasone is used to suppress the adrenal gland and immune response.
Parlodel is used suppress breast milk hormone after childbirth and can be used if breast milk hormone is high.
Thyroid is used to treat low thyroid
Human chorionic gonadotropin (HCG) is used to stimulate ovulation
Diabetic medication may be useful in some women. Some diabetic medicines work by increasing the sensitivity of the body to insulin and other hormones. These can also decrease hair growth, lower abnormal hormone levels, and increase the chance of ovulation. The increase in ovulation can occur without other medications. But, at other time, Clomid or other medication may still be useful.
Pergonal and other ovarian control hormones require more time, visits and expense. These resulted in septuplets (8 babies) in Iowa in 1997.

Surgery

In some cases, polycystic ovarian syndrome may be effectively treated by surgery, such as one of the following procedures:

Laparoscopic cyst puncture - The simplest of the surgical procedures, this technique punctures the cysts and allows them to drain. This allows the hormones to return to normal and generally gives the patient about 12 to 18 months of relief.
Open microsurgical wedge resection - This procedure has a longer effect, which is helpful since the cysts tend to reform over time. It is used both for fertility and for hirsutism (excessive hair growth), particularly when there is evidence of over function of the inner portion of the ovaries. Open wedge resection is generally avoided since laparoscopic puncturing of the cysts is an easier operation and causes less scarring than wedge resection.
Laparoscopic wedge resection – Laparoscopic wedge has been done as research. However, laparoscopic puncturing of the cysts is easier, and open wedge resection is a more accurate procedure.

Related medical conditions

Women who have polycystic ovarian syndrome may also be at risk for developing other, related complications, such as diabetes, cholesterol problems, and heart attacks, says Dr. Martin. Those risks are especially high for obese women with PCOS.

"Avoiding smoking and proper weight control can help to minimize the risk of developing these other medical conditions," he says. "Women should also have yearly exams that may include blood pressure monitoring, blood lipid profiles, and screening for diabetes (glucose & insulin).

If you think you might have polycystic ovaries or polycystic ovarian syndrome, be sure to get a thorough pelvic examination by your gynecologist or other health care provider to determine the best treatment for you.