What is Polycystic Ovary Syndrome?
What can you tell me about polycystic ovary syndrome? How should it be treated?
When I was in medical school, polycystic ovary syndrome (PCOS) was called Stein-Leventhal syndrome or polycystic ovary disease. Sadly, back then, it was often viewed mainly as a cosmetic problem because women who had the condition often had unsightly facial and body hair, male pattern baldness, severe acne, and excess body fat. Fortunately, much more is known about polycystic ovary syndrome today, although we still don't know what causes it. Essentially, PCOS is a condition in which the ovaries are enlarged and contain multiple cysts. Affected women have irregular menstrual periods, and the syndrome is now believed to be the most common cause of infertility among women.
In the past, we believed that the menstrual irregularity, excess hair, obesity, and acne were due to abnormally high levels of androgen (male hormones that are also secreted in small amounts by normal ovaries). More recent research suggests that some women with polycystic ovaries (about 30 percent) are also resistant to insulin, the hormone needed to absorb sugar from the bloodstream. This abnormality can lead to diabetes, which in turn is a risk factor for heart disease. Because women with polycystic ovaries don't menstruate regularly, they are also at higher than normal risk for endometrial cancer, a malignancy of the lining of the uterus.
Despite increasingly sophisticated medical knowledge about PCOS, there is no single effective treatment. Doctors may prescribe birth control pills to regulate the menstrual cycle and help reduce the risk of endometrial cancer. Anti-androgen drugs can often help reduce excess facial hair and acne, and infertility drugs can help some women with PCOS become pregnant. Some women with PCOS have found that high-protein, low-carbohydrate diets are more effective for weight loss than low-fat or low-calorie diets.
More recently, however, treatment has focused on controlling insulin resistance. By lowering insulin levels, you also reduce androgen production and may help regulate menstruation. A number of drugs designed to lower insulin levels among diabetics can be used to treat PCOS. They include Metformin (Glucophage), Pioglitazone (ACTOS), and Rosigliatazone (Avandia) -- all are considered relatively safe. (Another insulin-lowering drug, Rezulin, was prescribed for PCOS in the past, but was withdrawn from the market in March 2000 because studies showed that it could be toxic to the liver.)
To keep up with the latest research on PCOS, go to the Polycystic Ovary Syndrome Association's Web site.