PCOS Defined

Endocrinopathy Syndrome
- Hyperandrogenism
- Chronic Anovulation
- Once congenital adrenal hyperplasia and tumors and ruled out, PCOS may be presumed
Most often, symptoms first appear in adolescence, around the start of menstruation. However, some women do not develop symptoms until their early to mid-20’s.
Although PCOS presents early in life, it persists through and beyond the reproductive years.
Polycystic ovaries are not present in all women diagnosed with PCOS. Also, many women with regular menstrual periods and normal testosterone levels have cystic ovaries.

Follicles are sacs within the ovaries that contain eggs. In polycystic ovary disease there are many poorly developed follicles in the ovaries. The eggs in these follicles do not mature and, therefore, cannot be released from the ovaries. Instead, they form cysts in the ovary.
The immature follicles and the inability to release an egg (ovulate) are likely caused by low levels of follicle stimulating hormone (FSH) and higher than normal levels of male hormones (androgen) produced in the ovary.

Insulin resistance is a condition in which person’s body tissues have a lowered level of response to insulin, a hormone secreted by the pancreas that helps to regulate the glucose (sugar) level in the body.
Insulin resistance can be thought of as a set of metabolic dysfunctions associated with or contributing to a range of serious health problems including PCOS.
As a result, the person’s body produces larger quantities of insulin to maintain normal levels of glucose in the blood.
PCOS patients can have high insulin levels along with high glucose levels in the blood at the same time.

Abnormal, irregular, or very light or infrequent periods
Absent periods, usually (but not always) after having one or more normal menstrual periods during puberty (secondary amenorrhea)
Acne that gets worse
Decreased breast size
Development of male sex characteristics (virilization), such as increased body hair, facial hair, a deepening of the voice, male pattern baldness, and enlargement of the clitoris
Diabetes
Infertility
Poor response to the hormone insulin (insulin resistance), leading to a build-up of insulin in the blood
Weight gain, or obesity

Weight Loss – that may be difficult, but even a loss of as little as 5% to 7% over 6 months can lower insulin and androgen levels. This restores ovulation and fertility in more than 75% of women with PCOS.
Exercise
Infertility Treatments
Birth Control Pills – to regulate menstrual periods
Antiandrogens – (e.g. spironolactone, flutamide, cyproterone acetate) – block the effect of androgens (male hormones, including testosterone). In high doses, anti-androgens can reduce unwanted hair growth and acne.
Smoking Cessation – Women who smoke have higher levels of androgens than women who don’t smoke. Smoking also increases your risk of heart disease.
Hirsutism Treatments – many women with PCOS experience hirsutism but not all women with hirsutism have PCOS
- Metformin (Glucophage®) – reduces insulin levels, which reduces the ovarian testosterone levels by competitive inhibition of the ovarian insulin receptors. This drug is effective in treating hirsutism in women with PCOS.
- Eflornithine hydrochloride Cream 13.9% (Vaniqa®) – a prescription topical cream that acts as a growth inhibitor. Continued twice daily use for at least 4-8 weeks is necessary before effectiveness is noted.
- Electrolysis

Rather than focusing on relieving specific symptoms, the newer treatments aim at what may be the root cause of PCOS, i.e., insulin resistance. many of these new therapies are designed to lower insulin levels, thus reducing productions of testosterone.
Pioglitazone (Actos®) and Resiglitazone (Avandia®) are insulin-sensitizing agents that improve glucose tolerance and insulin resistance. These drugs are approved by the Food and Drug Administration (FDA) for the treatment of diabetes. Although they are not approved for treatment of PCOS, they have been shown to be effective for this purpose in many studies.
Metformin (Glucophage®). Metformin is an insulin-lowering drug. It is approved by the FDA as a treatment for diabetes, but is not yet FDA-approved for use in treating PCOS. In clinical trials, metformin has been shown to be very effective in restoring menstrual cycles in many, but not all, patients with PCOS.

Regular exercise
Low Glycemic Index Foods
Carbohydrate Addicts Diet
Books:
- Glycemic Load Diet by Rob Thompson
- Glycemic Load Diet Cookbook by Rob Thompson and Dana Carpender

There are a variety of online support groups for women suffering from PCOS
- PCOS Support Polycystic Ovarian Syndrome Association, INC. http://www.pcossupport.org
- PCOS Support Group http://www.dailystrength.org/c/Polycystic-Ovarian-Syndrome-PCOS/support-group

A.D.A.M.creates health content for consumers that is physician-reviewed by experts in their field. ©1997-2010 A.D.A.M., Inc
Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, PA: Mosby;2007
The University of Chicago Medical Center. (2010) Polycystic Ovarian Syndrome. Accessed on 12/5/2010 from http://www.uchosputals.edu/specialties/pcos/treatment.html