Understanding Polycystic Ovarian Syndrome

Q: Ever since I began menstruating at age 16 (I am now in my adult years) my periods have been abnormal. It is not unusual to go many months without one, and the bleeding is often very light when it arrives. My doctors wanted to put me on birth control medications to regulate my cycle, as well as medications for polycystic ovarian syndrome. However, my husband and I want to have a child. Please tell me how they know I have this syndrome, and can I still have a child?

A: A diagnosis of polycystic ovarian syndrome takes into consideration a variety of factors including blood tests, procedures such as an ultrasound, a physical examination, as well as a personal history (irregular menstruation, others) suggestive of this health concern. While I understand your frustration regarding the use of birth control pills to regulate your menstrual cycle, please know that is an effective approach for women who don’t want to get pregnant. Since you and your husband do want to have a baby, reproductive techniques (fertility medications, in vitro fertilization, others) may prove to be very helpful in your efforts to conceive.

Polycystic ovarian syndrome is a hormonal disorder in which androgens (male hormones) are produced in larger quantities than normal. It is common, affecting 5 percent to 10 percent of women. While the initial signs may appear during a woman’s early to mid-teen years, a diagnosis is often delayed until her 20s or 30s. That’s because the symptoms may be few (thinning scalp hair, acne) or many (irregular periods, increased body hair, weight gain, others), resulting in a varying pattern that is not initially attributed to a particular syndrome.

Unfortunately, this delay often takes an emotional toll due to uncertain diagnoses that end up leading to ineffective treatments. However, once a proper diagnosis is made, we do have medications (birth control pills, metformin, spironolactone, others) and lifestyle suggestions (exercise, weight loss, healthier diet, etc.) that have proven to be very helpful in reducing the signs, symptoms and long term health risks associated with this condition.

The hormonal changes seen in PCOS have the potential to affect many body systems. While some may be obvious, others are not. And, what may affect one woman may not affect the other. The outward signs include:

• Increased growth of hair on the face, back, chest, upper arms and upper legs
• Acne
• Weight gain, with extra fat distribution around the abdomen
• Thinning scalp hair or baldness, similar to a pattern seen in males
• Extra growths of skin (skin tags) around the neck or in the armpits
• Darker and thicker skin under the arms, neck, under the breasts, inner thighs, etc.
• Decrease in the size of the breasts
• Obstructive sleep apnea

There are also internal changes that have the potential to occur. These include but are not limited to:

• Reduced fertility or infertility
• Irregular (35 days or longer between periods) or decreased menstrual cycles (eight or less per year)
• Elevated insulin levels or insulin resistance (increases the risk for diabetes and cardiovascular disease)
• Diabetes or pre-diabetes
• High blood pressure
• Increased triglycerides
• Increased risk for non-alcoholic fatty liver disease
• Higher levels of the bad cholesterol known as LDL
• Decreased levels of the good cholesterol known as HDL
• Thickened inner lining of the uterus (endometrium). As a result, there is an increased risk for endometrial cancer.
• Enlarged ovaries and, in some women, increased numbers of ovarian cysts

There are other causes of irregular menstruation (thyroid disorder, poor diet, illness, stress, intense exercise, others) that may contribute to your problem. This makes it especially important to have a thorough evaluation by a physician with expertise in women’s reproductive health—a family doctor, gynecologist or reproductive endocrinologist. That said, a diagnosis of PCOS is based upon many factors, including:

• Your medical history (when did your periods begin, how long do they last, what is the interval between cycles, others)
• Family history (a possible hereditary link with a mother or sister with similar symptoms)
• Physical appearance and pelvic exam (enlarged ovaries)
• Blood tests for androgens (male hormones such as testosterone), female hormones (estrone, estradiol), thyroid, fasting blood sugar, and hormones known as LH, FSH, prolactin, others

If there is still a question as to your diagnosis, further testing may be requested. This would include a transvaginal and/or pelvic ultrasound (to get a better picture of the ovaries), and possibly, a laparoscopy (looking at the lining of the uterus and ovaries using a lighted instrument).

While there is no cure for polycystic ovarian syndrome, it is treatable—and the earlier the diagnosis, the better the physical, as well as emotional, outcome.

For further information, check out the American Association of Clinical Endocrinologistsand the American Society for Reproductive Medicine.

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)