PCOS

• 50 percent will develop diabetes
• 40 percent will develop gestational diabetes (during pregnancy)
  

Women with PCOS and insulin resistance are also more susceptible to heart disease, abnormal breast milk production, and endometrial (uterine) abnormalities, including uterine cancer.

How do you know you have PCOS?

Not all women with PCOS have the same symptoms. Some may notice these outward signs first:   

• Irregular or absent menstrual periods
• Acne
• Weight gain or difficulty losing weight
• Male pattern baldness or thinning hair on the scalp
• Hair growth on the face, back, or chest (hirsutism)

Less visible symptoms may include:

• High blood sugar (hyperglycemia)
• High cholesterol
  

PCOS may be hereditary. Women with family members with PCOS or Type II diabetes are considered at higher risk.

Women who do not have a menstrual period for more than six of any 12 months should see a physician, as PCOS is a possible cause. Regardless of PCOS diagnosis, women who have extremely irregular or absent periods are at much higher risk for cancer of the uterus.

How is PCOS treated?

PCOS sufferers cannot be cured, but their symptoms – including infertility – can be treated. Patients learn to manage the disease, just as they would any other life-long medical condition. Irritating but less serious symptoms like hirsutism, male-pattern hair loss, and acne will often respond to specific prescription medications that lower androgen levels.

Treatment can improve the chances of conception and reduce risks of diabetes or heart disease. Making lifestyle changes, especially nutritional and exercise habits, is a crucial part of treatment.

A key to reducing the symptoms of PCOS is the lowering of insulin levels. This can often be accomplished with medications. Any diet and physical activity that improves overall health will also considerably affect a woman's hormone levels and reduce her PCOS symptoms.

Treating Infertility from PCOS

The first steps in any infertility treatment will be semen analysis for the male partner and examination of the woman's reproductive system.

Overweight women will be advised to begin a healthy weight-loss program before or during infertility treatment. Studies have shown that some women experience spontaneous return of their ovulation and regulation of their cycles by simply losing weight through healthful eating and exercise.

Other women may need the further assistance of ovulation-inducing fertility medications, usually starting with clomiphene citrate tablets (the most common brand name is Clomid) or injectable drugs such as Follistim or Gonal-F. Treatment with these medications requires close monitoring by examination and ultrasound, as women with PCOS are more likely to have adverse reactions to fertility drugs. Injections of hCG are used to stimulate ovulation of matured follicles at just the right time.

If ovulation induction is followed by intrauterine insemination (IUI), the risk of a multiple pregnancy (twins or more) rises to about 18 percent. In vitro fertilization (IVF) can also be the course of action, with very good chances of pregnancy and fewer odds of high-order multiples.

Managing Hyperinsulinemia

Some PCOS patients also develop high levels of fasting blood insulin, called hyperinsulinemia, which is determined through blood tests. These infertility cases can be more difficult to treat. If a patient does not respond to initial treatment with fertility medications or develops resulting complications, her physician may prescribe drugs also used to treat adult onset diabetes. Daily doses of these medications can reverse hormonal abnormalities and eventually return normal menstrual and ovulatory cycles.

Can you prevent PCOS?

To date, physicians have not found a way to determine which girls may develop PCOS after menarche (the beginning of menstruation.) However, family history of obesity, diabetes, or infertility can be important indicators.

The earlier a young woman is diagnosed and begins managing PCOS, the less likely is long-term complications of infertility, heart disease, hypertension, and diabetes. Keeping family physicians and gynecologists informed about symptoms and following treatment plans helps the patient manage the disease.

For women who are not trying to conceive, hormone therapy through birth control pills or other hormonal contraceptives can be helpful. And all PCOS sufferers, regardless of desire to conceive or body weight, benefit from a healthy lifestyle of regular exercise and good nutrition.
 
Lastly, any woman with PCOS should be routinely monitored for complications such as:

• High blood pressure
• High cholesterol
• Heart disease
• Diabetes
• Uterine cancer