Polycystic Ovary Syndrome (PCOS) Q&A with Dr. Simona Ioja

Q. What is Polycystic Ovary Syndrome (PCOS)?  

 
PCOS is the most common endocrine (hormone/metabolic) disorder, affecting approximately 10% of women of reproductive age and is the leading cause of female infertility across the globe. It may manifest as early as adolescence and continue post-menopause. The cause of PCOS is complex, involving multiple genetic traits that impact ovary function and testosterone production. The way the body regulates its glucose metabolism (via the hormone insulin) is an important aspect of the mechanisms causing PCOS. Body weight and energy metabolism also play a very important role.  
 

Q. What are the symptoms of PCOS and how is it diagnosed? 

 
Symptoms of PCOS vary by individual. Some women have the full range of symptoms, including irregular menstrual cycles, clinical hyperandrogenism– which includes hirsutism (excess body hair), acne, female-pattern hair loss - and polycystic appearance of ovaries on an ultrasound. Others have limited symptoms, so the diagnosis may be a bit more challenging. Many only get a diagnosis during testing for infertility. Regardless of the presentation, it is important to rule out other hormone disorders or conditions that mimic PCOS with simple blood tests. It is also important to acknowledge that women with PCOS are at increased risk for developing other complex conditions throughout their lifetime, such as cardiovascular disease, type 2 diabetes, sleep apnea, and non-alcoholic fatty liver disease.
 

Q. What role do hormone imbalances play in the diagnosis of PCOS, and how are they typically assessed? 

 
Various hormone abnormalities can be present in PCOS. A blood test can assess some of the hormones that are important for diagnosis, like testosterone. Other hormones are important to test in order to exclude other conditions. One of the “cornerstones” of PCOS is insulin resistance. However, we don’t recommend measuring insulin levels; other tests such as an oral glucose tolerance test, a fasting glucose level, or a hemoglobin A1C level are recommended instead. These tests are also routinely used for diagnosis of type 2 diabetes.  
 

Q. Is there a preferred treatment for PCOS? 

 
The treatment for PCOS varies by patient and depends on whether the symptoms are important to the patient and their overall health. For instance, various hormone pills can be prescribed for control of irregular menstrual cycles, excess body hair, and acne. Laser hair removal in combination with medical therapy can be effective for body hair control. Some may benefit from treatment with Metformin, a drug commonly prescribed to treat type 2 diabetes. Women with PCOS who desire pregnancy and experience difficulties getting pregnant have various treatment options including medications or assisted reproductive techniques like in-vitro fertilization, if medications fail. Lifestyle changes are of utmost importance for the management of PCOS symptoms and its associated possible complications – dietary intervention and exercise can benefit many aspects of PCOS. Bariatric or metabolic surgery can also be considered a valuable treatment option.

by Dr. Simona Ioja of Southern NH Diabetes & Endocrinology