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Vital Signs

 
Fall 2011

Early Identification and Treatment of Polycystic Ovary Syndrome Key to Successful Outcome

09/16/2011

VS-Fall11-OvarySyndromePolycystic ovary syndrome (PCOS), a hormone abnormality that affects as many as one in eight reproductive-aged women, is best known for its cosmetic effects — male-pattern hair growth and acne — but also is recognized for its gynecologic effects such as irregular menstruation and infertility. It is associated with both serious reproductive consequences and serious medical consequences, says Daniel Dumesic, M.D., UCLA obstetrician/gynecologist who specializes in reproductive endocrinology. The long-term health impact of PCOS and the fact that symptoms usually can be controlled with lifestyle changes and medications are strong reasons not to ignore early signs of the condition, Dr. Dumesic adds.

In its most severe form, PCOS is characterized by overproduction of the male hormone testosterone, which can cause male-pattern hair growth, acne or hair loss; and menstrual abnormalities related to the failure to ovulate. But Susan Davis, M.D., a UCLA endocrinologist, notes that 60-80 percent of women with PCOS — and 95 percent of obese PCOS women — also have resistance to the action of insulin, putting them at increased risk for abnormal glucose utilization, type 2 diabetes and premature cardiovascular disease. “PCOS can adversely affect the health of a woman by increasing her risk for numerous problems, including infertility, obstetrical complications, diabetes, cardiovascular disease, and mood disorders,” Dr. Davis says.

Some women with PCOS will go many months or even years without having their period, or menstruating only sporadically; by the time these patients bring the matter up with their physician, they may have developed abnormal build-up of the uterine lining, a precursor to uterine cancer. “Unfortunately, many women aren’t aware of the long-term consequences of PCOS,” Dr. Dumesic says. “They might be concerned about fertility problems or they will see a dermatologist about their skin or hair, but there are other issues to think about as well.” While missing an occasional period is nothing to worry about, menstruating fewer than eight times a year is cause for consulting a physician, Dr. Dumesic says.

Although genetic factors are believed to make certain women more susceptible to PCOS, Dr. Davis notes that lifestyle, including diet and exercise, plays an important role in its severity. In particular, excess weight exacerbates both the reproductive problems and the insulin resistance that is linked to diabetes. Thus, weight loss through diet and exercise is one of the most important strategies to combat the effects of PCOS.

Beyond that, treatment is individualized, depending on whether the focus is to correct the irregular uterine bleeding; restore fertility; correct excessive hair growth, acne and hair loss from excess male hormone production; or prevent diabetes and cardiovascular disease. For irregular uterine bleeding — typically from lack of ovulation — women with PCOS who aren’t looking to become pregnant are often prescribed oral contraceptives. Similarly, oral contraceptives, often in combination with an androgen blocker, spironolactone, can successfully address the effects of excessive hair growth and acne by inhibiting new hair growth. Electrolysis or laser therapy can be used to remove existing facial hair.

For women with PCOS who do not ovulate but want to become pregnant, several medications are available to restore ovulation. Oral clomiphene citrate increases release of a hormone from the head called folliclestimulating hormone (FSH), which stimulates ovarian follicles to grow. Oral metformin lessens insulin resistance and is often used to induce ovulation in women with PCOS with impaired glucose metabolism. Synthetic FSH also can be given as an injection under the skin to substitute for the woman’s own FSH as needed. These medications can be used alone or in combination, depending on the conditions of the woman. In rare cases, surgery or other procedures are necessary.

“Women with symptoms of PCOS can become quite depressed, and the message they need to hear is that much can be done for their quality of life as well as their overall health,” says Dr. Davis. “The earlier these issues are addressed, the greater the likelihood that we can improve cosmetic appearance as well as preventing serious medical complications.”





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