The unfortunate term PCOS can be traced back to some surgeons in the early 20th century. They were operating on some women who had very infrequent menstrual cycles and they decided to inspect the big, round, smooth ovaries that looked almost like white cue balls on a pool table. Usually, the ovaries aren’t so smooth because the process of ovulation leaves craters on the surface of the ovary like craters on the moon. When they cut into these ovaries which appeared so unusual, they discovered that they looked almost like a pomegranate with the seeds arranged around the peel. They called what they saw “polycystic”, but there really aren’t any cysts-just immature, poorly developed egg follicles. The problem with these women was that they just did not ovulate, but their story left behind a legacy of a really bad name for their condition which has led to so much confusion. This syndrome should be called “Ovulatory Dysfunction”.
It is hard to believe that 15% of women in America do not ovulate on a regular basis. Although there are many reasons why ovulation might not occur, the most common cause has to do with being overweight and elevated blood sugars. Remember that 20-30% of Americans have pre-diabetes or worse. There are other causes of PCOS too many to mention here, but the end result is the same; infrequent and irregular periods, ovaries that have a classic look to them, and some sort of lab test that is abnormal. That’s PCOS.
As a fertility doctor, patients with ovulation disorders-PCOS make up to half the patients I see each day. The way to help them get pregnant revolves around trying to get the ovaries to develop mature eggs and then ovulate. We have various medications to get that done and a doctor can usually figure out a plan to get that done with either pills or injections or both. Weight loss is extremely helpful but of course, it is easier said than done. In fact, I often will treat aggressively for weight loss with diet pills even though patients typically put the weight back on later. The way I see it, once a woman is pregnant she is encouraged to gain 20-30 pounds anyway during pregnancy.
If the PCOS involves high blood sugars then a diabetes drug called metformin is sometimes all it takes to get the eggs to develop. This can be quite a difficult drug to take at first. Metformin can cause severe diarrhea and nausea. The good news is I that if you take the drug with an anti-diarrhea medicine such as Imodium you usually do just fine.
There is a lot to talk about with PCOS. Many women will have unwanted hair growth on their body while others will have significant acne. Some are bothered by the darkening of the skin at the folds such as behind the neck or the armpits or groin. Many suffer from mood disorders such as depression. All of these are symptoms of the hormonal disruption that has taken place in their bodies. The one important risk of PCOS aside from infertility and diabetes is the risk of developing cancer of the lining of the uterus. Women with PCOS need to be made to have regular menstrual cycles- at least every 2-3 months to prevent the risk of “endometrial cancer”. This is easy to do with a prescription for intermittent progesterone.
Once you have been diagnosed or if you believe you have PCOs you and your doctor need to sit down and plan out your goals for treatment. PCOS can affect you in so many ways and you must have a treatment in place so that you can take control of your body that can feel so out of whack.
