Polycystic ovary syndrome, abbreviated PCOS, is one of the leading causes of infertility. While the presence of multiple cysts is an important indicator of the disease, it is only one of many symptoms caused by PCOS, a condition that affects five to ten percent of all women.Polycystic ovary syndrome is not an ovarian condition, but a disease of the endocrine system. Hormone imbalances result in irregular menstruation and anovulation, an inability or failure to ovulate. Symptoms of PCOS most often develop within four years of a woman’s first period.
Polycystic ovary syndrome is caused by excess amounts of androgen. Androgens are hormones that control the development of male characteristics. The body responds by producing abnormally high amounts of luteinizing hormone, attempting to start the menstrual process. Estrogen levels are not affected by the excess androgen.
Androgen levels prevent follicle-stimulating hormones from activating progesterone, one of the hormones necessary for ovulation. As a result, the ovary’s follicles are unable to fully develop. The follicles turn into numerous small cysts. The cysts grow in number, leading to enlarged ovaries.
Enlarged Ovaries, Anovulation, Infertility and Other PCOS Symptoms
Despite the many symptoms associated with polycystic ovary syndrome, many women are unaware that they have the disorder. In addition to anovulation and enlarged ovaries, excess androgen levels can cause many other symptoms, including:
alopecia: hair thinning or baldness
amenorrhea: the absence of menstruation
hirsutism: excess body and facial hair
irregular menstrual periods
obesity, centered around the abdomen
type 2 diabetes.
PCOS Treatment Options
No known cure exists for PCOS: treatment focuses on managing its symptoms. Hirsutism may be controlled by mild oral contraceptives, although many doctors also recommend temporary cosmetic therapy such as waxing, electrolysis, and depilation.
Oral contraceptives can be used to maintain progesterone levels, allowing for a more regular menstrual cycle. A progesterone supplement called progestin may be used for this purpose. The down side, of course, is that such therapy only works while a woman takes the medication. Stopping the therapy for any reason, including attempts to conceive, causes a return of PCOS symptoms.
Polycystic ovary syndrome is a leading cause of infertility. Infertility treatment often starts with clomiphene citrate, a drug that induces ovulation and which has a high success rate when treating PCOS. Clomiphene induces ovulation in 75 percent of cases, and has a pregnancy success rate of thirty to forty percent. Fertility treatment may also include LHRH (luteinizing hormone releasing hormone) or FSH (follicle stimulating hormone).
Metformin: Treating PCOS and Type II Diabetes
A connection has been made between obesity, diabetes and PCOS. Weight loss and insulin modulating drugs appear to lower the excess androgen levels associated with polycystic ovary syndrome. Metformin is a drug that increases the body’s sensitivity to insulin, allowing the hormone to be used more effectively. Clinical trials are investigating the effect of metformin on women who have both PCOS and type 2 diabetes.