What is PCOS?
PCOS is thought to be the cause of up to 90% of ovulation disorders. It is characterized by evidence of excess male hormones (i.e., facial/chest/back hair, acne), irregular cycles, and ideally polycystic ovaries on ultrasound. Usually, patients have other metabolic syndromes as well: obesity, high blood pressure, prediabetes, etc. It is a complex and sometimes confusing picture, and because of this, it is a diagnosis of EXCLUSION, because other hormones can mimic the PCOS picture.
How do we diagnose PCOS?
We have to exclude other causes: gynecologic disorders, thyroid disorders, pituitary disorders, and a certain type of adrenal disorder. After excluding other causes, we consider three criteria, and if the patient has two of them, we can call the diagnosis:
- Physical OR lab evidence of excess male hormones
- Physical OR lab evidence of ovulation dysfunction
- > 12 ovarian cysts OR ovary size > 10cc on ultrasound
It’s harder to diagnose in adolescents because sometimes irregular cycles and cystic ovaries are just part of the NORMAL development.
I have PCOS, now what?
The diabetes medication metformin used to be prescribed just for PCOS, but this is no longer recommended. It will be used, however, if the patient meets diabetes or prediabetes criteria. Oral contraceptive pills are the first-line treatment. If additional control of masculine hair growth is needed, Spironolactone is the drug of choice.
Fertility and PCOS
Getting pregnant can be more difficult because of the irregularity of the cycles and determining for sure if each cycle has a successful ovulation. It is fundamental to control and optimize all metabolic syndromes prior to conception: BMI, glucose, blood pressure, etc., so lifestyle is key! If a couple has difficulty conceiving, there are a number of medications that can be used to assist in reproduction. Either endocrine or OB/GYN can facilitate this. If these fail, a reproductive endocrinologist can assist with IVF.