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Polycystic Ovary Syndrome (PCOS)

It is one of the most common causes of female infertility, but polycystic ovary syndrome (PCOS) affects the entire body, not just the reproductive system. Its exact cause is not known but may be due to a combination of insulin resistance, increased levels of hormones called androgens (such as testosterone) and an irregular menstrual cycle.

“PCOS is characterized by insulin resistance that drives abnormal production of testosterone. This, in turn, results in irregular menstrual periods,” says Rachel Kilpatrick, M.D., an endocrinologist at Washington Regional Endocrinology Clinic in Fayetteville. “It affects up to 10% of women and historically was diagnosed when they sought treatment for infertility.”

PCOS can increase the risk of developing other health conditions as well, such as Type 2 diabetes and cardiovascular disease. Some women with PCOS develop endometrial hyperplasia — when the uterine lining becomes too thick — which increases the risk of endometrial cancer. Women with PCOS are also more susceptible to sleep apnea and depression.

In addition to infertility, irregular periods and the ovarian fluid-filled sacs that give the disorder its name, other signs of PCOS include obesity, acne, other skin disorders and excessive hair growth on the face, chest, abdomen or upper thighs. “PCOS is a constellation of signs and symptoms,” Dr. Kilpatrick says, adding that the diagnostic criteria include having at least two of these three:

  • Ultrasound showing polycystic ovaries
  • Menstrual irregularity
  • Hyperandrogenism (high testosterone level)

“When I see someone for evaluation of PCOS, I first rule out other possible diagnoses,” Dr. Kilpatrick says. “Once the diagnosis is confirmed, we look at treatment options.” Treatment is tailored to each woman according to her symptoms, existing health conditions, and whether she wants to get pregnant. Medication treatment options include insulin-sensitizing drugs and drugs that combine the hormones estrogen and progestin.

“Lifestyle choices – like being physically active and maintaining a healthy weight – can go a long way and help some women avoid the need for medication,” Dr. Kilpatrick says. Overweight women with PCOS may find that losing even a small percentage of body weight can regulate their menstrual cycle, improve cholesterol and insulin levels and relieve excess hair growth and acne.

Choosing foods that contain probiotics may also benefit women with PCOS. Although very limited in scope, research has shown that probiotics may lower testosterone levels in women with PCOS. “There is some evidence that the gut microbiome may play a part in the pathogenesis of PCOS,” Dr. Kilpatrick says. “But until more research is done, my recommendation is to eat a balanced diet that is low in sugar and high in fiber. As I always say, eat more veggies!”

You can learn more about PCOS at Polycystic Ovary Syndrome (PCOS) | ACOG.