The polycystic ovarian syndrome or PCOS, is also known as the Stein Leventhal Syndrome, a group of gynecologists in 1935 that discovered this condition. PCOS is not only a medical condition of reproductive consequences, but of your entire metabolic system.  PCOS is one of the most common endocrinologic conditions in women of reproductive age ( around 5-10% in women) and its also one of the main factors for female infertility.

 

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Besides gynecologic disorders, what other medical conditions is PCOS associated with?

Besides female infertility and menstrual disorders, PCOS is associated with cardiovascular disease, atherosclerosis, hypertension, Diabetes Mellitus type 2, insulin resistance, endometrial cancer ( lining of the uterus) , sleep disorders, depression and anxiety.

 

How is PCOS diagnosed?

The diagnosis and therapy of PCOS is based in various methods and classifications.

The Institute of Health  (NIH) refers to PCOS as a medical condition that includes high levels of androgen levels in a female and irregular menstrual periods. (1990)

The Rotterdam classification (2003), refers to PCOS as: elevated levels of androgen in a female, anovulation and polycystic ovaries diagnosed with ultrasound.

The PCOS society (2006) established that PCOS is defined as high androgen levels in the female system, ovarian dysfunction defined by irregular periods, lack of menstruation (amenorrhea) and polycystic ovaries on an ultrasound exam.

Recently , a Task Force from the Endocrinologic Society designed new rules and criteria to diagnose polycystic ovarian syndrome: 1) Rotterdam criteria must be used for adult women 2) In girls and adolescent women the diagnosis is based on clinical symptoms and signs ( increased androgen levels) and irregular periods after other common causes of abnormal cycles has been ruled out 3) In perimenopausal and menopausal patients, PCOS is based on a long history of irregular periods and excess androgen levels 4) The finding of polycystic ovaries (PCOS) on ultrasound helps establish the condition, however is not mandatory on menousal patients  5) On the physical exam, excess terminal hair must be found, acne, acanthosis nigricans or even hair loss  6 ) Criteria used to diagnosed polycystic ovarian syndrome must include: Body Mass Index, Waist circumference, Blood pressure measurement , Glucose Tolerance test  7) Patient with PCOS must be evaluated for sleep disorders, anxiety and depression.

 

What are the therapeutic options for PCOS ?

The Endocrinology Society Task force recommended the following therapies for PCOS:

1) Oral contraceptive as a first line agen for menstrual irregularities and for acne

2) Exercise and diet to decrease BMI ( weight) and decrease chances of heart disease

3) Metformin ( a diabetic medication) is not longer recommended as a first line therapy, its only recommended for women with PCOS with Diabetis Mellitus Type 2 or with insulin resistance when they do not respond to weight loss and excercise , also for women who cant take or cannot tolerate OCP (oral contraceptives)

4) For women who suffer from infertility due to PCOS: clomiphene or clomid, its recommended as first line therapy.

5) Women that undergo IVF due to infertility problems, metformin is recommeded as a adjuvant therapy to avoid a serious condition called ovarian hyperstimulation syndrome, a medical condition that is relatively common in women who undergo IVF and suffer from polycystic ovarian syndrome.

If you suffer or have been diagnosed with polycystic ovarian syndrome, visit us at Pink Women’s Center, Katy Texas and West Houston, and we will help you achieve your health goals.

 

PCOS by Joel Rivera MD