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Polycystic Ovarian Syndrome (PCOS)

Polycystic ovarian syndrome was described about a century ago by doctors Stein and Leventhal. PCOS is a common cause of female infertility and usually presents with symptoms of obesity, and extra hair growth, especially on the face, neck and abdomen. We now know that PCOS affects a wide range of women of all weights and is typically defined by elevated androgen hormones (male hormones), the presence of irregular menstrual cycles, extra hair growth, and ovaries covered with cysts seen on ultrasound.


The exact cause of PCOS is still unknown. It affects the ovaries, the adrenal glands, the pancreas, the skin, and the brain among other organs. We do know some of the laboratory findings that accompany PCOS including an elevated testosterone level that is above the normal female range though far lower than the normal male range.


PCOS can lead to an increased risk of diabetes, pre-diabetes, or diabetes in pregnancy. Women with PCOS tend to be overweight for unknown reasons. They may have a desire to eat more, or utilize the food they eat for more efficiently (extracting more energy) than non PCOS women who eat the same amount of food. Nevertheless, PCOS patients often struggle to maintain a normal body mass index (BMI). Patients tend to have the accumulated fat on their waist as apposed to their hips, with an increased waist to hip ratio. This is sometimes referred to as a “pear shaped” body appearance.


PCOS is effectively treated with birth control pills in women who do not wish to conceive. BCP’s prevent the extra hair growth in several different ways, preventing excessive testosterone production, increasing testosterone binding, and possibly by acting at the hair follicle to slow growth. When PCOS is accompanied by pre-diabetes, or when weight loss is desired, metformin, a medicine that has traditionally used to treat diabetes, may be used. Metformin lowers circulating insulin levels which are elevated in PCOS patients (hyperinsulenemia).


When the main symptom of PCOS is infertility, medicines to help regulate ovulation are used like Clomid, FSH or Letrozole. Metformin is also being used as a first line treatment for PCOS.


PCOS patients tend to make a lot of eggs when using ovulation inducing drugs, so they have an increased risk of multiple pregnancies. These drugs are best prescribed by physicians experienced in their use such as an infertility specialist/reproductive endocrinologist. Medical treatment is often combined with intrauterine insemination. (See ovulation induction section)