Polycystic Ovarian Syndrome (PCOS)

The diagnosis of PCOS is typically a clinical one. These patients are typically overweight andhave 6 or fewer cycles per year, thus, by definition have decreased or absent ovulation. Nevertheless, many women with PCOS are very thin (or not overweight) and simply have irregular cycles (perhaps cycles every 45-90 days or more). PCOS is a common cause of infertility in women and may also be associated with elevated levels of male hormones (androgens) and ovaries that have multiple follicles (cysts) on their surface. PCOS patients are often resistant to insulin, a condition known as hyperinsulinemia. The elevated levels of insulin lead to overproduction of androgens (male hormones) by the ovaries.

Elevated levels of androgens cause the expression of male characteristics such as increased body hair (hirsuitism) and acne. PCOS patients often have a characteristic "pear shaped" body appearance, exhibit irregular ovulation, and are overweight. However, women who are not overweight can also have PCOS. Weight reduction will often correct PCOS because androgens are also converted to estrogens in the fat cells. It is very difficult for women with PCOS to loose weight.

Women with suspected PCOS should see a reproductive endocrinologist for a complete evaluation. PCOS is a complex condition and patients must be carefully managed as it can have long term health consequences such as diabetes and increased risk for cardiovascular disease.

Anovulatory (no ovulation) or oligoovulatory (decreased frequency of ovulation) in women with PCOS are usually initially treated with Clomid (clomiphene citrate). The starting dose is 50 mg or 100mg for five days of the menstrual cycle. If ovulation occurs, as evidenced by ultrasound confirmation of follicular development, or elevated levels of progesterone, Clomid may be continued for three to six months. Clomid may be increased by 50 mg each cycle if ovulation does not occur at a lower dose. The usual maximum dose is 200 - 250mg for 5 days (cycle days 3-7 or 5-9).

Many specialists now use Glucophage (metformin) as a "first line" treatment for PCOS. Metformin sensitizes the cells to insulin and corrects the underlying problem of hyperinsulinemia (elevated insulin). Once this condition is corrected, the ovaries reduce their production of androgens and ovulation can occur in up to 20% of patients without the additional use of Clomid. Sometimes Clomid and Metformin are given simultaneously. Many specialists recommend continuing metformin therapy "long term" to help prevent the adverse health consequences such as diabetes and increased cardiovascular risk.

If regular ovulation is not established with Clomid, metformin, or Clomid & Metformin; follicle stimulating hormone (FSH) is the next step. FSH (injectable drugs) with intrauterine insemination is also employed as the "next step" when pregnancy has not occurred after three to six ovulatory cycles on the Clomid or metformin regimens.

All PCOS patients undergoing ovulation induction with FSH should be managed by a reproductive endocrinologist. PCOS patients have a higher incidence of complications, such as ovarian hyperstimulation syndrome. Dosages must be carefully adjusted based upon estradiol hormone levels, ultrasound measurements, and clinical experience.

What is Syndrome O?

Ronald F. Feinberg, MD, PhD, FACOG
IVF Medical Director,Reproductive Associates of Delaware
Associate Professor ,Adjunct Yale University School of Medicine
Chairman, Professional Advisory Board for PCO Strategies , Inc.
Board Certified in Reproductive Endocrinology & Infertility
Board Certified in Obstetrics & Gynecology

Everyday, millions of women are struggling with heartbreaking problems - infertility, miscarriage, obesity, and cosmetic nightmares unimaginable to most men. Most of these women suffer in silence, since they don't know where to turn for help. Persistent frustration also pervades the lives of women who do seek care, aggravated by frequent doctor visits and costly, sometimes risky, fertility treatments. If that's not enough, there are the gynecologic "lady's problems" for countless others - missed menstrual cycles, heavy and unpredictable vaginal bleeding, bad reactions to birth control pills, and even unnecessary hysterectomy operations.

Amazingly, all of these diverse female health problems are closely related - a fact that is often not recognized by most doctors and nurses. Alternatively, many women are told by their health providers that they may have 'polycystic ovaries' or polycystic ovary syndrome (PCOS), a clinical label which doesn't really explain the root of their problem.

Syndrome O can be thought of as the 'World War III' of hormones in a woman's body - causing metabolism to be entirely out-of-whack, wreaking havoc with the possibility of getting pregnant and staying pregnant, and unraveling the normal sequence of hormone changes during the menstrual cycle. Left unchecked, Syndrome O leads to profound instability within the intricate internet of hormones and glands linking women's metabolism and reproduction. While the ovaries do bear a major brunt of Syndrome O, a cascade of hormonal disturbances occurs throughout the body, interfering with normal fertility and healthy pregnancies.

Syndrome O can also progress to much more serious medical complications - diabetes, uterine cancer, and heart disease - sometimes in young women. Only recently have these uniquely female health issues been linked to an imbalance in the insulin family of hormones. Essentially, the entire body can become the innocent victim of an exploding modern health phenomenon - the overproduction of insulin.

To read more about this modern epidemic affecting women everywhere, check out www.pcostrategies.org and www.ivf-de.org. PCOStrategies, a nonprofit organization, has gained national recognition for its devotion to education and research for women with Syndrome O and polycystic ovaries.