Polycystic Ovarian Syndrome
What is Polycystic Ovarian Syndrome and what are the latest ways to treat this disease if one desires pregnancy?
Polycystic Ovarian Syndrome or PCOS is diagnosed when a patient displays at least two of the following symptoms:
1. Excess hair growth on the face, abdomen, or chest or excessive acne
2. Chronic anovulation
3. Ultrasound evidence of polycystic appearing ovaries
This is a disease that affects greater than 7% of the population. The most commonly held belief today is PCOS is due to a genetic deficiency that causes insulin resistance. When a person is insulin resistant their insulin levels in their body increase. High insulin levels stimulate the ovaries to produce excessive adrogens leading to increased acne and hair growth. In addition, the high insulin and androgen levels inhibit ovulation.
The best approach to treating PCOS includes the following:
1. Weight loss of 5-20%
2. Exercise
3. Low carbohydrate diet
4. Ovulation stimulation with Clomiphene Citrate (Clomid)
For many patients Clomid will be inadequate. In these cases, low dose Follicle Stimulating Hormone either alone or used together with Clomid can be highly effective. Importantly, insulin sensitizing agents, such as Metformin and Actos, are no longer recommended in treating PCOS having been shown in several large studies to lack any benefit.
In the most resistant PCOS patients who fail all medical management, a surgical option called Laparoscopic Ovarian Drilling (LSOD) can be successful. LSOD is an outpatient surgery done through a small incision in the umbilicus (belly button).
PCOS is a complex disease entity. Many new and exciting adjuvant therapies are being researched. Unfortunately, most Primary Care and OB/GYN physicians do not have the time to specialize and keep up in this area. The best source of information about PCOS is a Reproductive Endocrinology and Infertility Specialist. Their three years of extra training focusing on the complete endocrine/hormone systems of the human body including PCOS allows them to give you the most up to date information.
Call today for an appointment with Dr. Dodds or Dr. Young if you think you have PCOS and want to learn more about your treatment options.
Tags: PCOS, polycystic ovarian syndrome
November 20th, 2010 at 6:19 pm
I have to disagree with the statement about Metformin not having any benefit with PCOS. I personally have PCOS, having been diagnosed in January 2007 by another RE. He put me on Metformin (1500 mg XR) and recommended diet and exercise to lose some weight. After 11 months, I had lost about 40 lbs and got my positive pregnancy test. During that 11 months that I was on Metformin, I never once took Clomid or any other fertility medications to assist in ovulation. I absolutely credit my getting pregnant to the Metformin.
As all of us familiar with PCOS know, carrying additional abdominal weight is a big factor in PCOS. Metformin is known for helping those with insulin resistance and, I believe, those with insulin resistance tend to carry more abdominal weight. So to me, it makes perfect sense to put a woman on Metformin who has PCOS.
By the way…in the months that I took Metformin I was able to have a somewhat regular cycle of 35 days and I was definitely ovulating. Prior to taking Metformin, I never got a regular cycle and did not ovulate.
It worked for me and it can work for you!
January 21st, 2011 at 2:12 am
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