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PCOS: A complex diagnosis for women

It's a medical mystery for some women. Symptoms like irregular menstrual cycles, hair loss, weight gain, insulin resistance, acne and excessive hair growth can bring many questions and worries. But, the mystery can be solved.

What is PCOS?
"Polycystic ovarian syndrome, or PCOS, is a metabolic syndrome disorder that causes hormonal imbalances in women," says David Goldstein, MD, Virtua obstetrician/gynecologist. "Those imbalances can affect fertility, the body's response to insulin, and may cause cardiovascular complications, weight gain and diabetes if untreated."

In a woman without PCOS, the body's hormones stimulate ovaries to release an egg. This is ovulation and, without pregnancy, the cycle ends in menstruation. But if a woman has PCOS, her ovaries have tiny cysts that interrupt the hormonal cycle. This can cause the ovaries to release an egg infrequently and prevent ovulation from occurring at regular intervals.

While researchers aren't sure what causes PCOS, Dr. Goldstein says there are treatment options for women with the syndrome.

"If a woman is overweight, weight loss is always the best treatment to get menstruation back on track," he says. "And for women who aren't ready to become pregnant, birth control pills are an option."

That's because birth control pills help regulate a woman's menstrual cycle, and can ease the pain and heavy bleeding that may come with it.

Metformin, a drug commonly used to treat people with type 2 diabetes, can also be used to alleviate PCOS symptoms. "Women with PCOS can also be insulin resistant," says Dr. Goldstein. "This drug regulates high insulin levels, which interfere with the hormones that stimulate and regulate ovulation."

PCOS and pregnancy
Because women with PCOS ovulate irregularly, they can have difficulty getting pregnant. Gary Packin, DO, a reproductive endocrinologist says: "Up to 40 percent of the women I see suffer from PCOS."

He says metformin can help a woman with PCOS and insulin resistance get pregnant by regulating insulin levels, and allowing her hormones to work properly.

Clomiphene is a treatment option for women who don't respond to metformin. "Clomiphene can help a woman get pregnant faster," says Dr. Packin. "It stimulates her ovaries to release an egg, increasing chances of conceiving."

For those women who do not respond to metformin or clomiphene when trying to conceive, injectable medications may help. With careful monitoring, injectables have a very high success rate.

Women with PCOS may also be more likely to develop complications in pregnancy. Virtua maternal fetal medicine specialist Ronald Librizzi, DO, explains: "Women with PCOS are at greater risk for gestational diabetes, high blood pressure, and birth defects if glucose and insulin levels get too high early in the pregnancy." Dr. Librizzi adds: "These women may need more specialized care."

Dr. Librizzi, along with Virtua's other maternal fetal medicine specialists, provides high-risk maternity care to women with chronic medical conditions. Women who see Dr. Librizzi do so with a referral from their obstetrician/gynecologist.

"Having PCOS doesn't automatically mean a high-risk pregnancy," says Dr. Librizzi. "But getting the right kind of treatment from the best specialists at Virtua will help women have healthy pregnancies."