PCOS Treatment Options

What is PCOS?

In order to understand PCOS treatment, it is necessary to understand what PCOS is and the symptoms it can cause.
The cause of PCOS is not known, but genetics may play a role for some women. Women who have a mother or sister with the condition are more likely to have PCOS. PCOS is a hormonal imbalance (an excess of androgen, a male hormone) which can result in a constellation of symptoms, such as:

• Infertility (due to abnormalities of ovulation)
• Menstrual periods that may be irregular, infrequent  or absent
• Excess hair growth (hirsutism)
• Ovarian cysts
• Acne/oily skin, dandruff
• Obesity (weight is often centered around the abdomen)
• Thinning hair or male-pattern baldness
• Skin abnormalities (skin tags, skin patches that are thickened and discolored)
• Anxiety and/or depression
• Pelvic pain (due to ovarian cysts)
• Sleep apnea (cessation of breathing for short periods while asleep)

Diagnosis of PCOS may include a thorough history, a complete physical, blood work (to check hormone levels and glucose in your blood), a pelvic exam (to determine the size and shape of your ovaries) and possibly a pelvic ultrasound, which can detect ovarian cysts.

As stated, PCOS is a hormonal imbalance in which the ovaries produce too much androgen (male hormones), which affects the development and release of eggs. Insulin has also been implicated in PCOS: many women with PCOS have excess insulin circulating in their blood because their body is not able to use insulin properly. Having too much insulin promotes excess androgen, which causes many of the symptoms of PCOS such as acne and excessive hair growth.

How is PCOS Treated?

Unfortunately, there is no cure for PCOS. Treatment is aimed at relieving symptoms and preventing complications:

• Birth control pills- can be used to regulate periods, reduce excess hair growth and improve acne
• Insulin-sensitizing medications- these medications can be used to regulate menstrual periods. They work by lowering insulin levels. These drugs have not yet been approved by the FDA for use in PCOS, but some women have benefitted from treatment with them
• 
  Clomiphene/gonadotropins- Clomiphene is often used in women with PCOS to induce ovulation, or the release of a mature egg by the ovaries. If Clomiphene is not successful in inducing ovulation, gonadotropins may be used as the next line therapy. Gonadotropins are produced naturally by the body to stimulate ovulation. IVF (in vitro fertilization) is another option for women with PCOS who are unable to get pregnant on their own.
• Drugs that block the production of androgen- these drugs can be used to treat unwanted hair growth (such as facial hair), acne and thinning scalp hair. Although their use in treating PCOS is controversial and they have not yet been approved for the treatment of PCOS, their use is promising.
• Hair removal products- medications are available that slow the growth of unwanted hair. Women may also use depilatory creams, waxing, plucking or shaving to rid themselves of unwanted hair. Laser hair removal and electrolysis are other methods to remove hair and may provide longer-lasting results.
• Hair loss medications- for women who experience thinning of scalp hair, oral or topical medications may arrest the thinning of hair.
• Proper nutrition/dietary restriction- obesity is a major health issue for many women with PCOS. Obesity can lead to other health issues, such as hypertension, coronary artery disease and Type 2 diabetes. Women with PCOS may need the assistance of a nutritionist to design a diet to combat obesity.
• Exercise- exercise can keep obesity in check and prevent some of the complications of PCOS, such as heart disease. Women should exercise regularly as part of their overall health plan.
• Skin problems- skin tags can be removed relatively easily by any physician. Acne may require treatment with potent oral medication to keep it in check. Those women with mild acne may require only a good skin care regimen.

What complications can result from PCOS?

Untreated PCOS may lead to numerous health complications:

• Diabetes- many women with PCOS develop diabetes or pre-diabetes. Some studies estimate that 50% of women with PCOS will develop diabetes or impaired glucose tolerance before the age of 40.
• 
  Heart disease- women with PCOS have a four-fold to seven-fold risk of having a heart attack when compared to women without the condition. Hypertension is common in women with PCOS and may be exacerbated by obesity.
• Hypertension- women who suffer from PCOS are more likely to have hypertension, and may develop hypertension at a younger age than women without PCOS,
• Hypercholesteremia- women with PCOS tend to have high levels of “bad” cholesterol and low levels of the good kind. This can lead to the development of heart disease.
• Sleep apnea- women with PCOS are at higher risk of developing sleep apnea (a condition in which the sufferer stops breathing for brief periods while sleeping). This may be partly due to obesity, which raises the risk of sleep apnea.
• Depression- women who have PCOS may be more prone to develop anxiety and depression. This may be due to unpleasant aspects of the condition such as acne, infertility, obesity and hirsutism that may cause low self-esteem. Depression and anxiety may also be influenced by hormonal imbalance.
• Cancer- women with PCOS are at higher risk of developing endometrial cancer due to irregular menses and lack of ovulation.

As can be seen, PCOS is a complicated condition that may require treatment from various specialists. There is no cure, so women diagnosed with the condition must treat the effects of their disease on a symptom-by-symptom basis. Women who have difficulty conceiving should consult a specialist in PCOS and fertility. IVF may be possible for women who are unable to conceive. Depression is common in this condition and should be monitored and treated. By keeping their symptoms under control, women with PCOS can lead full and satisfying lives.