Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is one of the most common female endocrine disorders and is now recognised to be a Metabolic Syndrome.

  • How is PCOS diagnosed?

PCOS is diagnosed based on the inability to release an egg from the ovaries on regular (monthly) bases, increased male hormone levels and/or an increase in hair in the midline of the body (hyperandrogenism), and polycystic-appearing ovaries on ultrasound. Because of the variables nature of PCOS, its diagnoses is based upon the combination of clinical, ultrasound and laboratory features.

  • What risks do women with PCOS have?

 Lack of ovulation in woman with PCOS results in continuous exposure of their uterine lining (endometrium) to estrogen. This may cause excessive thickening of the uterine lining and abnormal bleeding. The unopposed exposure to estrogen without ovulation may lead to eventual uterine cancer or pre-cancer. Metabolic syndrome along with increased insulin level is more common in obese women with PCOS. This condition is characterized by

  • abdominal obesity

  • Cholesterol abnormalities

  • Hypertension

  • Insulin Resistance / Diabetes Mellitus.

 Each of these increases the risk of heart Disease.

Obesity is noted in over 70% of women with PCOS. Diet and exercise that result in weight loss improve the frequency of ovulation, enhance the ability to get pregnant, lower the risk of Diabetes and lower androgen levels in many women with PCOS. All hyperinsulinemic PCOS patients need long-term Metformin therapy for the above-mentioned beneficial effects.

  • What is the link between PCOS and Insulin/Glucose Abnormalities?

A majority of obese women with PCOS have decreased sensitivity to Insulin due to increased weight. Higher levels of Insulin are needed to keep sugar levels under control. The resulting high levels of Insulin may contribute to excessive production of male hormones (such as Testosterone) and can lead to problems with Ovulation (timely release of an egg).

  • How is Insulin Resistance diagnosed?

A 12 hour fasting Serum Insulin of more than 10 mlU/ml, diagnosis Hyperinsulinemia and Insulin Resistance. If your fasting serum insulin is more than 10mIU/ml you may be advice Metformin therapy by your physician.

  • How can you treat Insulin Resistance?

Regular exercise, weight loss and improved nutrition are very important. Lifestyle modifications should be the first line of therapy for overweight women with PCOS. Oral Insulin Sensitizing Agents like Metformin can be used in conjunction with life style modifications.

  • How is Infertility in women with PCOS treated?

Ovulation may often be induced with Clomiphene Citrate. In hyperinsulinemic PCO women, a 1-3 month pre-treatment with Metformin (when indicated) helps in the ovulation induction process. Gonadotropins (Injectable fertility medication) may be used to induce ovulation. However, gonadotropins are associated with a higher risk of multiple pregnancy and/or overstimulation of the ovaries (Ovarian Hyperstimulation Syndrome). Therefore, PCOS patients must be monitored very carefully when gonadotropins are utilized.

  • Should all PCOS patients be started on Metformin?

No Metformin should be given only if associated Hyperinsulinemia is diagnosed.

  • Should Metformin continue during fertility treatment and pregnancy?

For hyperinsulinemic PCOS patients, the continuation of Metformin during fertility treatment improves pregnancy rates.