Women with PCOS do not ovulate regularly. Because there is no regular ovulation, women experience irregular menstrual bleeding.
Sometimes this means women skip cycles and sometimes it means women have heavy bleeding or experience two cycles in a month.
Women with PCOS can also have elevated levels of testosterone in their blood and/or outward signs of high testosterone like unwanted hair growth, balding, and acne.
PCOS is usually diagnosed with a thorough history, physical exam and lab work.
Interestingly, an ultrasound of the ovaries is not usually necessary and some women diagnosed with PCOS may have normal-appearing ovaries on ultrasound.
A primary goal in PCOS treatment is to regulate the menstrual cycle. It is important that a women who skips cycles has a period AT LEAST every three months. This helps ensure the lining of the uterus, known as the endometrium, stays healthy. If a woman skips a period more than three months at a time, the lining in the uterus can thicken and become abnormal, leading to pre-cancerous and cancerous conditions in the uterus. If a woman experiences heavy, frequent bleeding, the goal is to reduce this bleeding for her convenience and to prevent anemia.
Menstrual regulation is often accomplished by a birth control pill or a NuvaRing. These methods are often selected over other treatment options because they effectively reduce the signs of elevated testosterone as well. Women who do not want to take hormones every day may decide to take scheduled progesterone in order to have a regular bleed.
PCOS is frequently a result of metabolic dysfunction and accompanied by problems such as high cholesterol, insulin resistance and an increased risk for Type II diabetes. About half of all women with PCOS will have problems with their weight and many report not being able to lose weight despite making healthier dietary choices and increasing exercise. This problem losing weight is typically caused by high levels of circulating insulin which make it hard for the body to burn fat effectively.
Women with PCOS who also have elevated insulin levels are usually treated with a medication called metformin. This medication helps the body become sensitized to the insulin produced by the pancreas so that the insulin produced is more effective at lowering glucose levels. As insulin levels drop, weight loss becomes easier. Even if you do not have insulin resistance, it is important to make dietary modifications and exercise part of your PCOS treatment plan to reduce your chances of developing these metabolic problems later.
PCOS is also linked to problems with fertility. If a woman does not ovulate regularly, there will be less eggs released over time. Women with PCOS who are experiencing infertility are usually treated for insulin resistance, if indicated, and placed on a medication called Clomid which forces the ovary to release an egg.
In some patients metformin alone is sufficient to produce a more regular ovulation. It is also important to note that women with PCOS who do NOT want to be pregnant should use birth control as they usually do ovulate randomly and can become pregnant after ovulation.
PCOS does not go away; however, women with PCOS can be treated successfully and enjoy regular menstrual cycles, lowered testosterone levels and healthy pregnancies.