Polycystic Ovary Syndrome _PCOS_ - Download as PDF

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					                                                                      Frequently Asked questions




                              Polycystic
                                                                                Q: What causes PCOS?
                                                                                A: The cause of PCOS is unknown. But
                                                                                    most experts think that several factors,
                                                                                    including genetics, could play a role.

                              Ovary                                                 Women with PCOS are more likely to
                                                                                    have a mother or sister with PCOS.
                                                                                    A main underlying problem with

                              Syndrome                                              PCOS is a hormonal imbalance.
                                                                                    In women with PCOS, the ovaries
                                                                                    make more androgens than normal.


                              (PCOS)
http://www.womenshealth.gov                                                         Androgens are male hormones that
         1-800-994-9662                                                             females also make. High levels of these
                                                                                    hormones affect the development and
  TDD: 1-888-220-5446
                                                                                    release of eggs during ovulation.
                              Q: What is polycystic ovary syn-                      Researchers also think insulin may
                                  drome (PCOS)?                                     be linked to PCOS. Insulin is a hor-
                              A:	 Polycystic	(pah-lee-SIS-tik)	ovary	syn-           mone that controls the change of sugar,
                                  drome	(PCOS)	is	a	health	problem	that	            starches, and other food into energy for
                                  can affect a woman's:                             the body to use or store. Many women
                                                                                    with PCOS have too much insulin in
                              	   •	 Menstrual	cycle
                                                                                    their bodies because they have prob-
                              	   •	 Ability	to	have	children                       lems using it. Excess insulin appears to
                              	   •	 Hormones                                       increase production of androgen. High
                                                                                    androgen levels can lead to:
                              	   •	 Heart
                                                                                	   •	 Acne
                              	   •	 Blood	vessels
                                                                                	   •	 Excessive	hair	growth
                              	   •	 Appearance
                                                                                	   •	 Weight	gain
                                  With PCOS, women typically have:
                                                                                	   •	 Problems	with	ovulation
                              	   •	 High	levels	of	androgens	(AN-druh-
                                     junz).	These	are	sometimes	called	
                                     male hormones, though females also         Q: What are the symptoms of
                                     make them.                                    PCOS?
                              	   •	 Missed	or	irregular	periods	(monthly	      A: The symptoms of PCOS can vary from
                                     bleeding)                                      woman to woman. Some of the symp-
                                                                                    toms of PCOS include:
                              	   •	 Many	small	cysts	(sists)	(f luid-filled	
                                                                                	   •	 Infertility	(not	able	to	get	pregnant)	
                                     sacs)	in	their	ovaries
                                                                                       because of not ovulating. In fact,
                                                                                       PCOS is the most common cause of
                              Q: How many women have PCOS?                             female infertility.
                              A: Between 1 in 10 and 1 in 20 women of           	   •	 Infrequent,	absent,	and/or	irregular	
                                  childbearing age has PCOS. As many as                menstrual periods
                                  5 million women in the United States
                   page 1         may be affected. It can occur in girls as     	   •	 Hirsutism	(HER-suh-tiz-um)	
                                  young as 11 years old.                               — increased hair growth on the face,
                                                                                       chest, stomach, back, thumbs, or toes


                                       U.S. Department of Health and Human Services, Office on Women’s Health
                                                                    Frequently Asked questions



                              	   •	 Cysts	on	the	ovaries
                              	   •	 Acne,	oily	skin,	or	dandruff
                              	   •	 Weight	gain	or	obesity,	usually	with	                                     Normal ovary
                                     extra weight around the waist
                              	   •	 Male-pattern	baldness	or	thinning	
                                     hair
                                                                                                              Polycystic ovary
                              	   •	 Patches	of	skin	on	the	neck,	arms,	
                                     breasts, or thighs that are thick and
                                     dark brown or black
http://www.womenshealth.gov
                              	   •	 Skin	tags	—	excess	f laps	of	skin	in	
         1-800-994-9662
                                     the armpits or neck area
  TDD: 1-888-220-5446
                              	   •	 Pelvic	pain
                              	   •	 Anxiety	or	depression                     Q: Does PCOS change at meno-
                                                                                  pause?
                              	   •	 Sleep	apnea	—	when	breathing	
                                                                               A: Yes and no. PCOS affects many systems
                                     stops for short periods of time while
                                                                                   in the body. So, many symptoms may
                                     asleep
                                                                                   persist even though ovarian function
                                                                                   and hormone levels change as a woman
                              Q: Why do women with PCOS                            nears menopause. For instance, exces-
                                 have trouble with their menstru-                  sive hair growth continues, and male-
                                 al cycle and fertility?                           pattern baldness or thinning hair gets
                              A: The ovaries, where a woman’s eggs                 worse after menopause. Also, the risks
                                  are produced, have tiny f luid-filled            of	complications	(health	problems)	from	
                                  sacs called follicles or cysts. As the           PCOS, such as heart attack, stroke, and
                                  egg grows, the follicle builds up f luid.        diabetes, increase as a woman gets older.
                                  When the egg matures, the follicle
                                  breaks open, the egg is released, and the    Q: How do I know if I have PCOS?
                                  egg travels through the fallopian tube to    A: There is no single test to diagnose
                                  the	uterus	(womb)	for	fertilization.	This	       PCOS. Your doctor will take the fol-
                                  is called ovulation.                             lowing steps to find out if you have
                                  In women with PCOS, the ovary                    PCOS or if something else is causing
                                  doesn't make all of the hormones it              your symptoms.
                                  needs for an egg to fully mature. The            Medical History. Your doctor will ask
                                  follicles may start to grow and build            about your menstrual periods, weight
                                  up fluid but ovulation does not occur.           changes, and other symptoms.
                                  Instead, some follicles may remain as
                                                                                   Physical Exam. Your doctor will want
                                  cysts. For these reasons, ovulation does
                                                                                   to measure your blood pressure, body
                                  not occur and the hormone progester-
                                                                                   mass	index	(BMI),	and	waist	size.	He	or	
                                  one is not made. Without progesterone,
                                                                                   she also will check the areas of increased
                                  a woman's menstrual cycle is irregular or
                                                                                   hair growth. You should try to allow
                                  absent. Plus, the ovaries make male hor-
                                                                                   the natural hair to grow for a few days
                   page 2         mones, which also prevent ovulation.
                                                                                   before the visit.




                                       U.S. Department of Health and Human Services, Office on Women’s Health
                                                                    Frequently Asked questions



                                  Pelvic Exam. Your doctor might                   body weight can restore a normal peri-
                                  want to check to see if your ovaries are         od and make your cycle more regular.
                                  enlarged or swollen by the increased             Birth control pills. For women who
                                  number of small cysts.                           don't want to get pregnant, birth con-
                                  Blood Tests. Your doctor may check               trol pills can:
                                  the androgen hormone and glucose             	   •	 Control	menstrual	cycles
                                  (sugar)	levels	in	your	blood.
                                                                               	   •	 Reduce	male	hormone	levels
                                  Vaginal Ultrasound (sonogram).
                                  Your doctor may perform a test that          	   •	 Help	to	clear	acne
                                  uses sound waves to take pictures of the         Keep in mind that the menstrual cycle
http://www.womenshealth.gov
                                  pelvic area. It might be used to exam-           will become abnormal again if the pill is
         1-800-994-9662           ine your ovaries for cysts and check the         stopped. Women may also think about
  TDD: 1-888-220-5446             endometrium	(en-do-MEE-tree-uhm)	                taking a pill that only has progesterone
                                  (lining	of	the	womb).	This	lining	may	           (proh-JES-tuh-rohn),	like	Provera,	to	
                                  become thicker if your periods are not           control the menstrual cycle and reduce
                                  regular.                                         the	risk	of	endometrial	cancer	(See	
                                                                                   “Does PCOS put women at risk for
                              Q: How is PCOS treated?                              other	health	problems?”).	But,	proges-
                              A: Because there is no cure for PCOS, it             terone alone does not help reduce acne
                                  needs to be managed to prevent prob-             and hair growth.
                                  lems. Treatment goals are based on               Diabetes medications. The medi-
                                  your symptoms, whether or not you                cine	metformin	(Glucophage)	is	used	
                                  want to become pregnant, and lower-              to treat type 2 diabetes. It has also been
                                  ing your chances of getting heart disease        found to help with PCOS symptoms,
                                  and diabetes. Many women will need               though it isn’t approved by the U.S.
                                  a combination of treatments to meet              Food	and	Drug	Administration	(FDA)	
                                  these goals. Some treatments for PCOS            for this use. Metformin affects the way
                                  include:                                         insulin	controls	blood	glucose	(sugar)	
                                  Lifestyle modification. Many women               and lowers testosterone production. It
                                  with PCOS are overweight or obese,               slows the growth of abnormal hair and,
                                  which can cause health problems. You             after a few months of use, may help
                                  can help manage your PCOS by eat-                ovulation to return. Recent research has
                                  ing healthy and exercising to keep your          shown metformin to have other positive
                                  weight at a healthy level. Healthy eating        effects, such as decreased body mass and
                                  tips include:                                    improved cholesterol levels. Metformin
                                                                                   will not cause a person to become dia-
                              	   •	 Limiting	processed	foods	and	foods	           betic.
                                     with added sugars
                                                                                   Fertility medications.	Lack	of	ovu-
                              	   •	 Adding	more	whole-grain	products,	            lation is usually the reason for fertil-
                                     fruits, vegetables, and lean meats to         ity problems in women with PCOS.
                                     your diet                                     Several medications that stimulate
                                  This helps to lower blood glucose                ovulation can help women with PCOS
                                  (sugar)	levels,	improve	the	body's	use	of	       become pregnant. Even so, other rea-
                   page 3         insulin,	and	normalize	hormone	levels	           sons for infertility in both the woman
                                  in your body. Even a 10 percent loss in          and man should be ruled out before



                                       U.S. Department of Health and Human Services, Office on Women’s Health
                                                                      Frequently Asked questions



                                  fertility medications are used. Also,                Medicine for increased hair growth
                                  some fertility medications increase the              or extra male hormones. Medicines
                                  risk	for	multiple	births	(twins,	triplets).	         called anti-androgens may reduce hair
                                  Treatment options include:                           growth and clear acne. Spironolactone
                              	   •	 Clomiphene	(KLOHM-uh-feen)	                       (speer-on-oh-LAK-tone)	(Aldactone),	
                                     (Clomid,	Serophene)	—	the	first	                  first used to treat high blood pressure,
                                     choice therapy to stimulate ovulation             has been shown to reduce the impact
                                     for most patients.                                of male hormones on hair growth in
                                                                                       women.	Finasteride	(fin-AST-uhr-yd)	
                              	   •	 Metformin	taken	with	clomiphene	                  (Propecia),	a	medicine	taken	by	men	
                                     — may be tried if clomiphene alone                for hair loss, has the same effect. Anti-
http://www.womenshealth.gov
                                     fails. The combination may help                   androgens are often combined with
         1-800-994-9662              women with PCOS ovulate on                        birth control pills. These medications
  TDD: 1-888-220-5446                lower doses of medication.                        should not be taken if you are trying to
                              	   •	 Gonadotropins	(goe-NAD-oh-troe-                   become pregnant.
                                     pins)	—	given	as	shots,	but	are	more	
                                     expensive and raise the risk of multi-          Before taking Aldactone, tell your doctor
                                     ple births compared to clomiphene.              if you are pregnant or plan to become
                                  Another	option	is	in	vitro	fertilization	          pregnant. Do not breastfeed while taking
                                  (IVF).	IVF	offers	the	best	chance	of	              this medicine. Women who may become
                                  becoming pregnant in any given cycle.              pregnant should not handle Propecia.
                                  It also gives doctors better control over
                                  the	chance	of	multiple	births.	But,	IVF	             Other options include:
                                  is very costly.                                	     •	 Vaniqa	(van-ik-uh)	cream	to	reduce	
                                  Surgery. "Ovarian drilling" is a sur-                   facial hair
                                  gery that may increase the chance of
                                                                                 	     •	 Laser	hair	removal	or	electrolysis	to	
                                  ovulation. It’s sometimes used when
                                                                                          remove hair
                                  a woman does not respond to fertility
                                  medicines. The doctor makes a very             	     •	 Hormonal	treatment	to	keep	new	
                                  small cut above or below the navel                      hair from growing
                                  (belly	button)	and	inserts	a	small	tool	             Other Treatments. Some research
                                  that acts like a telescope into the abdo-            has	shown	that	bariatric	(weight	loss)	
                                  men	(stomach).	This	is	called	laparos-               surgery may be effective in resolv-
                                  copy	(lap-uh-RAHS-kuh-pee).	The	                     ing PCOS in morbidly obese women.
                                  doctor then punctures the ovary with a               Morbid obesity means having a BMI
                                  small needle carrying an electric current            of more than 40, or a BMI of 35 to 40
                                  to destroy a small portion of the ovary.             with an obesity-related disease. The
                                  This procedure carries a risk of devel-              drug	troglitazone	(troh-GLIT-uh-zohn)	
                                  oping scar tissue on the ovary. This                 was shown to help women with PCOS.
                                  surgery can lower male hormone levels                But, it was taken off the market because
                                  and help with ovulation. But, these                  it caused liver problems. Similar drugs
                                  effects may only last a few months. This             without the same side effect are being
                                  treatment doesn't help with loss of scalp            tested in small trials.
                                  hair or increased hair growth on other
                   page 4
                                  parts of the body.




                                       U.S. Department of Health and Human Services, Office on Women’s Health
                                                                     Frequently Asked questions



                                  Researchers continue to search for new        Q: Does PCOS put women at risk
                                  ways to treat PCOS. To learn more                for other health problems?
                                  about current PCOS treatment studies,         A: Women with PCOS have greater chanc-
                                  visit the clinicaltrials.gov Web site. Talk       es of developing several serious health
                                  to your doctor about whether taking part          conditions, including life-threatening
                                  in a clinical trial might be right for you.       diseases. Recent studies found that:
                                                                                	   •	 More	than	50	percent	of	women	
                              Q: How does PCOS affect a woman                          with PCOS will have diabetes or
                                 while pregnant?                                       pre-diabetes	(impaired	glucose	toler-
                              A: Women with PCOS appear to have                        ance)	before	the	age	of	40.
http://www.womenshealth.gov
                                  higher rates of:                              	   •	 The	risk	of	heart	attack	is	4	to	7	
         1-800-994-9662                                                                times higher in women with PCOS
                              	   •	 Miscarriage
  TDD: 1-888-220-5446                                                                  than women of the same age with-
                              	   •	 Gestational	diabetes
                                                                                       out PCOS.
                              	   •	 Pregnancy-induced	high	blood	pres-
                                                                                	   •	 Women	with	PCOS	are	at	greater	
                                     sure	(preeclampsia)
                                                                                       risk of having high blood pressure.
                              	   •	 Premature	delivery
                                                                                	   •	 Women	with	PCOS	have	high	levels	
                                  Babies born to women with PCOS                       of	LDL	(bad)	cholesterol	and	low	
                                  have a higher risk of spending time in a             levels	of	HDL	(good)	cholesterol.
                                  neonatal intensive care unit or of dying
                                                                                	   •	 Women	with	PCOS	can	develop	
                                  before, during, or shortly after birth.
                                                                                       sleep apnea. This is when breathing
                                  Most of the time, these problems occur
                                                                                       stops for short periods of time dur-
                                  in	multiple-birth	babies	(twins,	triplets).
                                                                                       ing sleep.
                                  Researchers are studying whether the
                                  diabetes medicine metformin can pre-              Women with PCOS may also develop
                                  vent or reduce the chances of having              anxiety and depression. It is important
                                  problems while pregnant. Metformin                to talk to your doctor about treatment
                                  also lowers male hormone levels and               for these mental health conditions.
                                  limits weight gain in women who are               Women with PCOS are also at risk for
                                  obese when they get pregnant.                     endometrial cancer. Irregular menstrual
                                  Metformin is an FDA pregnancy cate-               periods and the lack of ovulation cause
                                  gory B drug. It does not appear to cause          women to produce the hormone estro-
                                  major birth defects or other problems in          gen, but not the hormone progesterone.
                                  pregnant women. But, there have only              Progesterone causes the endometrium
                                  been a few studies of metformin use in            (lining	of	the	womb)	to	shed	each	
                                  pregnant women to confirm its safety.             month as a menstrual period. Without
                                  Talk to your doctor about taking met-             progesterone, the endometrium
                                  formin if you are pregnant or are trying          becomes thick, which can cause heavy or
                                  to become pregnant. Also, metformin               irregular bleeding. Over time, this can
                                  is passed through breastmilk. Talk with           lead to endometrial hyperplasia, when
                                  your doctor about metformin use if you            the lining grows too much, and cancer.
                                  are a nursing mother.
                   page 5




                                       U.S. Department of Health and Human Services, Office on Women’s Health
                                                                   Frequently Asked questions



                              Q: I have PCOS. What can I do to               Q: How can I cope with the emo-
                                 prevent complications?                         tional effects of PCOS?
                              A: If you have PCOS, get your symptoms         A: Having PCOS can be difficult. You
                                  under control at an earlier age to help        may feel:
                                  reduce your chances of having compli-      	   •	 Embarrassed	by	your	appearance
                                  cations like diabetes and heart disease.
                                  Talk to your doctor about treating all     	   •	 Worried	about	being	able	to	get	
                                  your symptoms, rather than focusing               pregnant
                                  on just one aspect of your PCOS, such      	   •	 Depressed
                                  as problems getting pregnant. Also, talk
                                                                                 Getting	treatment	for	PCOS	can	help	
http://www.womenshealth.gov       to your doctor about getting tested for
                                                                                 with these concerns and help boost
                                  diabetes regularly. Other steps you can
         1-800-994-9662                                                          your self-esteem. You may also want to
                                  take to lower your chances of health
  TDD: 1-888-220-5446                                                            look for support groups in your area or
                                  problems include:
                                                                                 online to help you deal with the emo-
                              	   •	 Eating	right                                tional effects of PCOS. You are not
                              	   •	 Exercising                                  alone and there are resources available
                                                                                 for women with PCOS. n
                              	   •	 Not	smoking




                   page 6




                                       U.S. Department of Health and Human Services, Office on Women’s Health
                                                                  Frequently Asked questions




                              For more information
                              You can find out more about PCOS by contacting womenshealth.gov at 1-800-994-
                              9662	or	the	following	organizations:	

                              Women’s Health Research, National             Center for Applied Reproductive
                              Institute of Child Health and Human           Science (CARS)
                              Development (NICHD), NIH, HHS                 Phone:	(423)	461-8880
                              Phone:	(800)	370-2943                         Internet	Address:	http://www.ivf-et.com
http://www.womenshealth.gov   Internet	Address:	http://www.nichd.nih.
                              gov/womenshealth                              InterNational Council on Infertility
         1-800-994-9662
                                                                            Information Dissemination, Inc.
  TDD: 1-888-220-5446         American Association of Clinical              (INCIID)
                              Endocrinologists (AACE)                       Phone:	(703)	379-9178
                              Phone:	(904)	353-7878                         Internet	Address:	http://www.inciid.org
                              Internet	Address:	http://www.aace.com
                                                                            Polycystic Ovarian Syndrome
                              American College of Obstetricians             Association, Inc. (PCOSA)
                              and Gynecologists                             Internet	Address:	http://www.pcosupport.
                              Phone:	(202)	638-5577                         org
                              Internet	Address:	http://www.acog.org
                                                                            The Hormone Foundation
                              American Society for Reproductive             Phone:	(800)	467-6663
                              Medicine (ASRM)                               Internet	Address:	http://www.hormone.org	
                              Phone:	(205)	978-5000
                              Internet	Address:	http://www.asrm.org



                                  This FAQ was reviewed by:
                                  Esther Eisenberg, M.D., M.P.H.
                                  Professor	of	Obstetrics	and	Gynecology,	Vanderbilt	University
                                  Medical Officer, Reproductive Sciences Branch
                                  The	Eunice	Kennedy	Shriver	National	Institute	of	Child	Health	and	Human	
                                  Development,	National	Institutes	of	Health

                                  All material contained in this FAQ is free of copyright restrictions, and may be copied,
                                  reproduced, or duplicated without permission of the Office on Women's Health in the
                                  Department of Health and Human Services. Citation of the source is appreciated.


                                  Content	last	updated March 17, 2010.

                   page 7




                                     U.S. Department of Health and Human Services, Office on Women’s Health

				
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