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Dan C. Martin, MD
UT Medical Group, Inc.

University of Tennessee Health Science Center (UTHSC)

UTHSC Academic Office

Daniel Clyde Martin, M.D.
UT Medical Group, Inc.
Infertility and Gynecology
Reproductive Surgery
Germantown Office Building
7945 Wolf River Boulevard
Suite 320
Germantown, Tennessee
TN 38138-1733

(901) 347-8331
(901) 347-8188 fax
Directions to Office

Updated information is at
UTMG 2006

Click for information on:
Glenn Ann Martin, Ph.D.
Clinical Psychologist

 

Polycystic Ovarian Syndrome
(PCOS)
(Stein-Leventhal Syndrome)

Up Diabetic Medication PCO Sonogram

Polycystic ovarian syndrome (PCOS) is a buildup of small cystic follicles and of associated infertility, hair growth, abnormal hormones and missed periods.  This may be started by stress, obesity, family genetics or other reasons but once this starts, the cysts can create hormonal problems within the ovary and increase the problem.  Polycystic ovaries (PCO) occur when there is a buildup the small cystic follicles occur with no other problems.

For women who are not sexually active and who are not trying to become pregnant, progestin pills are most useful.  Birth control pills are preferable in those women desiring to avoid pregnancy at this time.  The progestin pills are similar to the birth control pills but have less medicine.  The progestin pills are not designed to prevent pregnancy but only to regulate the periods and are taken for 14 days a month.  Birth control pills are taken 21 or 28 days a month.  A progestin shot may be useful in those women who have no desire for pregnancy in the near future as the shot can sometimes take 3 to 12 months to wear off.

For those women who are trying to get pregnant, Clomid is usually the first choice.  Dexamethasone may be used to suppress the adrenal gland, Parlodel to suppress breast milk hormone, thyroid to treat low thyroid and HCG to stimulate ovulation.  Metformin (Glucophage®) is a diabetic pill that may be of particular use in women with high fasting insulin levels.  Metformin has also been useful in PCOS and infertility.  When these do not work, Pergonal is generally felt to be a better approach than surgery but in certain situations, surgery may be advantageous for you.  The use of Pergonal requires more time and more visits to the office and has caused sextuplets (6 babies) in California.  Surgery, on the other hand, is quicker but has more chance of scar formation which might interfere in the future.

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Hair growth (hirsutism) can be one of the hardest problems to correct.  Birth control pills, spironolactone (a high blood pressure medicine), estrogen pills, progestin pills, progestin shots, electrolysis, bleaching of the hair, and other forms of therapy have been useful in some women.  Medication such as cyproterone acetate is available in Canada and Europe but is not approved by the FDA in the United States.

Conservative surgery includes laparoscopic cyst puncture, laparoscopic wedge resection and microsurgical wedge resection. The simplest of these is to puncture the cysts at laparoscopy and drain them which allows the hormones to return to normal.  This generally gives 12 to 18 months relief as the cysts do tend to reform but is still most useful in women trying to get pregnant.  Microsurgical wedge resection has a longer effect and is being used both for fertility and for hirsutism, particularly when there is evidence of over-function of the inner portion of the ovaries.  Laparoscopic wedge resection offers the outpatient advantages of laparoscopy (belly button surgery) but does not provide as good a control and as accurate a closure as microsurgical wedge resection.  Laparoscopic wedge resection is generally avoided as puncturing the cysts is an easier operation and microsurgical wedge resection is a more complete and more accurate operation.  In addition, microsurgical wedge resection can sometimes be done as an outpatient.  This is particularly true for those patients who have friends or family members that can give pain shots to them at home.

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In addition to fertility and hair growth, there are other problems including diabetes, cholesterol problems and heart attacks that are increased in women with PCOS and obesity.  Yearly exams may need to include blood pressure, blood lipid profiles, screening for diabetes, avoiding smoking and weight control.

With the large number of approaches and levels available, you will need to consider your goals carefully as the treatment must be individualized for you.

Additional information is available from the Polycystic Ovarian Syndrome Association and from Dr. Glueck's site.

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