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