Polycystic Ovary Syndrome (PCOS) Treatment

Polycystic ovary syndrome (PCOS) is a hormone imbalance problem that can interfere with normal ovulation. The disorder affects 5-10 percent of women of childbearing age, or about 6.1 million women in the United States alone.

Like any “syndrome,” PCOS is a collection of problems. Its cause is unknown but it is the most common hormonal abnormality in reproductive age women and a principal cause of female infertility.

Treatment for women experiencing infertility due to PCOS generally involves taking medications that promote healthy ovulation.

Our team was part of a recent National Institutes of Health study showing that Letrozole increased the chances of pregnancy by up to 45 percent over the previous gold standard treatment drug, Clomiphene citrate.

PCOS Symptoms

Symptoms tend to build gradually, and often begin in the early teens due to hormone changes. PCOS symptoms include:

• Missed menstrual periods, irregular periods, heavy bleeding during periods, or long times between periods
• Increased hair growth (hirsutism) on the face, chest, back and other areas
• Hair loss on the scalp
• Being overweight (other symptoms may be noticeable after weight gain)
• Acne problems
• Having trouble becoming pregnant

PCOS Risks

Women experiencing these symptoms should seek medical attention. When PCOS interrupts the ovulation cycle, estrogen can damage the uterine lining and cause thickening of the lining and possible abnormal bleeding. Continued presence of estrogen without ovulation can lead to uterine cancer or pre-cancer.

Women with PCOS often have metabolic syndrome, which can result in high blood pressure, high cholesterol, weight gain and insulin resistance. These increase the risk for heart disease.

PCOS Diagnosis

A physical exam, review of medical history, blood tests and ultrasound are used to detect PCOS. A woman is diagnosed as having PCOS if she has two of three issues: anovulation (lack of ovulation), high testosterone levels, and polycystic ovaries (ovaries that have multiple cysts containing eggs).

Ultrasound tests show that many women with PCOS have enlarged ovaries with small cysts. Blood tests may show high levels of male hormones, cholesterol and/or blood sugar.

PCOS Treatment

Treatments should be tailored to the individual. For women who are not concerned with immediate fertility, hormone medications usually correct symptoms, and oral contraceptive pills can reduce acne and hirsutism.

Women with PCOS seeking to get pregnant can take medications that promote ovulation. The oral medication Letrozole has been proven (in part by Advanced Reproductive Medicine) to increase ovulation and improve the chances of successful pregnancy after ovulation. It also has fewer side effects than Clomiphene, another medication often used to treat infertility due to PCOS.

If these drugs are not successful, fertility medicines known as gonadotropins may be injected to stimulate egg growth. Since gonadotropins are associated with higher risk of ovarian hyperstimulation syndrome and multiple pregnancy, women taking this medication should be closely monitored.