Learn about Polycystic Ovarian Syndrome (PCO or PCOS) from a leading specialist.

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By Dr. Kristen Cain, Reproductive Specialists of New York

Polycystic ovarian syndrome (PCO or PCOS) has been getting a lot of press lately. Many women wonder, do I have PCOS? How can I tell? And what can be done about it? Here are a few frequently asked questions about PCOS.

What is PCOS?
PCOS is a collection of symptoms related to infrequent ovulation. A better name would be "chronic anovulation syndrome" but that has never caught on. PCOS actually has very little to do with ovarian cysts and nothing at all to do with cysts in other parts of the body, such as the breasts. Instead, women with this syndrome have a complex of symptoms including irregular menstrual cycles, weight gain, and abnormal hair growth on the face or the body. Any or all of these symptoms may be present, but some women have none of these symptoms and still can carry the diagnosis. These tend to be very lean, athletic women who may be even underweight and this may mask the PCO syndrome. The good news is that the less symptomatic you are, the better you should respond to medication and treatment.

How can I tell if I have PCOS?
Your doctor should be able to do some basic hormone testing in addition to taking a history and performing a physical exam. Women with irregular cycles need to have other conditions ruled out, such as anorexia, stress or exercise-induced problems with the menstrual cycle, other hormonal problems such as thyroid disease, or medication problems.

How is PCOS treated?
This is actually an area of intense research. If you are not trying to get pregnant, birth control pills are a great option for many women with PCO. They help with cycle regulation and also may improve abnormal hair growth and acne. But if pregnancy is your ultimate goal, other treatments are necessary. PCO can't be "cured" any more than you can be "cured" of your height or the fact you are female. It is a natural tendency that often runs in families. Other diseases also tend to run in the same families, such as diabetes and cancer of the uterus. These diseases are related to PCO in ways that will be discussed later. But PCO is treatable. A common treatment is has be fertility pills such as clomiphene citrate (Clomid, Serophene) which can help a woman ovulate more predictably. Another newer treatment is with insulin sensitizers.

What are insulin sensitizers and why are they used?
Because obesity is a common part of PCOS, many of these women are also insulin-resistant. Insulin is a hormone that helps the body store sugar in the body's fat cells. It closely resembles a hormone in the ovary called, appropriately enough, insulin-like growth factor (IGF-1). IGF-1 and IGF-2 are important hormones that help the egg to mature each cycle. When a woman is insulin-resistant, her fat cells don't respond normally to the insulin in the blood stream. The body responds by making more insulin that then overreacts and stores all the available glucose into the fat cells. This is why weight gain occurs so easily and weight loss is so difficult in these women. Women with insulin resistance often have sudden drops in their blood sugar after an insulin surge like this, resulting in sugar cravings and the whole vicious cycle all over again. Meanwhile, the ovary is seeing a lot of extra insulin in the blood, and confusing it with IGF. Therefore, ovulation and hormone production are also affected and can become abnormal, leading to the abnormal hair growth and irregular periods.

Insulin sensitizers help interrupt this vicious cycle. Various medications can be used, including Metformin (Glucophage), rosiglitazone (Avandia), and pioglitazone (Actos). The best medication for you will be determined by your doctor after testing for insulin resistance. These medications should not be used if you have liver, kidney, lung, or heart disease or if you are having IV contrast for an X-ray procedure.

Does my weight affect my fertility?
Possibly. Most women have a weight range where they are most fertile. Weights above and below this range can be associated with decreased fertility. The catch is, this range is not the same for all women. Some women may be most fertile at weights they consider "too heavy". Others can't tolerate any weight above the normal range. To calculate your normal range, you can use a body mass index table (BMI). This calculates your weight for height and a normal BMI is between 18-25. A healthy, well- balanced diet that is low in refined sugar and fats, and controlling portions (size of an open hand or closed fist = 1 portion) will help you get a good start.

What about exercise?
If you are overweight and insulin-resistant, you will benefit from daily exercise. Exercise will help you decrease your weight and your insulin- resistance, decrease your risk of developing diabetes in pregnancy and later in life, and increase your chance of conception. If you already exercise a lot (more than 150 minutes per week) and you are not overweight, you might benefit by cutting back a little. All things in moderation!

See a fertility specialist now
We're a national network of over 100 fertility specialists. All our specialists treat PCOS.