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Polycystic ovary syndrome (PCOS)
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Polycystic ovary syndrome (PCOS)

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DIABETES AND ENDOCRINE SYSTEM

Endocrine System

Polycystic ovary syndrome (PCOS) is a condition most often characterized by irregular menstrual periods, excess hair growth (hirsutism) and obesity, but it can affect women in different ways. Irregular or heavy periods may signal the condition in adolescence, or PCOS may become apparent later when a woman has difficulty becoming pregnant.

The signs and symptoms of PCOS stem from a disruption in the reproductive cycle, which normally culminates each month with the release of an egg from an ovary (ovulation). The name of the condition comes from the appearance of the ovaries in some women with the disorder - large and studded with numerous cysts (polycystic). These cysts are follicles, fluid-filled sacs that contain immature eggs.

Although the condition has been noted since antiquity, it was first described in medical literature in the 1930s when Irving Stein and Michael Leventhal wrote about a group of women without menstrual periods (amenorrhea) who had large ovaries with multiple cysts. Doctors sometimes call the condition Stein-Leventhal syndrome, polycystic ovaries or polycystic ovary disease.

Early diagnosis and treatment of PCOS can help reduce the risk of long-term complications, which include diabetes and heart disease.

Treatment

Management of PCOS focuses on each woman's main concerns, such as infertility, hirsutism, acne or obesity. Long term, the most important aspect of treatment is managing cardiovascular risks such as obesity, high blood cholesterol, diabetes and high blood pressure. To help guide ongoing treatment decisions, your doctor will likely want to see you for regular visits to perform a physical examination, measure your blood pressure and obtain fasting glucose and lipid levels.

Overweight women with PCOS have more-severe signs and symptoms. Obesity makes insulin resistance worse. Weight loss can reduce both insulin and androgen levels. However, you may have more difficulty losing weight than other women do. Ask your doctor to recommend a weight-control program, and meet with a dietitian.

Your doctor may prescribe one or more medications to help manage the symptoms and risks associated with PCOS.

Medications for regulating your menstrual cycle
If you're not trying to become pregnant, your doctor may prescribe low-dose oral contraceptives that combine synthetic estrogen and progesterone. They decrease androgen production and give your body a break from continuous estrogen. This decreases your risk of endometrial cancer and corrects abnormal bleeding.

An alternative approach is taking progesterone for 10 to 14 days each month. This medication also regulates your menstrual cycle and offers protection against endometrial cancer, but it doesn't improve androgen levels.

Researchers are evaluating the use of metformin (Glucophage, Glucophage XR), an oral medication for type 2 diabetes, to treat PCOS. Metformin inhibits the production and release of glucose from the liver, thus requiring less insulin to transport blood sugar into cells. Several clinical trials have found that metformin improved ovulation or reduced androgen levels in women with PCOS, and the long-term hope is that metformin might reduce cardiovascular disease complications from PCOS.

Medications for reducing excessive hair growth
Your doctor may add a medication to counter the effects of excess androgen. Spironolactone (Aldactone) blocks the effects of androgen and reduces new androgen production. Spironolactone was introduced as a water pill (diuretic) and may cause you to urinate more frequently. Other possible side effects are dry skin, heartburn, headaches and fatigue. Other anti-androgen medications are finasteride (Propecia, Proscar) and flutamide (Eulexin), but they are more expensive than spironolactone and tend to have more side effects.

The Food and Drug Administration has approved a prescription cream for slowing facial hair growth in women. Eflornithine (Vaniqa) blocks the action of an enzyme in skin that stimulates hair growth. You apply it twice daily. Avoid using this medication during pregnancy.

Medications for achieving pregnancy
To become pregnant, you may need a medication to trigger ovulation. Clomiphene (Clomid, Serophene) is an anti-estrogen medication that you take for five days in the first part of your menstrual cycle. If clomiphene alone isn't effective, you may need corticosteroids along with clomiphene, a combination of LH and FSH called a gonadotropin (Repronex, Humegon, Pergonal), or FSH alone (Fertinex, Follistim, Gonal-F).

Surgery
If medications don't help you become pregnant, your doctor may recommend an outpatient surgery called laparoscopic ovarian drilling. In this procedure, a surgeon makes a small incision in your abdomen and inserts a tube attached to a tiny camera (laparoscope). The camera provides the surgeon with detailed images of your ovaries and neighboring pelvic organs. The surgeon then inserts surgical instruments through other small incisions and uses electrical or laser energy to burn holes in enlarged follicles on the surface of the ovaries.

The goal is to stimulate ovulation by reducing levels of LH and androgen hormones. Doctors aren't sure how this occurs. One theory is that drilling destroys hormone-producing ovarian cells.

Hair removal
Several options exist for hair removal. They include shaving, plucking and over-the-counter remedies such as waxes, gels, creams and lotions (depilatories). However, depilatories may irritate your skin, so follow package directions and on first use, apply the product to an inconspicuous area to determine if it's suitable for you. The results last for weeks, then you must repeat treatment.

Other options for hair removal include:

  • Electrolysis. To permanently remove excess hair, some women undergo electrolysis in addition to medical therapy. A fine needle is inserted into the hair follicle and electric current is applied to kill the follicle. Because only one follicle can be treated at a time, this method isn't useful for large areas of the body. Several treatments are usually necessary. Scarring or, rarely, skin infections may occur. Home electrolysis kits usually are ineffective because the hair follicle is deep in the skin, so seek care with an experienced, certified electrologist.

  • Laser therapy. Melanin, the substance that gives hair its color, absorbs light from the laser and transforms it into heat, which destroys the hair follicle. You'll need several treatments. Laser therapy is most effective for hair that's in the growth phase, and not all hairs are in the growth phase at the same time. It can be applied to almost any area of your body except around your eyes.

  • Laser therapy has been most effective for people with dark hair and lighter skin. Skin also derives its color from melanin, and darker skin with more melanin can absorb too much laser energy, leading to skin damage and discoloration. However, some doctors have begun using a laser instrument and technique that has better results for dark-skinned people.

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Last Modified : 03/15/08 01:53 AM