Polycystic Ovarian Syndrome (PCO)
Polycystic ovarian syndrome (PCO or PCOS) is a common disorder affecting 1 in 10 women. The syndrome is characterized by an irregular menstrual cycle, excessive hair growth and acne. Women with PCO also do not ovulate regularly. There is an increased risk of diabetes and uterine cancer in patients with PCO. These risks can be reduced with medical treatment. Frequently, obesity is associated with this syndrome.
How is this syndrome diagnosed?
Your medical history and physical exam will lead to a probable diagnosis but confirmation is usually made by obtaining several blood hormone levels. Sometimes a sonogram will also be useful in making the diagnosis but is not required.
How is PCO treated?
The treatment for PCO depends in part on whether or not pregnancy is desired at this time. If attempts at pregnancy are going to be put off for awhile, then the mainstay treatment of the past has been oral contraceptive pills. Oral contraceptive pills suppress the ovaries ability to make hormones. Patients with PCO secrete too much of a male hormone (testosterone) from their ovaries. Treatment with oral contraceptives reduces the testosterone level which then decreases the acne and prevents future excessive hair growth. However, any hair that is present when treatment is started will still grow back. The only cure for the hair that is present is a destructive procedure of the hair follicle such as electrolysis or the new laser procedures. Oral contraceptives also cause regular periods which reduces the long-term risk of endometrial cancer. Oral contraceptives do not lower the risks of diabetes.
If pregnancy is desired, treatment with ovulation drugs are started. Generally, treatment begins with the mild fertility pill clomiphene citrate (Clomid or Serophene). If ovulation has not occurred on maximum clomiphene therapy then treatment with the injectable fertility drugs is usually more successful. The injectable drugs are much more expensive and carry the risks of multiple births.
A new alternative treatment treats the underlying problem in patients with PCO. Recent studies have shown that most women with PCO have a problem known as insulin resistance. Insulin is a hormone that lowers blood sugar levels. Patients with type I Diabetes do not make insulin and have to be given the insulin in the form of a shot. Patients with type II Diabetes make insulin, but the insulin receptors on the body’s cells do not work well enough so that the blood sugar levels become elevated. Patients with PCO have abnormal insulin receptors but their pancreas is able to release extra insulin to get the blood sugar levels down to normal at least for awhile. Patients with PCO have high levels of circulating insulin. If the high levels of insulin are unable to keep the blood sugar level normal, then the patient with PCO becomes diabetic.
High levels of circulating insulin cause other problems within the body. High levels of insulin cross react with receptors on the ovary to cause release of male hormones such as testosterone. The testosterone then causes the abnormal hair growth, acne and also shuts down the normal menstrual cycle. High levels of insulin also make a person likely to gain weight easily. Lowering the insulin levels to normal may lead to a reversal of many of these symptoms including the extra weight gain.
A diabetes treatment for insulin resistance is also useful in women with PCO. Taking the medication Glucophage (Metformin) will result in a lowering of insulin levels. This frequently results in a return of normal menstrual function including ovulation in about half of women with PCO. In the other half, they then respond more easily to the traditional therapy as outlined above. Patients taking Glucophage for PCO frequently report an increase in energy level and weight loss of about 2-4 pounds per month. Exercising and dieting will accelerate the weight loss, yet not everyone taking Glucophage loses weight. Patients taking Glucophage may also experience gastrointestinal symptoms such as nausea, abdominal cramping and diarrhea the first month on the drug. The symptoms usually disappear after 30 days.
A serious and sometimes fatal condition called lactic acidosis can very rarely (1 chance in 30,000) be due to Glucophage. This complication is usually seen in someone with kidney disease and patients with kidney disease should not take Glucophage. To reduce the chances of lactic acidosis, patients should avoid excessive alcohol intake. Patients also should stop the Glucophage prior to any surgical procedure and not restart the medication until the patient can consume normal fluids. Anyone having injected X-Ray dye should stop the medicine a couple of days before and after the X-ray test.
The symptoms of lactic acidosis are muscle aches, feeling weak and tired, trouble breathing, increased sleepiness and abdominal discomfort. Once a patient becomes used to Glucophage, the abdominal complaints usually go away. If the abdominal complaints return at a later date, this may be a warning sign of lactic acidosis and the patient needs to notify her physician.