Diagnosis and Treatment of Polycystic Ovarian Syndrome (PCOS)

By Neil Smith

Published on January 15, 2009

Many of the symptoms of polycystic ovarian syndrome (PCOS)-including excessive body and facial hair, thinning head hair, weight gain, acne, and infertility-are so devastating and apparent to the sufferer that early diagnosis is a possibility.

Diagnosis of PCOS

There is no single method to determine polycystic ovarian syndrome. A doctor may:

• Check to see if the ovaries are enlarged or if cysts are present. This line of undeveloped eggs occurs like a "string of pearls"
• Check blood pressure and body mass index
• Use ultrasounds, MRIs and biopsies to determine whether cysts exist in the ovaries and whether the endometrium has become thick
• Use blood tests to check levels of glucose, insulin, thyroid function, male hormone levels, and egg-stimulating hormone levels

There is no cure for polycystic ovarian syndrome but management of the disease depends on many factors including:

• The severity of the symptoms
• The risk of heart disease and diabetes
• If physical appearance is key or resumed menstruation
• Whether or not a woman wants to get pregnant

Treatments for PCOS

• Facial creams to remove hair have proven effective
• Anti-androgen medications reduce male hormone levels and hair growth
• Birth control pills decrease male hormones, control the menstrual cycle, and clear acne
• Diabetes medications are not yet approved for treating PCOS but they affect insulin levels, lowering male hormone levels, reducing hair growth, and they may stimulate ovulation to occur
• Fertility medications stimulate ovulation but there is a risk of multiple births. Metformin, a drug that suppresses insulin production, taken along with fertility drugs may help ovulation to occur on lower doses of the stimulants.
• Ovarian drilling is done to stimulate egg production and release. A needle carrying a current is used to destroy parts of the ovary. This reduces the production of male hormones and 50 percent of cases have achieved conception. There is a risk that scarring of the ovary may inhibit egg release and if too much of the ovary is destroyed it can trigger early menopause.
• In vitro fertilization (IVF) is the process by which a woman's eggs are removed, fertilized in the lab and then placed back into the uterus to implant.
• In vitro maturation (IVM) may be used if there has been a poor response to medications or if there are cost considerations. The results are not as promising as IVF. It has a lower pregnancy success rate and a higher miscarriage rate. Follicles are removed from the ovary and matured in the lab.
• Lifestyle changes have marked effects on polycystic ovarian syndrome. Weight loss affects insulin levels, glucose levels, and hormone levels.

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