Diagnosing and Treating Hormonal Imbalances that are a Common Cause for Infertility
By Bruce Pierce, M.D., F.A.C.O.G., F.A.C.S.
An estimated one in 10 women of childbearing age will be affected by polycystic ovary syndrome (PCOS), a condition that can impact overall health and is a common cause of infertility.
While most often women learn they have PCOS when they have trouble getting pregnant, the condition is increasingly being identified in teens and girls as young as 11.
Once diagnosed, however, PCOS is often treatable through a combination of lifestyle changes, medication and in some instances surgery.
A Complex Cycle
In simplest terms, PCOS is a hormonal imbalance and metabolism problem that if left untreated can increase the risk for infertility and other health problems, including:
- Diabetes
- High blood pressure
- Unhealthy cholesterol
- Sleep apnea
- Depression and anxiety
- Endometrial cancer
Though the exact cause of PCOS is unknown, doctors believe that a combination of factors, including genetics, play a role.
More specifically, in women with PCOS, it appears that higher than normal levels of testosterone prevent normal ovulation. At the same time, women with PCOS may often have high levels of insulin, which further boosts the production of testosterone. Working together, high testosterone and high insulin create a cycle that can lead to PCOS.
In addition, women who are overweight or obese are at greater risk for PCOS because obesity is linked to insulin resistance. Conversely, PCOS can also cause women to gain weight, further contributing to the stubborn cycle.
According to the American College of Obstetricians and Gynecologists (ACOG), up to 80 percent of women with PCOS are obese.
Irregular Periods Common Sign
Common signs of PCOS include:
- Irregular menstrual cycle. Women with PCOS may miss periods, have fewer periods or no periods at all.
- Infertility. PCOS is one of the most common causes of female infertility.
- Weight gain or difficulty losing weight.
- Excessive hair growth on the face, chin, chest, upper thighs or other parts of the body where men normally have hair. This condition, called hirsutism, affects more than 70 percent of women with PCOS, according to ACOG.
- Severe acne or acne that occurs after adolescence and does not respond to usual treatments.
- Thinning hair or hair loss at the scalp. Male-pattern baldness.
- Darkening of the skin, particularly along neck creases, in the groin and underneath the breasts.
If you have signs of PCOS, talk to your doctor. Though there is no cure, with the appropriate diagnosis and treatment plan, symptoms of PCOS can be effectively managed.
Diagnosing and Treating
Diagnosing PCOS usually involves a blood test to check hormone levels as well as an ultrasound to look for small cysts on the ovaries. However, it is important to note that cysts are not always present in women with PCOS and are not necessary for a PCOS diagnosis.
Treatment for PCOS is multifactorial and typically involves:
- Weight loss. Losing weight may help lower your blood glucose levels, improve the way your body uses insulin, and help your hormones reach normal levels. As ACOG notes, even a loss of 10 to 15 pounds can help make menstrual periods more regular and improve chances of getting pregnant.
- Medication. Depending on your childbearing plans, doctors can prescribe certain medications to regulate your menstrual cycle. For women who are not trying to conceive, hormonal birth control in the form of a pill, patch, shot, vaginal ring or IUD, is often recommended. Hormonal birth control can regulate your menstrual cycle and reduce hirsutism and acne by decreasing testosterone levels. Medication to lower insulin levels may also be prescribed. For women who are attempting to conceive, doctors may prescribe drugs to stimulate ovulation and improve fertility.
- Surgery. In instances where other treatments do not work, surgery on the ovaries may restore ovulation, but only for a period of months.
Learn More
Penn Medicine Princeton Health, through its Community Education & Outreach Program, will host a discussion titled Get the Facts: Polycystic Ovary Syndrome from 7 p.m. to 8 p.m. on Thursday, Sept. 13 at the Hickory Corner Library, 138 Hickory Corner Road, East Windsor.
To register for the free session or for more information visit www.princetonhcs.org/calendaror call 609.448.1330.
To find a physician affiliated with Penn Medicine Princeton Health call 888-742-7496 or visit www.princetonhcs.org.
Bruce Pierce, M.D., F.A.C.O.G, F.A.C.S. is board certified in obstetrics and gynecology and a fellow of the American College of Obstetricians and Gynecologists and the American College of Surgeons. He is the Medical Director of the Robotic Surgery Program at Penn Medicine Princeton Medical Center.