PCOS: A Vexing Hormone Imbalance


Amy is 32 years old, overweight, has irregular periods, uncontrollable acne, and excessive hair on her face. And she is having a hard time getting pregnant. The “trouble getting pregnant” part is why she came to see me. Amy is a typical patient of mine who has Polycystic Ovary Syndrome, or PCOS for short. But, she didn’t know before her visit that all of the disparate symptoms described above actually have a common link and are part of a common female disease.

September is PCOS Awareness Month, so it’s a good time to talk about this disease that is estimated to affect nearly one in every 10 women. It is a lifelong disorder that is the leading cause of female infertility and a risk factor for many life-threatening illnesses. Yet half of all women with PCOS go undiagnosed.

Women with PCOS can experience irregular ovulation and menstrual cycles, changes in physical appearance (acne, weight gain, excessive hair growth), heart problems, increased risk for diabetes and infertility. In addition, the ovaries tend to produce excess levels of androgens (male hormones) in women with PCOS, which can also negatively impact ovulation and fertility as well as other medical problems.

PCOS_USIn a normal ovary, eggs mature and are released every cycle. But for women who have PCOS, there is an imbalance of hormones which can prevent this release.   Many people immediately worry when they hear the word “cyst.” They think of cancer. They worry the cysts will “rupture” and cause problems.   This is NOT the case.  Each egg is surrounded by a collection of fluid called a follicular cyst, about the size of a pencil eraser. Yes, it is NORMAL for a woman to have a cyst every month.  But if it is not released, or in other words, if she doesn’t ovulate, the collection of fluid just hangs around month after month, producing more and more androgens (testosterone).  This is why the symptoms of hair growth and infertility go together in PCOS.

PCOS can be analogous to a light bulb and its switch. The bulb is ok. It’s the signal going to the bulb that is abnormal.  The eggs in women with PCOS are normal.  They just need the right hormone stimulation.   Here’s where it gets complicated.  Most women with PCOS also have a problem with their metabolism.    Specifically they respond to carbohydrates much differently than others.  The carbs lead to excess insulin and the insulin can cause their ovaries to overproduce testosterone.  This, then, interferes with the signal for ovulation.  It’s not the light bulb; it’s the signal! If only we could fix the signal!

There is good news. Lowering carb intake, increasing exercise and taking medication that can improve the insulin levels makes the eggs more responsive (almost like a normal ovary now!).  Testosterone levels can drop, facial hair can disappear and the risk of diabetes can be lowered. But women with PCOS are different.  They have a harder time losing weight because their bodies respond to some foods differently.  That’s why it’s so important for us to diagnose it early.  If we could warn young women in their teens and 20’s that they should avoid high carbs in their diet and exercise regularly, they may never encounter the infertility, hair growth, acne and risk of heart disease and diabetes later in life.   In addition, they may be able to start medication earlier that would benefit them long term.

What should you do if you feel you may have PCOS? Probably, the most important suggestion is to not wait to get an opinion and a diagnosis. Left untreated, PCOS causes infertility and can eventually lead to diabetes, cancer and heart problems. A reproductive endocrinologist who understands the complexities of hormones in a woman’s body can set you on the right path to managing your PCOS. By optimizing any one imbalanced hormone, you are taking a step towards optimizing the others and increasing your chances of becoming fertile.

We are now excited to be actively involved in research at Woman’s Hospital that will study different medications to treat the problems with insulin resistance and weight loss for patients with PCOS. If you are exhibiting the signs of PCOS or having difficulty getting pregnant, you can find more answers at the links below.  If you are interested in clinical research for PCOS, contact the research office listed below.

FertilityAnswers: http://www.fertilityanswers.com/infertility/polycystic-ovary-syndrome/

PCOS Foundation: http://www.pcosfoundation.org/index.php

PCOS Awareness Association: http://www.pcosaa.org/

PCOS Research Study: http://www.womans.org/about-womans/research/

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Infertility PCOS

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