Is there a cure for PCOS?
There is no cure yet, but there are many ways you can decrease or eliminate PCOS symptoms and feel better. Your doctor may offer different medicines that can treat symptoms such as irregular periods, acne, excess hair, and elevated blood sugar. Fertility treatments are available to help women get pregnant. Losing as little as 5% excess weight can help women ovulate more regularly and lessen other PCOS symptoms. The ideal way to do this is through nutrition and exercise.
You may feel that it is difficult to lose excess weight and keep it off, but it is important to continue the effort. Your efforts help reduce the risk of developing serious health complications that can impact women with PCOS much sooner than women without PCOS. The biggest health concerns are diabetes, heart disease, and stroke because PCOS is linked to having high blood pressure, pre-diabetes, and high cholesterol.
What is an Ovarian Cyst?
The definition of a cyst is a fluid-filled sac. Cysts can occur anywhere in the body. With PCOS, women can develop "cysts" due to eggs not being released over time. The follicles keep growing and form multiple "cysts." These may be described as appearing like a "string of pearls" in an ultrasound image.
Despite the name, women with PCOS don't need to have ovarian cysts. Women without PCOS may develop cysts related to other reasons. The most common type of ovarian cyst is called a functional cyst.
These cysts are described as "functional" because they often develop during the menstrual cycle. There are 2 types:
Follicular Cysts: These usually go away on their own in 1 to 3 months. These form when an egg doesn't get released as expected, so the follicle keeps growing.
Corpus Luteum Cysts: These also usually go away on their own. They form after the follicle ruptures and releases the egg (ovulation). The follicle reseals and fluid starts to build up within it. They can enlarge and cause pain, bleed, or twist the ovary. Fertility medicines used to promote ovulation (such as clomiphene) can increase the chances of developing these types of cysts.
Ovarian cysts can also be related to endometriosis, or formed from the outer surface of the ovary (cystadenomas), or formed with non-ovarian tissue (dermoid cysts).
Possible Symptoms
Most ovarian cysts are small and don't cause symptoms. Women may not even know they have one until they have a pelvic exam. If there are symptoms, they may include:
Pressure
Bloating
Swelling
Pain in the lower abdomen, on the side where the cyst is located
You may need surgery if you have pain, are past menopause, or if the cyst does not go away. If a cyst bursts or causes bleeding, you should get medical help right away.
Getting a Proper Diagnosis
Ovarian cysts can sometimes be detected during a pelvic examination, although an imaging test, usually a pelvic ultrasound, is necessary to confirm the diagnosis.
A CT scan or MRI is sometimes used to determine information about the cyst's size, location, and other important characteristics.
One or more blood tests may be recommended if you are found to have an ovarian cyst. The blood test(s) can help to determine the nature of the cyst.
Ovarian Cyst Treatment
Ovarian cysts do not always require treatment and often resolve on their own within one to three months. In postmenopausal women, ovarian cysts are less likely to resolve.
If a cyst is large, causing pain, or appears suspicious for cancer, treatment could involve surgery to remove the cyst or the entire ovary.
Endometriosis
Ovarian cysts can also be related to endometriosis, or formed from the outer surface of the ovary (cystadenomas), or formed with non-ovarian tissue (dermoid cysts). Dermoid cysts come from cells present from birth. Because these cysts form from embryonic cells, they can contain tissue such as hair, skin, or teeth. They're rarely cancerous and do not usually cause symptoms.
Endometriosis occurs when pieces of the tissue that line the womb (endometrium) are found outside the womb in the fallopian tubes, ovaries, bladder, bowel, vagina, or rectum. Blood-filled cysts can sometimes form in this tissue.
When to Seek Medical Treatment
If you have been diagnosed with an ovarian cyst and you develop any of the following symptoms, seek medical help immediately:
Pain with fever and vomiting
Sudden, severe abdominal pain
Faintness, dizziness, or weakness
Rapid breathing
These symptoms could mean that your cyst has broken open, or ruptured. Sometimes, large ruptured cysts can cause heavy bleeding.
Prevention
Although there's no way to prevent ovarian cysts, regular pelvic exams help ensure that changes in your ovaries are diagnosed as early as possible. Be watchful of changes in your monthly cycle, including any unusual menstrual symptoms. Talk to your doctor about symptoms that concern you, especially ones that persist for more than a few menstrual cycles. If your PCOS cyst changes or becomes worrisome, please talk to your health care provider.
Sources: Office of Women's Health, Department of Health and Human Services. American College of Obstetrics and Gynecology.
What Causes PCOS?
The cause of PCOS is unknown. But most experts think that several factors, including genetics, could play a role. Women with PCOS are more likely to have a mother or sister with PCOS.
A main underlying problem with PCOS is a hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. Androgens are male hormones that females also make. High levels of these hormones affect the development and release of eggs during ovulation.
Researchers also think insulin may be linked to PCOS. Insulin is a hormone that controls the change of sugar, starches, and other food into energy for the body to use or store. Many women with PCOS have too much insulin in their bodies because they have problems using it. Excess insulin appears to increase the production of androgens. High androgen levels can lead to:
Acne
Excessive hair growth
Weight gain
Problems with ovulation
Getting Tested
There is no single test to diagnose PCOS. Your doctor will take the following steps to find out if you have PCOS or if something else is causing your symptoms:
Medical history. Your doctor will ask about your menstrual periods, weight changes, and other symptoms.
Physical exam. The doctor will want to measure your blood pressure, body mass index (BMI), and waist size. He or she also will check the areas of increased hair growth. You should try to allow the natural hair to grow for a few days before the visit.
Pelvic exam. Your doctor might want to check to see if your ovaries are enlarged or swollen by the increased number of small cysts.
Blood tests. The androgen hormone and glucose (sugar) levels in your blood may be checked by your doctor.
Vaginal ultrasound (sonogram). The doctor may perform a test that uses sound waves to take pictures of the pelvic area. It might be used to examine your ovaries for cysts and check the endometrium (en-do-MEE-tree-uhm) (lining of the womb). This lining may become thicker if your periods are not regular.
Associated Health Risks
Women with PCOS have greater chances of developing several serious health conditions, including life-threatening diseases. Recent studies found that:
More than 50 percent of women with PCOS will have diabetes or pre-diabetes (impaired glucose tolerance) before the age of 40.
The risk of heart attack is 4 to 7 times higher in women with PCOS than women of the same age without PCOS.
Women with PCOS are at greater risk of having high blood pressure.
Women with PCOS have high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol.
PCOS sufferers can develop sleep apnea. This is when breathing stops for short periods of time during sleep.
Women with PCOS may also develop anxiety and depression. It is important to talk to your doctor about treatment for these mental health conditions.
There is also the risk for endometrial cancer. Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Progesterone causes the endometrium (lining of the womb) to shed each month as a menstrual period. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia, when the lining grows too much, and cancer.
Many women with PCOS choose to be involved with polycystic ovary syndrome support groups to gain support and knowledge from other women going through similar symptoms and situations. Understanding what others other going through can be a great help in managing PCOS.
U.S. Department of Health and Human Services
Individualized PCOS Treatments
PCOS treatments focus on managing your individual concerns, such as infertility, hirsutism, acne, or obesity. PCOS treatments can include lifestyle changes like healthy eating and losing weight, or in some cases, medications can help. If a woman is not seeking to become pregnant, hormonal birth control (most often birth control pills) is a standard treatment. Here is a list of PCOS treatments available:
Birth Control Pills
This is a common treatment to regulate periods and limit excess hair growth and acne by lowering androgen levels and protecting the endometrium (inner lining of the uterus) against abnormal cell growth. Regulating your hormones can lower your risk of endometrial cancer.
Pills that contain estrogen and progestin decrease androgen production and regulate estrogen. Older types of birth control pills have a lower risk for dangerous blood clots and are preferable over new types of birth control pills.
Instead of pills, you might prefer to use a skin patch or vaginal ring that contains a combination of estrogen and progestin.
Metformin
Although metformin is not approved by the FDA for the treatment of PCOS, many doctors prescribe it for PCOS patients. Metformin is a medicine that makes the body more sensitive to insulin. This can help lower elevated blood glucose levels, insulin levels, and androgen levels. People who use metformin may lose some weight as well. Metformin can improve menstrual patterns, but it does not help as much for unwanted excess hair.
Many women who are diagnosed with PCOS are often automatically prescribed metformin. However, it's important to have a reason for taking metformin and not be on it just because of a diagnosis of PCOS. Discuss with your doctor the reason why you are taking metformin and whether it is providing a benefit to you.
Clomiphene (Clomid)
This is an oral medication that is the most common treatment used to induce ovulation. The use of both metformin and clomiphene has about the same fertility results as clomiphene used alone. A benefit is that metformin may help reduce the risk for ovarian hyperstimulation syndrome (OHSS) during assisted reproductive technology (ART) fertility treatments.
Letrozole (Femara)
Other treatments to stimulate ovulation include another oral medication called letrozole (Femara) and gonadotropins which are hormones that are given by injection. In vitro fertilization (IVF) and in vitro maturation (IVM) may be other fertility treatment options.
Lifestyle Changes
Your doctor may recommend weight loss through a low-calorie diet combined with moderate exercise activities. Lifestyle measures to achieve a weight loss of 5%-10% in overweight women can help regulate ovulation and periods. Although basic good nutrition is needed, it can be more challenging to lose weight and maintain weight loss with PCOS. Dr. Dunaif from Northwestern University is very encouraged that even “a little bit of weight reduction and exercise can improve insulin sensitivity.”
Spironolactone
Drugs that curb androgen levels are another common treatment used for PCOS, although they are not officially FDA-approved for PCOS treatment. By lowering androgen levels, many patients have significant improvements in androgen-related symptoms such as excess hair. Spironolactone is the anti-androgen drug most often used.
To curb hirsutism (excess hair), Dr. Andrea Dunaif from Northwestern University typically starts patients with spironolactone. A 6-month trial is needed to show effects on unwanted hair, and she usually starts women at a higher dose. The unwanted hair doesn’t disappear but grows finer and lighter.
Improvement of acne generally comes more quickly. Unfortunately, this drug is unlikely to help with androgen-related hair loss (aka androgenic alopecia) which is more difficult to treat.
Two important things to note are that the long-term safety effects of use are not known (but the drug has been in use for decades already) and spironolactone IS NOT SAFE to take during pregnancy, so it is commonly used in conjunction with birth control pills.
This use of birth control pills also protects against abnormal growth of the lining of the uterus. Some women cannot take birth control pills, in which case it is important to use other means of birth control if you are sexually active while taking spironolactone.
Prescription Creams
Treatments targeting the skin or hair more directly are also available to help with hair problems. These include the prescription cream eflornithine hydrochloride (Vaniqa), acne products, and cosmetic treatments such as laser therapy and electrolysis.
Vitamins
Vitamins, supplements, and other complementary treatments are popular among women with PCOS. Researchers are studying the effectiveness of such treatments. Popular options include cinnamon, Myo-inositol, vitamin D, B complex vitamins, and acupuncture. We hope to share and explain the evidence for these and other treatments as well as research findings as they develop.
Because the severity of PCOS can vary from person to person, treatment plans are highly individual. It’s extremely important to talk to your doctor about all potential treatments for PCOS and discuss the different options.
Remember to consider factors such as cost, desire to have children in the future, regular periods versus irregular bleeding, and effectiveness at preventing pregnancy if you’re not trying to conceive right now.