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  » Medical Topic Archive  »  A Guide to Polycystic Ovary Syndrome (PCOS)

A Guide to Polycystic Ovary Syndrome (PCOS)

You may be a young woman who has just been told you have PCOS or you may be wondering whether you have this diagnosis because you have irregular periods, acne, excess body hair, or have had a hard time keeping a normal weight. PCOS is a common problem among young women. In fact, almost 1 out of 10 women has PCOS. This guide was created to help you understand PCOS by answering the most commonly asked questions. What is PCOS? Polycystic ovary syndrome (PCOS) is a hormone imbalance that can cause irregular periods, unwanted hair growth, and acne. PCOS begins during the teenage years and can be mild or severe. What are the signs of PCOS? Young women with PCOS commonly have one or more signs. Some of the most common signs include:

  • Irregular periods—periods that come every few months, not at all, or too frequently
  • Extra hair on your face or other parts of your body, called "hirsutism" (her-suit-is-em)
  • Acne
  • Weight gain and/or trouble losing weight
  • Patches of dark skin on the back of your neck and other areas, called "acanthosis nigricans" (a-can-tho-sis ni-gri-cans)
Could I have PCOS? If you have some or all of the above signs, you might have PCOS. There can be other reasons why you might have one or more of these signs. Only your health care provider can tell for sure. If you do have PCOS, you'll want to know what causes it and how to treat it. What causes PCOS? PCOS is caused by an imbalance in the hormones (chemical messengers) in your brain and your ovaries. Many girls also have higher than normal levels of insulin from the pancreas. PCOS usually happens when the LH levels or the insulin levels are too high, which results in extra testosterone production by the ovary. For a more detailed explanation, take a look at the figure below:

image of the body and hormone cycle
  1. The pituitary (pi-tu-i-tary) gland in your brain makes the hormones luteinizing (lu-tin-iz-ing) hormone and follicle (fall-icall)-stimulating hormone (LH and FSH).
  2. After getting the signal from the hormones, LH and FSH, the ovaries make estrogen (es-tro-gen) and progesterone (pro-ges-ter-one), the female sex hormones. All normal ovaries also make a little bit of the androgen testosterone (an-dro-gen tes-tos-ter-own), a male sex hormone.
  3. The pancreas (pang-cre-us) is an organ that makes the hormone "insulin." High levels of insulin can also cause the ovaries to make more of the testosterone hormone.
Why are my periods so irregular? Having PCOS means that your ovaries are not getting the right hormonal signals from your pituitary gland. Without these signals you will not ovulate (make eggs). Your period may be irregular or you may not have a period at all. Let's review a regular menstrual cycle.
  1. The menstrual cycle starts when the brain sends LH and FSH to the ovaries. A big surge of LH is the signal that tells the ovaries to ovulate, or release a ripe egg.
  2. The egg travels down the fallopian tube and into the uterus. Progesterone from the ovary tells the lining of the uterus to thicken.
  3. If the egg isn't fertilized, the lining of the uterus is shed = a menstrual period.
  4. After the menstrual period, the cycle begins all over again.

Normal Ovulation

Ovulation PCOS

The diagram on top shows a normal menstrual cycle; the diagram on the bottom shows a PCOS cycle where the menstrual cycle stops just before ovulation. As a result, girls with PCOS may ovulate occasionally or not at all, so periods may be too close together or more usually too far apart. Some girls may not get a period at all. Now, let's look at what happens during a menstrual cycle with PCOS.

  1. With PCOS, LH levels are often high when the menstrual cycle starts. The levels of LH are also higher than FSH levels.
  2. Because the LH levels are already quite high, the surge that sets off the chain reaction causing ovulation does not happen. Without this LH surge, ovulation does not occur and periods are irregular.
What types of tests will my health care provider do to diagnose PCOS? Your health care provider will ask you a lot of questions about your menstrual cycle and your general health and then do a complete physical examination. You most likely will need to have a blood test to check: your hormone levels, blood sugar, and cholesterol. Your health care provider may also want you to have an ultrasound test of your uterus and ovaries. Does PCOS mean I have cysts on my ovaries? The term "polycystic ovaries" means that there are lots of tiny cysts, or bumps, inside of the ovaries. Some young women with PCOS have these cysts; many others do not. Even if you do have them, they are not harmful and do not need to be removed. Why do I get acne and/or extra hair on my body? Acne and extra hair on your face and body can happen if your body is making too much testosterone. All women make testosterone, but if you have PCOS, your ovaries make a little bit more testosterone than they are supposed to. Skin cells and hair follicles are extremely sensitive to the slight increases in testosterone found in young women with PCOS. Why do I have patches of dark skin? Many adolescents with PCOS have higher levels of the hormone, insulin, in their blood. Higher levels of insulin can sometimes cause patches of darkened skin on the back of your neck, under your arms, and in your groin area (inside upper thighs). Will PCOS affect my ability to have children some day? Women with PCOS have a normal uterus and healthy eggs. Many women with PCOS have trouble getting pregnant, but some women have no trouble at all. If you are concerned about your fertility (ability to get pregnant) in the future, talk to your doctor about all the new options available including medications to lower your insulin levels and help you ovulate each month. What can I do about having PCOS? While you can't cure PCOS, you can treat it. A healthy lifestyle is very important, including a healthy eating and daily exercise. There are excellent long-term medications to help you manage irregular periods, hair growth, and acne. Ask your doctor about the various options, including hormone treatment and insulin-sensitizing medications. What is the treatment for PCOS? The most common form of treatment for PCOS is the birth control pill. Birth control pills contain hormone medicine. Even if you are not sexually active, birth control pills may be prescribed by your doctor because they contain the hormones that your body needs to treat your PCOS. By taking the birth control pill either continuously or in cycles you can :
  • Correct the hormone imbalanceLower the level of testosterone, which will improve acne and lessen hair growth
  • Regulate your menstrual periods
  • Lower the risk of endometrial cancer (which is higher in young women who don't ovulate regularly)
  • Prevent an unplanned pregnancy, if you are sexually active
Is there any other medicine to treat PCOS? A new medicine which helps the body lower the insulin level is called metformin. It is particularly helpful in girls who have high levels of insulin or have pre-diabetes or diabetes. You will need to have your kidney and liver function checked before taking this medication. It is important to discuss with your doctor whether this medicine is right for you. Because you may ovulate while on this medication, you will also need to use birth control if you are sexually active. You should not drink alcohol if you are taking metformin. Sometimes girls are treated with both metformin and birth control pills at the same time. Ask your health care provider about treating hair growth Only you and your doctor can decide which treatment is right for you. Options may include bleaching, waxing, depilatories, spironolactone (spi-ro-no-lac-tone) which is an anti-hair growth medication, electrolysis, and laser treatment. Finding a local salon that provides high quality, cost-effective services can help you choose the right option for you. Ask your health care provider about treatment for acne There are various ways to treat acne, including the birth control pill, topical creams, oral antibiotics, and other medications. Ask your health care provider about a weight loss plan If you are overweight, losing weight may reduce some of the symptoms of PCOS. Talk to your doctor or nutritionist about healthy ways to lose weight and increase your exercise. Following a nutrition plan that helps manage insulin levels may help girls with PCOS manage their weight too. It also keeps your heart healthy and lowers your risk of developing diabetes.
  • Choose nutritious, high-fiber carbohydrates instead of sugary carbohydrates
  • Balance carbohydrates with protein and healthy fats
  • Eat small meals and snacks throughout the day instead of large meals
  • Exercise regularly to help manage insulin levels and your weight
What if I have worries about having PCOS? If you have been told you have PCOS, you may feel frustrated or sad. You may also feel relieved that at last there is an explanation and treatment for the problems you have been having, especially if you have had a hard time keeping a normal weight or you have excess body hair, acne, or irregular periods. Having a diagnosis without an easy cure can be difficult. However, it is important for girls with PCOS to know they are not alone. Finding a doctor who knows a lot about PCOS and you feel comfortable talking to is very important. Keeping a positive attitude and working on a healthy lifestyle even when results seem to take a long time is very important too! Many girls with PCOS tell us that talking with a counselor about their concerns can be very helpful. What else do I need to know? It is important to follow-up regularly with your health care provider and make sure you take all the medications prescribed to regulate your periods and lessen your chance of getting diabetes and other problems. Because you have a slightly higher chance of developing diabetes, your doctor may suggest that you have your blood sugar tested once a year or have a glucose challenge test every few years. Quitting smoking (or never starting) will also improve your overall health.

As you learn more about PCOS, you will find out more about good nutrition and ways to stay fit. Having a healthy lifestyle through ups and downs is the first step to living with PCOS!


For more information, visit our PCOS Nutrition Guide
and our PCOS Resource Guide .

Resources Helpful Websites for Young Women with PCOS

The International Council on Infertility Information Dissemination This well-organized site presents comprehensive but easy-to-read information on PCOS. Also check out the PCOS message board, the "PCOS Café."

http://www.inciid.org/faq/pcos.html The National Women's Health Information Center: 4Girls This website offers basic information about health conditions affecting girls. The PCOS information is written for girls and younger adolescents and includes links to sites.

http://www.4girls.gov/4girls.cfm?page=body/period_problems.htm The National Women's Health Information Center This government-run site offers basic information about PCOS, as well as links to other informative sites.

http://www.4woman.gov/faq/pcos.htm
The Nemours Foundation: KidsHealth The KidsHealth website offers information about many health-concerns for children and teens. The PCOS information is written for adolescents and explains the condition, tests, and treatments in easy-to-understand language.

http://www.kidshealth.org/teen/sexual_health/girls/pcos.html
The Polycystic Ovarian Syndrome Association The PCOSA is a nonprofit organization run by women with PCOS. The website offers general information about PCOS and details some of the organization's activities, including several that are specifically for teens. The organization offers PCOTeen, with message boards, chat rooms, and a mailing list specifically for adolescents. The Big Cyster program is a pen pal program that matches adolescents with older women with PCOS. Finally, Project HEART (Helping Educate And Reach Teens) is a program designed to raise PCOS awareness among adolescents.

http://www.pcosupport.org
Helpful Books for Young Women with PCOS Best-Boss, Angela; Weidman, Evelina Sterling; and Richard Legro. Living with PCOS: Polycystic Ovary Syndrome . Addicus Books, 2000. This book offers a very readable description of PCOS, informative but not too heavy with medical jargon. Dotson, Angela Kay. Polycystic Ovary Syndrome: Fighting Back! Sparhawk Health Publications, 2002. This book, described as a "lifestyle manual" offers a fresh perspective on self-help techniques and positive lifestyle changes for women with PCOS. Hammerly, Milton and Cheryl Kimball. What to Do When the Doctor Says It's PCOS (Polycystic Ovarian Syndrome) . Fair Winds Press, 2003. In this recent book, Hammerly and Kimball include stories of women's experiences with PCOS along with more standard medical information. Harris, Colette and Adam Carey. PCOS: A Woman's Guide to Dealing with Polycystic Ovary Syndrome. Thorson's Publishing, 2000. Harris and Carey describe medical alternatives and self-help techniques to help women in daily life with PCOS. Thatcher, Samuel. PCOS: The Hidden Epidemic . Perspectives Press, 2000. The Hidden Epidemic is a great and thorough resource for young women wanting to learn more about the medical side of PCOS.

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