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Ask Dr. K: Women with PCOS can restore fertility

DEAR DOCTOR K: I was just diagnosed with polycystic ovary syndrome. My doctor said it explains why I haven’t been able to get pregnant. What else can you tell me about this condition?

DEAR READER: Polycystic ovary syndrome (PCOS) is a group of symptoms that results from an imbalance of certain hormones in the female body. It is relatively common: About 7 to 8 percent of adult women in the United States have PCOS.

As the name of the condition implies, the ovaries have multiple little cysts or follicles that can be seen using an ultrasound examination. However, similar cysts are seen in some other conditions, as well, so just seeing the cysts does not mean a woman has PCOS.

The abnormalities that are more characteristic of PCOS involve sex hormones. Estrogen and progesterone are female hormones produced by the ovaries. These hormones trigger monthly menstrual cycles and help eggs develop in the ovaries. The male hormone testosterone is also produced by the ovaries, usually in small amounts. It is in a class of hormones called androgens. Women who produce too much testosterone develop PCOS.

When everything is working properly, the ovaries release an egg each month. But when a woman has high levels of testosterone, her ovaries have difficulty releasing her eggs. Ovulation may stop or happen only occasionally, which makes it difficult to get pregnant. In addition, when no egg is released during a monthly cycle, a woman doesn’t have normal menstrual periods. This increases the risk of cancer in the uterus.

Excess androgen hormones can cause acne and increased facial hair growth. Women with PCOS have high levels of insulin (a hormone that helps lower blood sugar) and tend to be insulin-resistant. They are more likely to become obese and develop diabetes, high blood pressure, cholesterol problems and heart disease.

Women with PCOS also are more likely to develop obstructive sleep apnea, a potentially serious sleep disorder. It is not clear if this is because women with PCOS tend to be overweight, and being overweight is a risk factor for sleep apnea.

In any event, all women with PCOS should maintain a healthy weight, eat a healthy diet and exercise regularly. This will help to prevent obesity, heart disease and diabetes.

Restoring normal menstrual cycles can reduce the risk of uterine cancer, and this can be done by using birth control pills containing estrogen and progesterone. In addition, they can control hair growth and acne. Anti-androgen medicine also can help with unwanted hair and acne.

Most women with PCOS who want to get pregnant are now able to. A drug that helps the ovary to release its eggs is the main treatment.

Your doctor may prescribe a medicine called metformin if you have insulin resistance and pre-diabetes, or metabolic syndrome. Metformin also can lower testosterone levels, and restore normal menstrual cycles and fertility.

To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.

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