Polycystic ovarian syndrome (PCOS) is one of the most common female hormonal
disorders and affects between 5% and 10% of all women aged between the ages
of 12 and 45. It is a leading cause of female infertility yet sadly is among the most underdiagnosed and overlooked illnesses in women. Since PCOS is often associated with weight gain and particularly since weight loss often improves the symptoms of PCOS in overweight sufferers, I will discuss it here.
What is PCOS?
PCOS is a syndrome of unkown cause whose features often (but not always)
Multiple cysts in ovaries by ultrasound
-"Oligomenorhea": Irregular or too few or totally absent
-"Hirsuitism" meaning the growth of facial hair or hair in
other locations not normally seen in women
-Infertility: difficulty getting pregnant and high risk for
-Insulin resistance and high risk for type-2 diabetes
-Hypertension (high blood pressure)
-Acanthosis nigricans (patches of darkened skin under arms,
in the groin area, and on the back of the neck)
-Depression, alone or in combination with anxiety
-Dyslipidemia: Elevated serum triglyceride and LDL (bad)
Treatment Options for Women With PCOS:
Clomiphene citrate and Follicle Stimulating Hormone (FSH) are the most
effective drug-hormonal treatments for PCOS-induced infertility. This benefit is
further enhanced by weight loss through dietary modification, particularly with
low-glycemic diets. In-vitro fertalization can also be effective.
Many doctors prescribe metformin either alone or in combination with the
treatments described above because of early studies that suggested that
agressive management of the insulin resistance commonly found with PCOS also
improves fertility. More recent and larger studies show no improvement in
fertility with metformin and in Britain and continental Europe, metformin is no
longer much used in women who have PCOS-related infertility alone. Metformin
still has a valuable role to play in helping with the insulin resistance from PCOS,
it just no longer appears useful for enhancing fertility.
Treatment of Insulin Resistance:
Insulin resitance and overt diabetes in women with PCOS is treated exactly as
it is in all patients with type-2 diabetes: through weight loss, low glycemic
index diets, metformin and other oral hypoglycemic medications when needed
and of course, in severe cases, insulin injection.
Treatment of Other Associated Conditions:
Hair growth is managed with drugs that suppress testosterone like
spironolactone, or with medications that directly target hair follicles. Nearly all
of the other risks like dyslipidemia are managed as they are in all patients.
The Central Role of Weight Control for Improving PCOS
Nearly every symptom and risk associated with PCOS improves with weight loss.
It is important to remember that women with PCOS who are overweight should
be especially careful to chose foods low on the glycemic index and to limit their