What is PCOS?
Polycystic Ovary Syndrome, often referred to by its acronym PCOS affects between 5% and 10% of all women, and is the most common disorder affecting reproductive-aged women. PCOS is a hormonal imbalance likely caused by insulin resistance, in which the body’s cells are less able to respond to insulin and take in circulating glucose. This is particularly evident in patients who are overweight and have additional insulin resistance due to their weight. It is of note that not only is it more difficult for women with PCOS to get pregnant, but once pregnant, they are at higher risk for pregnancy- related diabetes, and are at an increased risk of developing Type 2 diabetes as they get older.
- Irregular and/or painful menstrual cycles
- Unwanted excess hair or acne
- Having trouble conceiving a child
Treatment for PCOS is tailored to the patient’s goals. If a patient is simply looking to reduce the unpleasant androgenic side effects, the combination of birth control pills and an anti-androgen, such as spironolactone is highly effective. If insulin resistance is severe and the patient wants to lose weight, we often consider insulin-sensitizing agents, such as Metformin along with appropriate diet, weight loss, and nutritional counseling. If pregnancy is desired, we often start with an ovulation-induction agent such as clomiphene citrate or letrazole, and may add Metformin either if there is significant insulin resistance or a very high AMH. Due to the common multi-follicular response to gonadotropins in women with PCOS, we tend to reserve the injectable stimulation medication for IVF, which is generally highly effective in women with PCOS.