What is PCOS?
- A condition where the ovaries contain a large number of small cysts at the periphery of the ovary
- This is usually but not always, associated with irregular periods, weight problems and acne. Any combination of the symptoms below can be present in a patient
- Patients do not need to be overweight to have PCOS
What are the symptoms?
- irregular cycles
- no cycles
- weight gain
- abnormal hair growth, typically on the nipples, face and up to the belly button
- any combination of the above
What tests should be done?
- ultrasound to look at the ovaries and measure the volume of the ovaries
- fasting insulin and glucose levels
- day 2 of your cycle LH levels
- testosterone and sex hormone binding globulins
- BMI determination
Can the cysts be removed?
How long has this been there?
- You have always had this and you will always have this
- It is a chronic medical condition and needs to be managed like one manages other chronic conditions like high blood pressure
What is actually wrong?
- you do not ovulate.
- you produce and excess of male hormones
- the follicles do not mature and when stimulated not all follicles will contain eggs
What are the treatment options?
- this depends on the patient's wish and is usually one of a few:
- young girl with irregular cycles only - the oral contraceptive pill
- acne - tablets to decrease the excess male hormones
- insulin resistance - insulin lowering drugs
- weight problems - dietary advice and insulin lowering drugs if insulin levels are high
- infertility - ovulation induction using either tablets or injections or a combination
- ovarian drilling - a last resort in patients that do not respond to ovulation induction using standard protocols
any combination of the above treatments may be necessary.
Can I actually get pregnant if I have PCOS?
- You have a very good chance of conceiving, especially if PCOS is the only reason why you are not conceiving
- Yes you most probably can, depending on other factors as well like your state of your tubes and your husband's semen analysis
- However, patients with PCOS are difficult to stimulate and it will not always work the first time and different protocols might be used
- Usually stimulation is started with only tablets and later injections are added if necessary
- One of the problems is the possibility of over stimulating due to the number of eggs that you have in your ovaries
- Your LH hormone will be checked at the beginning of the treatment cycle during your period - the reason for this is that if your LH level is raised, you have a poor chance of actually stimulating and an increased chance of having a miscarriage