 Menstrual Irregularities? Overweight? Excessive Facial/Body Hair? |
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 Dr. Allen MorganDr. Allen Morgan of Shore IVF and Reproductive Medicine on Route 70 in Lakewood has been practicing for sixteen years and is board certified by the American Board of Obstetrics and Gynecology (1994) and Reproductive Endocrinology and Infertility (1999). Dr. Morgan teaches OB-GYN residents at Jersey Shore University Medical Center who get their clinical experience in reproductive endocrinology under his tutelage. |
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You Might Have PCOS
Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women, affecting 5-10% of the female population. This syndrome was first identified in 1935 by Stein and Leventhal who found certain common characteristics among women with PCOS. It is characterized by irregular menstrual periods and infertility due to a lack of ovulation (release of an egg), and by signs of excess male hormones overproduced by the ovaries. The ovaries are usually enlarged with a smooth surface and multiple small cysts seen on an ultrasound exam. The small cysts are actually follicles (the small fluid sacs that house the eggs) that have not grown large enough to release their eggs. Because PCOS is a syndrome, and not a disease, the treatment is targeted at the most concerning symptom. Lifestyle changes and treatments to prevent diseases associated with PCOS can be implemented.
Q What are theSymptoms?
❖ Irregular periods are a symptom of PCOS. The most common treatment is the birth control pill. The pill provides the right hormonal signals to the uterus to allow regular menstrual periods, and to keep the lining of the uterus from getting too thick. This effect allows for lighter periods and a reduced risk of cancerous changes to the lining. It also suppresses the ovaries, so that they do not make as much testosterone. Another hormonal option is to give progesterone for 5-10 days each month. This will cause the thickened lining of the uterus to slough within one week. This treatment is often given (after a negative pregnancy test) prior to starting birth control pills or fertility treatments. Neither treatment makes the ovaries ovulate.
❖Excess hair growth is a frustrating problem and is due to the effects of excess testosterone on the hair follicles. Normally in women hair follicles on the face and lower abdomen don’t make thick hair, but with excess testosterone they do. The hair follicles may also make excess sebum leading to acne, or grow hair so fast that it falls out. One effective treatment is the birth control pill, which lowers testosterone levels and lessens hair growth and acne. It takes several months to see the improvement. Other medicines that block testosterone production can be given but must be accompanied by birth control because they can cause birth defects, particularly in male fetuses. Laser hair removal is the most effective way to permanently remove the unwanted hair and takes about 6 treatments over one year. It should be done only after the ovaries have been suppressed of their testosterone production or the hair will continue to grow. “Women who have excessive facial or body hair are often ashamed,” Dr. Morgan says. “They don’t realize that their ‘problem’ could be a treatable syndrome.”
❖It is estimated that up to 3/4 of patients with PCOS have some form of insulin resistance, particularly those who are overweight or obese. Up to 15% of patients actually have diabetes. Studies have shown that weight loss can improve or eliminate these problems, but many patients also need the help of medications to lower insulin levels and balance their sugar metabolism. This is important for overall health because it will decrease the risk of diabetes and heart disease. Medications can also allow the ovaries to start functioning normally, which could result in more regular menstrual cycles, ovulation and pregnancy.
❖Infertility problems occur with PCOS because of the lack of ovulation. The most common treatment for inducing ovulation is to give the fertility pill clomiphene citrate (Clomid, Serophene). Clomiphene citrate helps the body make more follicle stimulating hormone (FSH) to stimulate the growth and release of follicles and their eggs. Eighty percent of patients will ovulate and half of those who ovulate will ultimately conceive after several attempts. There is a modest increase in the risk of having twins (5-7%) with clomiphene citrate. Some patients do not respond to clomiphene citrate and may require other therapies.
One option is to give medications to lower insulin levels to help the ovaries ovulate, or to respond better to other fertility medications. Another option is to use fertility shots that contain FSH. These shots directly stimulate the ovaries, but must be used carefully because patients with PCOS can have an excessive response to these medicines and make too many eggs, increasing the risk of multiple pregnancies including the possibility of triplets or higher order pregnancies. Therefore, these medicines must be monitored carefully by a trained Fertility Specialist (Reproductive Endocrinologist). Some patients can also benefit from in Vitro Fertilization (IVF).
Luckily, most of the symptoms caused by PCOS can be successfully treated. Dr. Allen Morgan is an expert in PCOS and would be happy to discuss your situation with you.
✦ For a special offer on hair removal see the
article on page 17 of this issue.
Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women, affecting 5-10% of the female population. This syndrome was first identified in 1935 by Stein and Leventhal who found certain common characteristics among women with PCOS. It is characterized by irregular menstrual periods and infertility due to a lack of ovulation (release of an egg), and by signs of excess male hormones overproduced by the ovaries. The ovaries are usually enlarged with a smooth surface and multiple small cysts seen on an ultrasound exam. The small cysts are actually follicles (the small fluid sacs that house the eggs) that have not grown large enough to release their eggs. Because PCOS is a syndrome, and not a disease, the treatment is targeted at the most concerning symptom. Lifestyle changes and treatments to prevent diseases associated with PCOS can be implemented.
Q What are theSymptoms?
❖ Irregular periods are a symptom of PCOS. The most common treatment is the birth control pill. The pill provides the right hormonal signals to the uterus to allow regular menstrual periods, and to keep the lining of the uterus from getting too thick. This effect allows for lighter periods and a reduced risk of cancerous changes to the lining. It also suppresses the ovaries, so that they do not make as much testosterone. Another hormonal option is to give progesterone for 5-10 days each month. This will cause the thickened lining of the uterus to slough within one week. This treatment is often given (after a negative pregnancy test) prior to starting birth control pills or fertility treatments. Neither treatment makes the ovaries ovulate.
❖Excess hair growth is a frustrating problem and is due to the effects of excess testosterone on the hair follicles. Normally in women hair follicles on the face and lower abdomen don’t make thick hair, but with excess testosterone they do. The hair follicles may also make excess sebum leading to acne, or grow hair so fast that it falls out. One effective treatment is the birth control pill, which lowers testosterone levels and lessens hair growth and acne. It takes several months to see the improvement. Other medicines that block testosterone production can be given but must be accompanied by birth control because they can cause birth defects, particularly in male fetuses. Laser hair removal is the most effective way to permanently remove the unwanted hair and takes about 6 treatments over one year. It should be done only after the ovaries have been suppressed of their testosterone production or the hair will continue to grow. “Women who have excessive facial or body hair are often ashamed,” Dr. Morgan says. “They don’t realize that their ‘problem’ could be a treatable syndrome.”
❖It is estimated that up to 3/4 of patients with PCOS have some form of insulin resistance, particularly those who are overweight or obese. Up to 15% of patients actually have diabetes. Studies have shown that weight loss can improve or eliminate these problems, but many patients also need the help of medications to lower insulin levels and balance their sugar metabolism. This is important for overall health because it will decrease the risk of diabetes and heart disease. Medications can also allow the ovaries to start functioning normally, which could result in more regular menstrual cycles, ovulation and pregnancy.
❖Infertility problems occur with PCOS because of the lack of ovulation. The most common treatment for inducing ovulation is to give the fertility pill clomiphene citrate (Clomid, Serophene). Clomiphene citrate helps the body make more follicle stimulating hormone (FSH) to stimulate the growth and release of follicles and their eggs. Eighty percent of patients will ovulate and half of those who ovulate will ultimately conceive after several attempts. There is a modest increase in the risk of having twins (5-7%) with clomiphene citrate. Some patients do not respond to clomiphene citrate and may require other therapies.
One option is to give medications to lower insulin levels to help the ovaries ovulate, or to respond better to other fertility medications. Another option is to use fertility shots that contain FSH. These shots directly stimulate the ovaries, but must be used carefully because patients with PCOS can have an excessive response to these medicines and make too many eggs, increasing the risk of multiple pregnancies including the possibility of triplets or higher order pregnancies. Therefore, these medicines must be monitored carefully by a trained Fertility Specialist (Reproductive Endocrinologist). Some patients can also benefit from in Vitro Fertilization (IVF).
Luckily, most of the symptoms caused by PCOS can be successfully treated. Dr. Allen Morgan is an expert in PCOS and would be happy to discuss your situation with you.
✦ For a special offer on hair removal see the
article on page 17 of this issue.- By Dr. Allen Morgan
- Medical Professionals
- Published 01/11/2010
