PCOS (Polycystic Ovary Syndrome) Treatment
The Center for Endometriosis & Fertility in Newport Beach, California
What is PCOS?
What is PCOS (Polycystic Ovary Syndrome)?
PCOS is a condition in which a woman’s ovaries produce an abnormally high amount of androgens or male sex hormones, something usually only present in small amounts. The name polycystic ovary syndrome (pronounced PAH-lee-SIS-tik OH-vuh-ree SIN-drome) reflects the numerous tiny cysts or fluid-filled sacs that have formed in the ovaries. The name itself can be confusing because many women with PCOS do have small cysts on their ovaries, but not everyone, and some women have these cysts without having PCOS. Though medical science hasn’t quite yet figured out the exact cause of PCOS – know that it’s very common and you’re not alone if you have PCOS.
PCOS symptoms most commonly emerge around puberty or within the first few years after starting menstruation. Irregular periods and excess hair growth are frequent early signs. Some women may develop initial symptoms in their 20s or even into their 30s when they experience unexplained weight gain and fertility difficulties. The age of onset of PCOS can be influenced by family history and individual genetic predispositions. Sometimes stressful events, significant weight gain, or changes in lifestyle can trigger PCOS symptoms in those already predisposed.
How Does It Affect Women?
How Does PCOS Affect a Woman’s Body?
- Irregular periods: Menstruation might become unpredictable – coming frequently, rarely, or not at all.
- Extra hair growth: You might detect more or thicker facial hair, perhaps hair on your chest or other areas.
- Acne: PCOS can sometimes cause skin to break out.
- Difficulty getting pregnant: PCOS’s disruption to your ovaries can make it harder for them to consistently release an egg each month.
- Having PCOS might slightly increase your chances of developing other health issues later in life like diabetes or high blood pressure.
- Insulin is a hormone that helps regulate the amount of glucose (sugar) in blood and many women with PCOS experience insulin resistance, meaning their body doesn’t use insulin effectively. This leads to higher insulin levels, which can in turn further increase androgen (male hormone) production.
Symptoms?
Symptoms of PCOS (Polycystic Ovary Syndrome)
Be mindful not everyone with PCOS experiences the same symptoms and women can have a wide range of symptoms, in both type and severity.
Menstrual Irregularities
- Having less than eight periods a year.
- Not having a period for several months or more (amenorrhea or the absence of menstruation).
- Experiencing heavy bleeding during menstruation.
- Having the length of your menstrual cycle and bleeding pattern vary widely.
Signs of Excess Androgens (male hormones)
- Hirsutism, which is excess hair growth on the face or body. For women, the hair may grow on the upper lip, chest, back, stomach or chin.
- Development of adult-onset acne or increased severity, particularly on the face, chest, or back.
- Male-pattern hair loss: Thinning of hair on the scalp or receding hairline.
Fertility Issues
- Trouble getting pregnant: PCOS can disrupt regular ovulation.
- Some women with PCOS may not ovulate at all (anovulation).
Other Potential Symptoms
- It’s common for women with PCOS to experience weight gain or have difficulty losing weight, particularly around the abdomen.
- The appearance of dark patches of skin (acanthosis nigricans) in body folds like the neck, armpits, or groin. The skin may have a leathery appearance with dark-skinned people.
- PCOS can heighten the risk of experiencing anxiety and depression.
- Some women with PCOS may experience sleep apnea, a disorder where breathing repeatedly stops and starts during sleep.
While experiencing these symptoms may point to PCOS, a proper diagnosis is essential to rule out other conditions and use a combination of your medical history, physical exam, blood tests, and ultrasound to confirm PCOS. It’s worth noting research (study, study) has indicated associations between PCOS and increased levels of inflammation in the body. This inflammation may contribute to excess androgen production and other aspects of PCOS. Medical science is continually investigating the various biological and environmental factors potentially linked to developing PCOS in order to understand it better as researchers have identified multiple genes possibly linked to an increased predisposition for PCOS.
Diagnosing?
Diagnosing PCOS (Polycystic Ovary Syndrome)
There is no one test to definitively diagnose polycystic ovary syndrome (PCOS). Diagnosing PCOS involves a combination of assessing your symptoms, performing a physical exam, and using the following tests:
Medical History & Physical Exam
- A symptom review takes place learning about your menstrual history (irregularities, heaviness), signs of excess androgens (hair growth, acne), weight changes, and fertility difficulties.
- A standard physical exam that may include a pelvic exam with particular interest in signs like excess hair growth or skin changes.
- A transvaginal pelvic ultrasound imaging test enables visual inspection to check for enlarged ovaries or presence of many small cysts on the ovaries (giving them a “polycystic” appearance).
Blood Tests
- Hormone levels are checked:
- Androgens (like testosterone) to see if they are elevated.
- Luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin to help identify or rule out other conditions.
- Fasting glucose and insulin to evaluate insulin resistance.
- Thyroid function tests or other checks t
- o exclude alternative causes for your symptoms.
How a PCOS Diagnosis is Made
There are different diagnostic criteria but generally, you need to meet at least two of the following three to be diagnosed with PCOS:
- Irregular, infrequent, or absent periods
- Signs of elevated androgens (either on blood tests or through symptoms like excess hair growth)
- Polycystic ovaries seen on ultrasound
Self diagnosis is not advised and tests are important for excluding other health problems that can mimic PCOS, such as thyroid disorders or adrenal gland issues. Also, some women with PCOS won’t have “polycystic ovaries” on ultrasound, it varies from person to person.
Treatment If You Want To Get Pregnant
Treatment if You Have PCOS & Want To Get Pregnant
While PCOS can present a challenge for pregnancy, there are effective treatment options to boost your chances. Here’s an overview of commonly used approaches:
Lifestyle Interventions:
- Weight Management: Weight gain and obesity worsen PCOS and cause irregular periods so even a small weight reduction of 5% can dramatically improve ovulation in women with PCOS.
- Eat whole foods, lean protein, fiber-rich fruits and vegetables, and minimizing processed and sugary items improves insulin sensitivity and regulates hormones. Adopting a low glycemic index diet such as the Mediterranean diet is suggested. But there is no single, rigid “PCOS Diet for pregnancy” but rather nutritional principles centered on whole foods, blood sugar control, and achieving hormone balance.
- Exercise: Regular, moderate-intensity exercise helps lower insulin levels and promotes healthy weight, ultimately benefiting ovulation.
Medications commonly prescribed include:
- Clomiphene Citrate (Clomid): Intended to induce ovulation, it blocks estrogen receptors, resulting in the release of hormones essential for egg development.
- Letrozole: Similar to clomiphene, but potentially associated with lower risk of multiple births.
- Metformin: This medication improves insulin sensitivity, helps regulate menstrual cycles, and increases the chances of ovulation.
- Gonadotropins: Injections of follicle-stimulating hormone (FSH) can directly stimulate the ovaries to develop mature eggs.
Assisted Reproductive Technologies (ART):
- Intrauterine Insemination (IUI): Combined with ovulation-inducing medications, IUI places concentrated sperm directly into the uterus, maximizing chances of an egg being fertilized.
- In Vitro Fertilization (IVF): If medication isn’t successful, IVF often has improved success rates. It involves egg retrieval, fertilization outside the body, and then embryo transfer back into the uterus.
Other: Surgery: Sometimes recommended for PCOS, involving procedures that lower male hormone levels, such as ovarian drilling.
For many women with PCOS, conceiving takes extra time, planning, and treatment. Staying patient and optimistic is important as PCOS affects each woman differently, so there’s no single method that works for everyone. Having PCOS doesn’t mean you can’t get pregnant and let me share with you a surgical path for those coping with PCOS that lowers male hormone levels called Laparoscopic Ovarian Drilling (LOD).
Treating PCOS with Laparoscopic Ovarian Drilling (LOD) for Pregnancy
Treating PCOS with Laparoscopic Ovarian Drilling (LOD) for Pregnancy
What is Laparoscopic Ovarian Drilling (LOD)?
- LOD is a surgical procedure used as a treatment option for some women with polycystic ovary syndrome (PCOS) who have trouble getting pregnant (infertility) due to irregular ovulation and have not responded to fertility medications.
- It involves making small incisions in the abdomen and using heat (electrocautery) or a laser to create tiny punctures on the surface of the ovaries to destroy the tissue that’s producing androgens (male hormones).
How does LOD work?
The exact mechanism isn’t fully understood, but here’s the theory:
- The punctures are thought to reduce the production of androgens (like testosterone) by the ovaries. This helps shift the hormonal balance back towards regular ovulation achieving a kind of ‘hormonal reset’ and restoring the normal function of your ovaries.
- The damaged androgen-producing tissue heals and decreases overall ovarian tissue mass.
- Research indicates LOD may also improve insulin sensitivity, further helping with the hormonal imbalances seen in PCOS.
What does the procedure involve?
- General anesthesia: You’ll be asleep during the procedure.
- Small incisions: The surgeon makes a few small incisions in your abdomen.
- Laparoscope: A thin, fiber optic tube with a camera is inserted to allow the surgeon to see inside your abdomen.
- Ovarian drilling: The surgeon uses a thermal source or laser to create multiple small punctures (usually 4-10 per ovary) on the ovary’s surface.
Who is a candidate for LOD?
LOD may be considered if:
- You have a confirmed diagnosis of PCOS.
- Infertility: You’re experiencing anovulation (not ovulating) or irregular ovulation contributing to infertility.
- Medication resistance: You haven’t achieved ovulation or pregnancy with fertility medications.
- Laparoscopy already planned: Some doctors prefer LOD if you are already having a laparoscopy for another reason related to PCOS.
Benefits of LOD
- Improved ovulation: LOD can increase the chances of regular ovulation for several months to a year, boosting pregnancy chances.
- Second-line treatment: It’s an option when first-line fertility medications aren’t working.
- Lower risk: LOD usually has a lower risk of multiple pregnancies compared to injectable fertility medications (gonadotropins).
Dr. Sadikah Behbehani is in an OBGYN who specializes in Reproductive Endocrinology and Infertility as well as Minimally Invasive Gynecologic Surgery. She completed her 5 year OBGYN Residency at the well renowned McGill University in Montreal, Canada. She then completed a 2 year fellowship in Reproductive Endocrinology and Infertility (REI) at McGill University which makes her double board certified by the Royal College of Physicians & Surgeons of Canada in both OBGYN and REI. In addition, Dr. Behbehani completed a second fellowship in Minimally Invasive Gynecologic Surgery at the prestigious Mayo Clinic and can perform complex pelvic surgeries with both laparoscopy and robotics.
There are only a handful of physicians in the country with such training and being double fellowship trained in surgery and infertility allows Dr. Behbehani to treat complex gynecologic conditions affecting fertility such as endometriosis and fibroids.
Dr. Behbehani is very passionate about providing the best care to her patients, and she’s able to use her robotic skills and her fertility expertise to remove advanced endometriosis from the pelvis while still maintaining the integrity of the reproductive organs allowing them the best chances of pregnancy. With fibroid removal, Dr. Behbehani is able to skillfully remove large fibroids robotically, and expertly restore the anatomy of the uterus to reduce the chance of scar formation and improve pregnancy chances. Dr. Behbehani is also a mother herself, and feels passionate about helping patients start or grow their families. She is skilled in IVF and fertility treatment and has helped many patients become parents over the years.
As an Associate Professor at the University of California, Riverside School of Medicine, Dr. Behbehani is also heavily involved in medical research and publications. She’s presented at numerous national and international conferences, and her research is consistently quoted in women’s health. She’s a member of many international and national gynecologic societies including American Society of Reproductive Medicine (ASRM), American Association of Gynecological Laparoscopists (AAGL), and the Society of Gynecologic Surgeons (SGS). Click here for an overview of publications involving Dr. Sadikah Behbehani.
(949) 200-9038
1901 Newport Blvd, Suite 278 Costa Mesa, CA 92627