Polycystic Overarian Syndrome
and Insulin Resistance
Polycystic ovarian syndrome (PCOS) is a metabolic disorder that is estimated to affect approximately 10 percent of reproductive aged women. In fact, it is the most commonly identified fertility obstacle in women.
 PCOS is a syndrome rather than a specific disease. Even the world's experts cannot agree on a single definition. Most experts would agree that a minimal requirement for this diagnosis would be an absence of regular ovulation. Other symptoms might include increased hair growth, acne, and weight gain. However, there are women who will have few if any of these symptoms.
There is a clear link between insulin resistance and PCOS. Insulin resistance is a condition in which the pancreas (abdominal gland that makes insulin) must secrete much higher amounts of insulin in order to keep blood sugars in the normal range. Through a variety of mechanisms, this results in higher male hormone production by the ovary, often causing anovulation, weight gain, and the other symptoms listed above.
CLICK HERE FOR A QUESTIONNAIRE TO ASSESS
YOUR NEED FOR A PCOS WORKUP
Diagnostic Workup
A clinical workup for PCOS should include a careful history and physical exam. It is important to assess for blood pressure, body mass index, ovarian features and other skin and hair distribution irregularities. In addition, lab values obtained from bloodwork is a hallmark of establishing a PCOS diagnosis. Further evaluation may be necessary to rule out other causes of PCOS symptoms.
Management
Treatment of PCOS depends greatly on the patient goals. Please choose which treatment goal is of primary importance to you at this time:
FERTILITY
LONG TERM RISK REDUCTION
It is very important to remember that PCOS does not go away once a woman reaches her reproductive goals. Because PCOS increases the risk for diabetes, heart disease, certain kinds of cancers and other health concerns, it is important that continuing management be maintained.
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Southeastern Center for Fertility and Reproductive Surgery and PCOS
We were one of the first centers in the nation to begin testing for and treating PCOS. Our reputation has brought invitations to lecture on this topic at both local and national levels.
Tina Jackson, our Women's Health Nurse Practitioner, is particularly interested in the area of PCOS and has extensive experience in long-term management of women with this condition. We believe that aggressive and ongoing management is important for optimal reduction of long term health risks and maintenance of favorable cosmetic features such as weight management and hair reduction. We are experienced in the use of hormones, antiandrogens, weight loss medications, lifestyle modifications and support groups to achieve long term success in managing PCOS.
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PCOS QUESTIONNAIRE
This questionnaire is an assessment of your possible need for further evaluation for a disorder called Polycystic Ovarian Syndrome (PCOS). If you have one or more "yes" answers, it would be advisable to follow up with a medical provider who specializes in the evaluation and treatment of PCOS.
- Do you have irregular/infrequent menstrual cycles?
- Do you have excess hair growth on your upper lip, chin, lower abdomen or
inner thighs?
- Do you have darkening &/or thickening of the skin on the back of your neck
armpits, or under your breasts?
- Do you have recurrent cysts or "boils" in the groin area?
- Is your waist circumference >35 inches?
- Do you or another family member have a history of diabetes?
- Have you had trouble achieving pregnancy?
Clients with PCOS often require medication and specialized behavioral changes to achieve improvement in their healthcare. If you have one or more yes answers to the above questionnaire and would like further evaluation, our center would be happy to speak with you.
Please contact us to schedule an appointment with Tina Jackson, our Nurse Practitioner who specializes in PCOS management. (865-218-6600)
FERTILITY AND PCOS
From a fertility standpoint, the goal of treatment for PCOS is inducing regular ovulation. Weight loss and exercise are often helpful, but medications are the cornerstone of therapy. Anti-estrogens such as Clomiphene, Tamoxifen and letrozole will induce ovulation in 90% of patients, although only 40-50% will actually conceive. For those patients who do not ovulate or conceive with oral therapy, low dose injectable hormones are extremely effective. Finally, surgical therapy for PCOS remains a viable option and is a preferred method in certain individuals.
It is common to incorporate insulin-sensitizing medications such as metformin to the above therapies. These medications have been shown to assist in ovulation induction and to decrease the risk of miscarriage and gestational diabetes in women with insulin resistance.
LONG TERM RISK REDUCTION
Studies have shown that women with PCOS have a 40% chance of developing diabetes later in life. They are also more likely to develop heart disease, high blood pressure, elevated cholesterol levels, and endometrial cancer.
PCOS patients also have great difficulty with weight control, acne, increased hair growth and other skin complaints. While some of these symptoms are mainly cosmetic, others can increase the risk for other health problems.
Treatment for women who are not pursuing pregnancy often includes birth control pills. These hormones protect the lining of the uterus and decrease the risk of endometrial cancer. Metformin is used to regulate high levels of insulin that many PCOS women have. Anti-androgens are incorporated for hair and acne complaints, and to reverse some of the other detrimental biochemical changes of PCOS.
Weight loss is an important part of PCOS management. Modified exercise and diet plans are crucial as the metabolic activity of these patients is different than the typical dieter. Certain weight loss drugs can assist with the often-frustrating plateaus of weight loss that PCOS patients hit. Goal setting and reward planning are also vital to success in achieving a healthy weight.
Finally, careful monitoring of associated health issues are important for long term PCOS management. Among the recommended areas of monitoring are blood pressure, blood sugar, lipids, uterine lining status and body mass index.
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