Affecting between 5-10% of women in the United States, PCOS (a.k.a. Stein-Leventhal Syndrome) refers to a condition that primarily affects those between the ages of 15 to 30 years, and occurs when there is an imbalance within a woman's endocrine system resulting in cystic build up within the ovaries. The imbalance includes higher than normal blood levels of estrogen, Testosterone, luteinizing hormone (LH), and decreased levels of follicle-stimulating hormone (FSH). As a result of this imbalance, under-developed follicles accumulate in the ovaries, rather than maturing and releasing during ovulation. As the follicles accumulate, cysts are formed producing pelvic pain. Further, due to lack of ovulation, those with PCOS often suffer from pelvic pain, irregular menses (periods), and may have difficulty getting pregnant.
Insulin resistance appears to play a key role in PCOS. In addition to other hormones, insulin helps regulate ovarian function. When someone has insulin resistance, cells throughout the body do not readily respond to the insulin within the blood. As a result, the insulin level within the blood remains high. These high levels may contribute to lack of ovulation, high androgen levels, infertility, and early pregnancy loss. High androgen levels correlate with weight gain, acne, decreased breast size, and increased hair growth in areas that are typical to males (face, chest, abdomen, and back). This is referred to as Hirsutism. Having insulin resistance also contributes to high levels of glucose and lipid levels within the blood, placing a person at risk for diabetes and cardiovascular disease.
Pharmacologic Treatment
As there is no cure for this condition, the primary goal of treatment is to reduce symptoms of PCOS. Pharmacologic options to treat symptoms, available from your health provider, include birth control pills, Spironolactone (a drug that promotes fluid loss .a.k.a. diuretic), and Flutamide ( which blocks the activity of Testosterone). Additionally, Metformin (Glucophage) has been shown to lower insulin levels, cholesterol levels and blood pressure, and helps women regain regular menstrual cycles.
If pregnancy is desired, fertility drugs are usually considered. These include Comiphene (a.k.a. Clomid- which induces ovulation) and other more-potent ovulation-inducing medications. These drugs are not without risk, and must be prescribed and carefully monitored by a licensed healthcare professional who has special training in the field of reproductive endocrinology.
Alternative Treatments
Studies have shown that weight reduction (through dietary changes and regular exercise), as little as 5% below baseline, can effectively treat menstrual irregularities, problems getting pregnant, and high insulin levels. Dietary measures include limiting simple carbohydrates, and focusing on small frequent meals high in protein, healthy fats, and complex carbohydrates. Polyunsaturated fatty acids, common in the Mediterranean diet (oily fish, nuts, and olive oil) have been shown to greatly benefit patients with PCOS.
Additionally, moderate exercise, of 30-60 minutes per day, should be incorporated into a treatment plan. Recommendations include walking, jogging, swimming, or biking. However, any exercise that causes you to reach your target heart rate for the recommended time (50-85% of resting heart rate) can be beneficial. The American Heart Association recommends the following target heart rates based on age:
Age Target Heart Rate20 years 100-170 beats per minute
25 years 98-166 beats per minute
30 years 95-162 beats per minute
35 years 93-157 beats per minute
40 years 90-153 beats per minute
45 years 88-149 beats per minute
50 years 85-145 beats per minute
55 years 83-140 beats per minute
60 years 80-136 beats per minute
65 years 78-132 beats per minute
70 years 75-128 beats per minute
Finally, alternative treatment options for those with increased facial hair growth include measures such as shaving, bleaching, electrolysis, and laser therapy. A small Turkish study indicated drinking spearmint tea, twice a day, may also help to reduce hirsutism. Currently, studies using acupuncture to treat PCOS are being conducted. As always, contact your physician or nurse practitioner to discuss the best treatment option for you.
Susan Quinn, R.N. B.S.N -
