Polycystic Ovarian Syndrome

The first thing to remember when considering Polycystic Ovarian Syndrome (PCOS) is that each person can have a different set of symptoms.  It is estimated that as much as 6% of all women have PCOS.  To review these symptoms:

Menstrual Irregularities:  This is the most common symptom.  It can be infrequent or even absent.  Most medical experts agree that PCOS patients will have no more than 5 menses a year.  Some patients can experience polymenorrhea or excessive bleeding. Moreover, some women will have menstrual cycles, but will not ovulate.  In cases of PCOS, the ovaries are not working properly, and because of this, an egg is not released.

Infertility: PCOS can account for as much as half of all cases of infertility.  In women with PCOS, abnormally elevated levels of testosterone and luteinizing hormone disrupt the process of ovulation.

Hirsutism: Excess hair is one of the more difficult aspects of living with PCOS.  Hair that was previously light in color and texture can be stimulated by free androgens that can be present because of the hormone imbalance.  For most women, this manifests itself as a darkening and coarsening of the hair in the mustache, beard, neck, or breast areas.  There are several means of removal for these hairs including bleaching, waxing, tweezing, shaving, cream depilatory, electrolysis, and now, laser treatments.  If you are now using any of these removals, speak with your physician and get a referral for a cosmetic therapist that is licensed by the State Medical Board.

Thinning Hair: Scalp hair loss, also known as androgenic alopecia, is another physical manifestation of the excess of androgen associated with PCOS.  It is an unwelcomed daily reminder of life with this syndrome.  As with hirsutism, the reduction of androgen levels is the key to combating this problem.  Sudden onset of either hirsutism or hair loss could be a sign of an underlying androgen-secreting tumor and should be addressed with medical attention.

Acne: This skin condition can be another particularly annoying problem for women with PCOS.  Found mostly on the face, chest, and back, it can be treated with some success.  Several prescription medications have proven helpful, including the anti-androgenic medications.  Anti-androgens work because acne is caused by the same hormone imbalance that causes hirsutism.  It must be noted that these anti-androgenic medications cannot be used during a pregnancy or if trying to conceive.

Weigh Gain: A very high percentage of PCOS patients struggle with their weight.  The weight gain is exemplified in women with an apple-shaped body as opposed to a pear-shape body type.  Weight loss can be a helpful tool to decrease PCOS.  A high hip to waist ratio is commonly seen in PCOS and is associated with impaired glucose and insulin metabolism.  Women with PCOS typically find more success by both reducing total carbohydrate consumption and by choosing to eat different types of carbohydrates.  Replacing fine carbohydrates with whole grains, fruit, and vegetables, not only helps to reduce insulin response, it increases the daily intake of essential micronutrients.  Choosing this better plan of eating the right carbohydrates and ensuring adequate protein intake at each meal can go a long way towards helping control the hypoglycemic/low blood sugar episodes that many women experience.

Skin Abnormalities: Skin abnormalities can take different forms.  Skin tags are tear-dropped pieces of skin that can be the size of raisins and are typically found in the armpit or neck areas.  They are painless and do not grow or change, except for occasional irritations and can be removed by a medical physician.  Another unusual skin problem is acanthosis nigricans.  This is a darkening and thickening of the skin found on the neck, groin, underarms, or in other skin folds.  This condition occurs as a direct result of excess insulin circulation in the blood stream and is a definitive sign of an insulin abnormality.

Depression and Anxiety:  There is no current research indicating that depression and/or anxiety are symptoms of PCOS.  However, many women with PCOS can have one or both conditions.  Depression can manifest itself in physical symptoms such as headaches, stomach problems, insomnia, change in appetite, or sudden change in menstruation, feelings of emptiness, sadness, hopelessness, guilt, remorse, loss of concentration, memory loss, libido problems, and withdrawal from social interactions.   

Treatment for PCOS

The treatment for PCOS is relatively simple and is based upon the goals of the patient.  Some people will be concerned with infertility, while others are more concerned about the regulation of menses, hirsutism, or acne.  PCOS should be treated even if fertility is not a concern because of the risks of a long-term exposure to androgens and estrogen unopposed by progesterone.  These risks include hirsutism, acne, heart disease, diabetes, and uterine cancer.

Weight Loss: Weight for PCOS patients will improve as hormonal conditions do, but overweight PCOS patients may have great difficulty losing weight, so a permanent weight loss plan is essential for lasting results.  Increasing physical activity is an important step in any weight reduction plan.

Ovulation Induction:  If fertility is the immediate goal, ovulation may be induced with either clomiphene citrate or gonadotropins, which are a mixture of LH and FSH hormones.

Hormonal Treatments:  The best treatment for PCOS patients is a low-dose oral contraceptive, which will decrease ovarian hormone production and will help reverse the effect of excessive androgen levels.  If hirsutism is also a concern, the use of spironolactone, alone or with birth control pills, may be used.

Surgery:  In very rare cases, ovulation is not achieved, and then ovarian surgery may be needed to stimulate ovulation.

Other Medication:  Hyperinsulinemia, more specifically, insulin resistance appears to be a key component in the pathogenesis of PCOS.  Glucophage has been shown to improve insulin sensitivity, decrease androgen production, and reverse some of the clinical manifestations, particularly menstrual irregularities, of obese women, or women of normal weight with PCOS.  The effects of glucophage in pregnant women have not been established.

    Reloxin:

The Food and Drug Administration approved Reloxin as an injectable treatment for wrinkles. Made from the same neurotoxin as Botox, Reloxin will most likely be on the market by the end of 2009.
Reloxin has been marketing for several years in Europe and South America under the brand name Dysport. It was originally developed to treat muscular disorders. Just like Botox, Reloxin immobilizes the muscles that cause facial wrinkles. It has been said that the main difference between Reloxin  and Botox is that Reloxin starts taking effect sooner and lasts longer.  There is still some controversy as to how long Reloxin will last.
Allergan, the manufacturer’s of Botox, responded to NBC news about the upcoming Reloxin hype by emphasizing it’s track record, “ Physicians should not assume that they can use another products such as Reloxin and get the same precise and predictable results, with the same safety profile, as they do with Botox.”

Dr. Michael Sullivan is the only Allergan Platinum Plus Botox provider in central Ohio. This status is awarded only to highly experienced Botox providers. He has been using Botox Cosmetic since its FDA approval in 2002. In his experience, there are very few patients who either don’t respond or don’t get a good response to Botox Cosmetic. For these patients, Reloxin may be a viable option.