Ooh, Friend. Let’s dig in!
PCOS stands for polycystic ovarian syndrome, and there are some different criteria for diagnosis out there, but the mainstay of diagnostic criteria are called the Rotterdam Criteria.
The Rotterdam Criteria propose that a woman with irregular cycles, for which other causes of cycle irregularity have been ruled out, she must have one or both of the following:
-Increased testosterone (whether on exam evidence of increased testosterone like cystic acne or increased hair growth) or increased testosterone levels on blood work
AND/OR
-Characteristic appearance on ultrasound of multiple cysts or follicles (12 or more) on the ovaries or an enlarged total volume of the ovaries on ultrasound.
Keep in mind that having multiple cysts or follicles on the ovaries is normal for reproductive age women, so cysts on the ovaries alone is not diagnostic of PCOS.
While it is not a diagnostic criterion, PCOS almost always is associated with insulin resistance and a high risk of developing diabetes later on in life. About 80% of women with PCOS are obese. So we know that there is a metabolic component for a lot of women who have PCOS.
So what do we do about it?
For all women with PCOS, healthy lifestyle modifications are always recommended. For women who are obese, weight loss of 5% can improve insulin resistance, and weight loss of 20% can make menstrual cycles more regular. Physical activity, including exercise geared toward building muscle, can help with the insulin resistance or metabolic abnormalities associated with PCOS. No one diet has been shown to be superior to another—just limiting calories for weight loss is the best bet for women who are overweight or obese.
For ladies who do not wish to be pregnant, good ol’ birth control pills with estrogen and progesterone are the first choice to help regulate the cycle and decrease the unwanted testosterone effects like acne and unwanted hair growth. Medications like metformin or inositol supplements can improve the insulin resistance and slow the progression to diabetes.
For women who do want to be pregnant, metformin or inositol supplements and oral ovulation induction medications like clomiphene or letrozole are the place to start. Usually if it is going to happen with these medicines, conception will occur within 6 months of use. In my practice, if a patient has not become pregnant after 6 months of ovulation induction medication, I recommend seeing a reproductive endocrinology and infertility specialist and moving forward with injectable medications that help trigger ovulation.
As always, talk to your gynecologist about what might be best for you.
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