Physician Referral Online

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of Yale-New Haven Hospital.

Physician Referral Online
Using your own criteria, you can request information from a database of 900 area physicians who have registered to participate.

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203-688-2000
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For the 12th year in a row, Yale-New Haven has been highly ranked by U.S. News & World Report for its programs in gynecology.

Education, assessment and treatment essential for PCOS

Our awareness of the prevalence of polycystic ovary syndrome has increased considerably over the last decade or so. This condition was first recognized as a distinct disorder in 1935 and was called Stein-Leventhal syndrome after the physicians who identified it. Its current name is derived from the characteristic changes that may occur in the ovaries, which become enlarged and covered with small fluid-filled cysts.

Today, we have a better understanding of PCOS and its relationship to the metabolic syndrome that we talk about in relation to heart disease. We recognize it as both a hormonal disorder—marked by the excess production of androgens—and a metabolic one, associated with insulin resistance, a condition where increased production of insulin is required in order to maintain a normal level of blood sugar.

Connection to obesity
One reason we may be hearing more about PCOS is its connection to obesity. As women get heavier, PCOS becomes more severe. We are not sure at this point whether PCOS predisposes women to gain weight or if weight gain results in a higher incidence of PCOS, but we do know there's a definite relationship. Two-thirds of PCOS patients are overweight. Most are insulin resistant.

Symptoms and risks
Adolescent girls often present with irregular menstrual periods or no periods at all; dark, thickened skin around the neck, armpits or below breasts; acne and excess body hair. Young adults may seek medical attention for fertility issues, another symptom of the syndrome.

The skin patches are a marker of high insulin levels, and it is this aspect of the condition that may have the most serious long-term effects—an increased risk of cardiovascular disease and heart attacks. Long-term menstrual irregularities are also suspected to result in precancerous changes in the lining of the uterus and the development of endometrial cancer.

Genetic predisposition
We do know PCOS tends to run in families, but the exact role of genetics is not understood. Diagnosing the syndrome is a process of ruling out other conditions. There is not a definitive blood test or imaging exam that confirms the presence of PCOS. We rule out other conditions such as an underactive thyroid or adrenal or pituitary abnormalities that could account for the symptoms. Ovarian cysts are often present, but they are not enough to confirm a diagnosis since many women who have cysts do not have PCOS.

Treatment options
We often prescribe lifestyle modifications such as diet and exercise for overweight women. Significant weight loss can result in an improvement or even a remission of symptoms. Women who are insulin resistant are treated with medications such as glucophage (metformin), which helps with weight control, blood sugar management and fertility. For women whose periods continue to be irregular, we prescribe fertility drugs or birth control drugs. Women bothered by heavy body hair can be treated with medications that block the production or action of androgen.

Evaluation essential to curtail bad outcomes
PCOS is the most common hormonal problem of premenopausal women. Education about the symptoms and the availability of treatment options are important to get women in to see their physicians for a complete endocrine evaluation. Treating PCOS patients for insulin resistance and obesity are important to their long-term health since they are at risk for several serious health conditions.

PCOS patients are two to three times more likely to miscarry during their reproductive years and develop uterine cancer later in life. They are at risk for developing diabetes, hypertension and cardiovascular disease. Research has shown that these women in their late 20s and early 30s already show evidence of thickened arterial walls and unhealthy lipid profiles.

There is no single specialist who treats PCOS, and symptoms may be treated individually, based on what's most troubling to the woman and what kind of physician she consults. Gynecologists may be more inclined to treat the menstrual and fertility issues, while a dermatologist would focus on the acne and an endocrinologist on insulin issues.

It's important to see that these symptoms may be connected to an underlying condition and to seek someone who has some expertise in PCOS.

Because of the risk of developing serious medical conditions, it is important for any woman who is experiencing the symptoms we've talked about—irregular or absent periods, unusual body hair growth, unusually severe acne, darkened skin patches and rapid weight gain—to be evaluated and treated as soon as possible.

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Dr. Duleba is a board-certified specialist in obstetrics and gynecology as well as reproductive endocrinology and infertility. He is an associate professor at the Division of Reproductive Endocrinology and Infertility at the Yale University School of Medicine.