Irregular Periods May Mean Polycystic Ovarian Syndrome

When Jaime King, a star of The CW’s TV series Hart of Dixie, recently disclosed to her Instagram followers that she had struggled four and a half years to get pregnant with her now 11-month-old son, she shed light about infertility issues, including polycystic ovarian syndrome and endometriosis. The 35-year-old actress, who has also played roles in the movies Pearl Harbor and Sin City, wanted women who suffered multiple miscarriages and failed fertility treatments like she had to know that they weren’t alone.

Ms. King’s story is raising awareness about polycystic ovarian syndrome, or PCOS, which the PCOS Foundation estimates affects 7 million women and adolescent girls.

According to the National Institutes of Health, polycystic ovarian syndrome results from an imbalance of female hormones and sometimes, higher-than-normal levels of male hormones. This imbalance prevents normal monthly ovulation from occurring. Instead, a woman’s eggs, which are released during ovulation, remain in the ovaries as fluid-filled sacks, or cysts. Without the release of the eggs, a woman cannot get pregnant.

Michael Jacobs, M.D., a fertility specialist affiliated with Baptist Hospital, South Miami Hospital and medical director of the Fertility & IVF Center of Miami in Kendall, attributes 35 percent of female infertility problems at his practice to PCOS. The PCOS Foundation reports that 70 percent of women who have difficulty ovulating have polycystic ovarian syndrome.

“The first sign of PCOS is infrequent menstrual periods,” Dr. Jacobs said. “If a woman has fewer than eight periods a year or cycles that are longer than 35 days, we usually check for PCOS.”

To diagnose polycystic ovarian syndrome, Dr. Jacobs takes a thorough medical and gynecologic history and looks for other signs of PCOS, including obesity, excessive facial or body hair known as hirsutism  and insulin resistance. He also orders a blood test to check hormone levels and an ultrasound to examine the ovaries for more than 20 cysts or unruptured ovarian follicles – a classic sign of this ovulatory dysfunction.

Once PCOS is confirmed, treatment can be tailored to meet the lifestyle goals of the woman.

“For women who want to get pregnant but who are obese from the metabolic abnormalities we see in patients with PCOS, we advise losing weight,” Dr. Jacobs said. “Usually when a 10- to 20-pound weight loss is attained, ovulation kicks in and pregnancy can occur.”

For women who are unable to lose weight, diabetes medications, like Metformin, that increase insulin sensitivity can be helpful in controlling how the body stores fat.
Then, drugs, like Clomid, and injectable gonadotropins can be used to stimulate ovulation, Dr. Jacobs says.

“When women do not want to get pregnant, the standard treatment for PCOS is the birth control pill,” he said. “This regulates a woman’s period and balances her hormones so the other symptoms of PCOS – acne, excess body hair, thinning hair (alopecia)  and irregular bleeding – are also controlled.”

Like Ms. King, who was able to manage her PCOS, have a baby and talk about her struggle with infertility, women should discuss any irregularities with their doctor.

Dr. Jacobs sees the devastation that women and couples face when dealing with infertility and hopes increased awareness about PCOS will bring more women to seek the help they need to get their PCOS under control. But, he also advises those women who do not wish to conceive should still seek help, since evidence points to increased risks of type 2 diabetes and heart disease for women with PCOS.


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