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Diagnosing & Treating Polycystic Ovary Syndrome

Because polycystic ovary syndrome (PCOS) is the leading cause of infertility in women, those who experience any symptoms of this condition should consult a physician to get a proper diagnosis and begin treatment immediately.

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Keep in mind that PCOS and the presence of polycystic ovaries (enlarged ovaries that have a number of small cysts present on the ovarian follicles) are not necessarily mutually exclusive: While those who suffer from PCOS may have polycystic ovaries, women can suffer from PCOS without their ovaries being polycystic. Similarly, others can have polycystic ovaries without necessarily suffering from PCOS.

Keep reading to learn more about diagnosing and treating polycystic ovary syndrome.

Diagnostic Tools for PCOS

Currently, there isn't a set method for diagnosing PCOS. While a variety of tests may be used in the diagnostic process, doctors are continually debating which are more effective. As a result, the medical community officially characterizes polycystic ovary syndrome as a syndrome and not a disease.

The main tool used to diagnose PCOS is a pelvic ultrasound (also known as an ultrasonography) that provides gynecologists with images of a woman's ovaries. An ultrasonography renders a visual image of internal structures that can help doctors identify the presence of diseases, lesions, cysts and other health problems. However, because the pelvic ultrasound alone isn't sufficient to officially diagnose PCOS, doctors use other tests as well, including:

a fasting biochemical screen that diagnoses insulin resistance, a factor that is associated with the presence of PCOS
hormone-measuring tests that evaluate the levels of testosterone, LH, FHS and SHBG hormones that a woman has in her body (While high levels of LH, FHS and testosterone indicate PCOS, low levels of SHBG are associated with this condition.)

PCOS Treatment

Once a physician has officially diagnosed a patient with PCOS, proper treatment that is designed with an eye toward a woman's goals can begin. The treatment courses can help a woman:

minimize or eliminate hirsutism (male pattern baldness)
prevent cancers related to continued lack of estrogen, namely cancer of the uterus
restore ovulation and promote fertility.

While doctors prescribe oral contraceptives to treat hirsutism and prevent certain cancers related to estrogen deficiency, they generally administer injections of FSH (follicle stimulating hormone) to promote ovulation and prevent infertility.

Because polycystic ovary syndrome is closely associated with insulin resistance (the inability of the body to properly use insulin, creating high levels of insulin in the blood), doctors may also prescribe medications that lower patients' insulin levels. Along with regulating insulin levels, the following medications can also promote regular ovulation:

metformin hydrochloride, brand name Glucophage®
pioglitazone hydrochloride, brand name Actos®
rosiglitazone maleate, brand name Avandia®.

Although each of these medications has associated side effects that generally disappear within two to three weeks, available slow-release versions of them are easier on the body. Potential side effects of the above medications include:

diarrhea
loss of weight
upset stomach.

Last-Resort Treatments for PCOS

Unfortunately, not all patients respond to insulin-lowering medications. If PCOS doesn't respond to the above treatment options or appears to worsen over time, then PCOS surgery or hormone therapies may be necessary. The following last-resort treatments may be invoked:

Laparoscopy Electrocauterization: Similar to laser cauterization, laparoscopy electrocauterization is the process using a laparoscope (a long, thin tube that contains a small video camera at the end of it) and an electric pulse to destroy harmful tissue, namely malignant cysts on the ovaries.
Ovarian Drilling: In this procedure, doctors drill a series of small holes (about four to 10) in a woman's ovaries to reduce the presence of cysts and promote fertility. Although ovarian drilling restores ovulation 80 percent of the time, it is a last-resort treatment for PCOS because it can cause ovarian failure.
Ovarian Hyperstimulation: This is a process of administering a series of FSH injections to promote ovarian follicle growth. While this is generally part of in vitro fertilization, it puts women with PCOS at high risk for complications and occasionally death.
Ovarian Wedge Resection: This antiquated treatment revolved around removing part of the ovary in the thought that this would reduce the amount of male hormones that it produced. While this theory has been proven wrong, the procedure is still used in severe cases of PCOS.

Alternative Treatments PCOS

Aside from taking medications and possibly getting surgery for PCOS, doctors also recommend alternative treatments that revolve around lifestyle changes. The two most important alternative treatments that PCOS patients should start as soon as possible include adopting a diet that is low in carbohydrates (to naturally reduce insulin levels in the blood) and exercising regularly. Each of these helps keep down weight as well as promotes normal thyroid activity.

Resources

Fertility Journey.com (2006). ovarian wedge resection. Retrieved June 21, 2007, from the Fertility Journey.com Web site: http://www.fertilityjourney.com/therapyOptions/surgery/
ovarianWedgeResection/index.asp.

Georgia Reproductive Specialists. Ovarian Drilling. Retrieved June 21, 2007, from the IVF.com Web site: http://www.ivf.com/drilling.html.