PCOS Is a Hormonal Disease That Affects the Ovaries and Can Lead to : 19 – 37% of Females with Moderate-to-Severe May Have This Disorder
+ Excessive Hair Growth: Because high male hormone levels in the body tend to produce , females with PCOS very often struggle with . associated with PCOS is more inflamed (red and sore) and appears on a larger portion of the body than normal that appears during puberty. Another common symptom of elevated male hormone levels is excessive hair growth, and many females with PCOS also experience unwanted hair growth.
When It Appears: Polycystic ovary syndrome often first appears in adolescence, making diagnosis difficult because the symptoms overlap with normal symptoms of puberty, such as .
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How It Is Treated: The most common treatmentfor PCOS-associated is a combined oral contraceptives (COCs – a.k.a. the birth control pill), which reduce male hormone levels, helping to treat PCOS as well as the associated with it. For women whose medical history puts them at increased risk of side effects from COCs, a few non-hormonal treatments are also available.
Important: Polycystic ovary syndrome is common, so don’t discount it as something rare that you probably don’t have. If you are a female with moderate-to-severe on the face and/or body, particularly if you notice irregular periods and/or excessive hair growth, or if you are a female with that has persisted into adulthood that doesn’t respond to typical medications, make sure to see a dermatologist to be evaluated for PCOS. Left untreated, PCOS can impair fertility.
The high level of androgens in PCOS is part of a chain reaction involving several different hormones. The final result is an increase in androgens, and very often, .
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Polycystic ovary syndrome often appears during adolescence. However, diagnosing it in adolescents is difficult because symptoms such as irregular menstruation and are often a normal part of puberty. Because of this, PCOS most frequently is diagnosed between the ages of 25 and 35 and is much less frequently diagnosed before age 20. Because there are no tests that can diagnose PCOS, it is a diagnosis of exclusion, meaning that it is diagnosed after ruling out all other possible conditions.
As we have stated, because PCOS symptoms such as irregular menstruation and overlap with normal puberty symptoms, they are not reliable indicators of PCOS. During the teen years, the most reliable symptoms that indicate PCOS are:
As we have seen, PCOS comes with increased androgen levels. Androgens stimulate the skin to produce more skin oil, called sebum. Excess sebumgreatly increases the chance of developing .
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, “Women with moderate to severe should be investigated for PCOS, because 19% to 37% of [female] patients with moderate to severe meet the criteria for this disorder.”
This review also recommends that women with that persists into adulthood and does not respond to traditional treatment be examined for PCOS.
Different medications are available to treat the various symptoms of PCOS. Since androgens lead to the that appears as a symptom of PCOS, treatment of PCOS-related aims to reduce androgen levels.
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Combined oral contraceptives are birth control pills that contain a combination of ethinyl estradiol (synthetic estrogen, a female hormone that is present in both males and females) and a progestin (synthetic progesterone, another hormone that is present in both males and females).
Different COCs contain different progestins. While all COCs reduce androgen levels, certain progestins, such as cyproterone acetate (CPA), drospirenone, and chlormadinone acetate (CMA), possess specific anti-androgen properties. Some research suggests that these progestins are somewhat more effective in treating than COCs that contain progestins without these properties. However, many studies show that all COCs are effective in reducing androgen levels and clearing .
Numerous studies investigated the efficacy of COCs in women with PCOS-associated and have all found a significant improvement in in the women studied. We can conclude from these studies that all COCs work equally well in treating but that COCs that contain an anti-androgen progestin, such as CPA or drospirenone, may be more effective for treating accompanied by other androgen-related symptoms, such as hirsutism. Based on these studies, women with PCOS-related who use a COC can expect a 50% – 87% improvement in their , though some women’s may clear completely.
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Side effects of COCs include nausea, headache, and breast pain, but also can raise the risk of some more severe side effects, such as heart disease and thromboembolism (blood clot).
Examined the effectiveness of a COC that contained CPA. This study included 82 women with PCOS and moderate to severe . The authors found that after 18 4-week cycles of the COC, cleared in 87% of the women, and after 24 cycles, cleared in all 82 women.
Looked at the effectiveness of a COC containing drospirenone in 13 women with PCOS-associated . This study found a significant improvement in after six months of treatment.
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, compared the effectiveness of a COC containing drospirenone with a COC containing desogestrel, which does not have specific anti-androgen properties, in 60 women with PCOS. This study found that of the women who had , 50% of those who took the COC containing drospirenone experienced improvement in their , compared to 30% of those who took the COC containing desogestrel. The authors did not mention the effectiveness of the two medications, but they did state that there was no clinical difference in how the women’s responded to them.
Compared the effectiveness of a COC containing CMA in 15 women with PCOS to 15 women who received no COC treatment. The women who received the COC treatment experienced significantly more improvement in their after six months than the women who received no COC.
Compared the effectiveness of two COCs that each contained an anti-androgen progestin: one with drospirenone and one with CMA. This study included 59 women with mild to severe and PCOS, who randomly were assigned to one of the two COCs for six months. Both groups experienced a significant reduction in : the drospirenone group experienced a 71% reduction, and the CMA group experienced a 65% reduction.
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, investigated the effectiveness of a COC containing desogestrel in 42 women with PCOS. After 12 months of treatment, the percentage of women with decreased from 54% to 18%.
Randomly assigned 52 women with PCOS to take a COC containing either CPA or drospirenone for 12 months. improved by 50% in the CPA group and by 66% in the drospirenone group, though the difference between the two was not statistically significant.
, compared three different COCs: one containing desogestrel, one containing CPA, and one containing drospirenone. This study included 171 women with PCOS. decreased in all three groups after 12 months of treatment, with no significant difference between the three COCs. However, the authors concluded that when they considered androgen-specific symptoms, such as hirsutism, in addition to , CPA showed the strongest anti-androgen activity.
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Evaluated the effectiveness of a COC containing CPA in 41 women with PCOS. This study found that improved by 87% in only three months.
While doctors almost always prescribe cyproterone acetate (CPA) with a combined oral contraceptive (COC), in rare cases it is sometimes prescribed on its own. Because CPA is anti-androgen, it can cause birth defects in a male fetus. This means that women taking CPA alone must also use some form of birth control.
Side effects include headache, weight gain, breast tenderness, loss of libido (sex drive), and mood changes. In high doses, CPA also can cause liver damage.
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Because CPA rarely is used alone, there is not much research concerning its efficacy for PCOS-related . One small 1987 study found that improved significantly after two months of solo CPA therapy. However, when the treatment was stopped, returned quickly. In addition, the women using CPA experienced either irregular menstruation or a complete cessation of their periods.
Spironolactone is an anti-androgen that usually is prescribed as an additional medication along with a COC. Because spironolactone is an anti-androgen, it can cause birth defects in a male fetus, so using birth control while taking it is required.
The typical dosage of spironolactone is between 50 – 200 mg per day, with the most common (“preferred”)dose being 100 mg/day. Side effects, especially in higher doses, include breast tenderness, irregular periods, and headache, among others.
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Studies show us that when spironolactone is prescribed on its own and not with a COC to females with both and hirsutism, it may be beneficial for hirsutism, but not for .
Gave 25 women with PCOS 100 mg/day of spironolactone for 12 months. Only 8 of the women had . After 12 months of treatment, 4 women experienced improvement in their . According to this study, it appears that 50% of the women experienced improvement. However, so few women had to begin that we shouldn’t conclude anything from this study.
Compared spironolactone with a placebo in treating women with both and hirsutism. This review found that while the women experienced improvement in their hirsutism, their did not
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