March 28, 2023

#MountSinaiLive: In honor of Polycystic Ovary Syndrome (PCOS) Awareness Month in September, Andrea Dunaif, MD, System Chief of the Division of Endocrinology, Diabetes, and Bone Disease at Mount Sinai, joins us to discuss the common symptoms and treatment options of PCOS.

Hello i’m andrea denaeff i’m the system chief for endocrinology diabetes and bone disease for the mount sinai health system polycystic ovary syndrome is a very very common disorder that’s characterized by irregular periods increased male hormone levels and often polycystic ovarian changes in the ovaries it’s the most common endocrine disorder of women of reproductive

Age and it affects about 5 to 20 percent of women worldwide depending on how it’s diagnosed so it’s a very very important health problem it is not only the leading cause of an ovulatory infertility but it’s associated with an increased risk for pre-diabetes and type 2 diabetes thank you the signs that a person has pcos are irregular periods usually periods that

Are infrequent more than 40 days or six to eight periods per year occasionally women can have more frequent bleeding such as bleeding every two weeks which we call dysfunctional uterine bleeding another very common symptom of pcos is increased hair growth in a male pattern such as in the beard area upper lip back and chest occasionally women with pcos can have hair

Thinning and sometimes severe acne can be associated with pcos pcos affects a person’s general health because of its association with insulin resistance which increases risk for pre-diabetes as well as progression to type 2 diabetes and pcos is a very important cause of type 2 diabetes in young women increasing the risk by about four-fold pcos is also the leading

Cause of an ovulatory infertility and women with pcos frequently need treatment to become pregnant pcos is treated by the symptoms a woman has so unfortunately at this point we don’t have a cure for pcos so our treatments are totally symptom focused and the major treatments then are for the symptoms of male hormone excess such as hirsutism which is the increased

Hair growth and acne and occasionally hair loss and the common medications we use to treat that are birth control pills and sometimes combined with the off-label use of a medication that blocks male hormones and high doses called spironolactone or aldactone for infertility there are oral medications such as clomiphene citrate or letrozole again used off label to

Induce ovulation and if those are ineffective we can go on to assisted reproductive technologies such as in vitro fertilization the metabolic issues of pcos are often treated with metformin which is a diabetes drug that can improve the body’s sensitivity insulin and in women with pcos it can restore regular cycles and reduce the pre-diabetes and progression to type

2 diabetes another very common problem in women with pcos is weight management issues and we have many new weight management medications that are effective in women with pcos pcos is associated with an increased risk for type 2 diabetes because it is a cause of insulin resistance insulin resistance is when the body is not sensitive to the normal circulating amounts

Of insulin to regulate glucose uptake therefore more insulin has to be made by the pancreas so higher levels of insulin are circulating and if the pancreas is unable to keep up with the demands then the insulin is no longer adequate to maintain the glucose uptake the glucose levels raise in the blood to progress to type 2 diabetes insulin resistance also we believe

That is associated with increased risk for heart disease and so it hasn’t been proven definitively but there’s considerable evidence that women with pcos also have an increased risk for heart disease such as heart attacks and strokes prolonged irregular menstrual cycles are a sign of an underlying endocrine disorder the most common reason for irregular menstrual

Cycles is pcos but there can be other causes of irregular menstrual cycles some women have a decrease in the secretion of the hormones that regulate the reproductive system by the master gland the pituitary gland and hypothalamus due to changes in weight stress exercise and that form of irregular periods is called hypothalamic amenorrhea and it is common but much

Less common than pcos irregular periods can also be caused by damage to the ovaries we call that premature ovarian insufficiency and that disorder is less common than pcos or functional hypothalamic amenorrhea the important take-home point for women is if you’re skipping periods or having more frequent periods that needs to be evaluated by a physician to determine

What the underlying causes because that cause needs to be addressed to pres prevent adverse health outcomes thank you if a woman has pcos she can try to conceive on her own and have about six months of appropriately timed intercourse with her partner and if she doesn’t conceive within that period of time it is a good idea for her to see a reproductive endocrinologist

Who’s a specialist in infertility treatments and specialized treatment for infertility is often needed by women with pcos so it’s wise to go to a specialist right from the start rather than seeing a general obstetrician gynecologist i think it’s important though to note that women with pcos can get pregnant on their own and frequently do get pregnant and in their

30s the reproductive abnormalities tend to improve somewhat and many women with pcos are able to get pregnant on their own in their 30s mount sinai is one of the leading centers for research on pcos in particular research investigating the genetic causes of pcos and there’s been tremendous success in the past 10 years in identifying gene regions that lead to pcos

And by understanding what those genes do and the pathways that they regulate one can identify targets for treatment so this is a very promising way to find out what causes pcos and identify how those pathways might be blocked leading to treatments and perhaps cure of pcos and even genetic predictors so early treatment can be started to really prevent the serious outcomes of pcos

Transcribed from video
What You Need To Know About Polycystic Ovary Syndrome (PCOS) By Mount Sinai Health System