In our practice, we often treat polycystic ovarian syndrome (PCOS), also referred to as polycystic ovaries (PCO) or polycystic ovarian disease, (PCOD). This condition affects as many as five million women in America. With PCOS, one of the main causes of infertility in women, regular reproductive processes, like the menstrual cycle, don’t function properly.
At IVF Plano, we see multiple patients each day who suffer from polycystic ovarian disease, (PCOD). Although there are varying degrees of PCOS, many patients experience several of the following symptoms:
- Absent or irregular menstrual cycles
- Acne flare ups
- Dark hair on the chin, upper lip or lower abdomen
- Weight issues, including a great difficulty losing weight
These symptoms are related to two hormones that PCOS patients make in excess, testosterone and insulin. In higher than normal amounts, these hormones can block ovulation and thereby produce irregular menses and fertility issues. They also can both contribute to weight gain. High testosterone causes the increased hair growth and acne.
The easiest way to treat PCOS is with a birth control pill, which turns off the ovaries and lowers the testosterone levels. However, for patients trying to conceive, birth control pills aren’t an option. Women with PCOS don’t ovulate, which causes irregular menses, so the best way to increase the odds of conception is to give the ovaries a push using a fertility medication called clomid. We can help 80 to 85 percent of women with PCOS ovulate with clomid. The other 15 to 20 percent will require a stronger treatment.
Another way we can address PCOS is to lower the insulin level with a medicine called metformin. At the same time, we emphasize the need to watch how many, and what type of, carbohydrates you eat. Essentially, carbohydrates fall into two categories, good carbs and bad carbs (for more information on this, google “glycemic index”). Bad carbs cause insulin to spike to very high levels, very quickly. High insulin levels will cause the ovaries to produce more testosterone, which makes it harder to ovulate. Treatment with metformin can lower insulin levels. With metaformin, ovulation will become more frequent, but will seldom fall into regular monthly cycles.
Because metformin can cause liver damage, although a rare side effect, we will check liver function tests prior to starting metformin and for a month or two after a patient begins the medication. Metformin needs to be taken two to three times a day. Common side effects include bloating, gas, diarrhea, and abdominal cramps. Usually, we will begin to see some benefit from the medication after the first six to eight weeks. Some studies suggest that metformin may lower miscarriage rates and improve pregnancy rates.
Unless our PCOS patients have significant insulin resistance, we will usually start with clomid first since it is easier, safer, and has fewer side effects than metformin. If a patient does not achieve ovulation with clomid, then we will consider adding metformin. Recent medical literature also suggests this is the preferred course of treatment.
James Douglas, M.D.©
6300 W. Parker Rd. #G28
Plano, TX 75093