Polycystic Ovary Syndrome (PCOS) is widely recognized as the most common endocrine disorder in both adolescents and adult women. Whilst the symptoms of PCOS differ according to characteristics such as age and weight, the condition has both reproductive and metabolic consequences.
Diagnosing PCOS in adolescents is not always so straightforward but an early diagnosis is imperative in view of the reproductive health consequences and cardiometabolic risks associated with the condition. Dreaming of Baby speaks with Dr. Fares Diarbakerli, MD FACOG, a Board-certified OB-GYN doctor and specialist in Laparoscopic Robotic and minimally invasive surgery in Clifton, NJ.
What is PCOS?
Daniela: Good morning Dr. Diarbakerli, it’s a pleasure to welcome you on Dreaming of Baby. Today we shall be discussing PCOS, more specifically its treatment from a young age with the aim of preserving fertility in the long run. To start with, how would you best describe PCOS?
Dr. Fares Diarbakerli, M.D.: Polycystic ovary syndrome (PCOS) is the most common cause of infertility in women. It frequently becomes manifest during adolescence and is primarily characterized by ovulatory dysfunction and hyperandrogenism. The syndrome is heterogeneous clinically and biochemically.
The diagnosis of PCOS has lifelong implications with increased risk for metabolic syndrome, type 2 diabetes mellitus, and possibly cardiovascular disease and endometrial carcinoma.
Daniela: Grateful if you could provide further insight as to what is hyperandrogenism, as well as what is meant by the condition being heterogeneous, clinically and biochemically?
Dr. Fares Diarbakerli, M.D.: To clarify, the condition involves:
(i) An abnormal degree of hirsutism or a hirsutism equivalent, such as inflammatory acne vulgaris, that is poorly responsive to topical therapies
(ii) Menstrual abnormality (persistent amenorrhea or oligomenorrhea, or excessive uterine bleeding)
(iii) Obesity or focal hirsutism accompanied by menstrual abnormality
Hyperandrogenism presents as acne and increased hair in different parts of the body and infrequent or no periods.
PCOS in adolescents
Daniela: Thank you for clarifying. You mentioned earlier that the condition frequently manifests itself during adolescence; what are the symptoms to look out for at such a young age?
Dr. Fares Diarbakerli, M.D.: The main symptoms are menstrual abnormality (such as total absence of period or very infrequent periods, for instance, a period every few months or an increase in uterine bleeding); increased hair in different part of the body; darkness in the back of the neck and under the armpits; and obesity accompanied by menstrual abnormality.
Daniela: With regards to menstrual abnormality, how would this symptom be different from simply a menstrual cycle in adolescence which has not settled into a predictable routine?
Dr. Fares Diarbakerli, M.D.: It is the combination of the symptoms, including long term menstrual abnormality, hirsutism, acne, Polycystic ovaries on ultrasound, obesity and some characteristic blood work.
Daniela: That’s very good to know. Once an adolescent is diagnosed with PCOS, what is the usual treatment process followed?
Dr. Fares Diarbakerli, M.D.: Well, treatment is based on the goals to be reached: be it the regulation of cycles and protection of the endometrium, or fertility-based treatment, or treatment for other underlying medical problems like diabetes type 2. We treat patients based on the goals we trying to achieve.
Daniela: That is understandable; what would be the treatment path followed if the aim is to not impede fertility in the long run?
Dr. Fares Diarbakerli, M.D.: For adolescents, the main goal is to regulate their cycles and protect against long term risk of uterine cancer. This is done via birth control pills which are also a good option in that they will not impede fertility. Added to this, weight loss in obese adolescents will have a very positive effect in reversing most of the negative effects of PCOS.
Getting Pregnant and PCOS
Daniela: For the woman diagnosed with PCOS in adolescence and who now wishes to start trying for a baby, what would be the treatment path to follow?
Dr. Fares Diarbakerli, M.D.: They can try on their own to have a baby the natural way with simple tools like ovulation monitoring. If pregnancy doesn’t happen after 6 months up to a year, they can go through a more thorough investigation to identify the reasons behind infertility. In general, though, they do get pregnant or respond well to treatments.
Daniela: In this sense, would you say that if the condition is diagnosed early on; then it makes it easier to achieve pregnancy?
Dr. Fares Diarbakerli, M.D.: Yes of course; this in terms of regulating the cycle in the beginning and monitoring the patient for any ovulation disorder.
Daniela: Once pregnancy occurs, how does PCOS affect it? Is the journey different to someone without the condition?
Dr. Fares Diarbakerli, M.D.: Once pregnancy occurs, usually everything goes very well. Still, patients need to be monitored closely for any glucose intolerance during pregnancy as they are at a higher risk of developing diabetes.
Daniela: And how does pregnancy affect PCOS? Does the condition get better?
Dr. Fares Diarbakerli, M.D.: Not really. Usually the patient reverses to their PCOS after delivery so they need to go back to their treatment with birth control pills etc.
‘There is no magic pill that one can take and make PCOS disappear. It’s a metabolic syndrome. Lifestyle changes help especially weight loss in obese patients.’
Daniela: So actually, you could say birth control pills are prescribed for the duration of a woman’s reproductive life? Can the condition be treated?
Dr. Fares Diarbakerli, M.D.: Birth control pills help regulate the cycle and protect from uterine cancer. They can be used long term with PCOS except when women are trying to conceive. Weight loss also helps in obese patients. Medications like Metformin and Clomid help patients who are trying to conceive. So yes, it is treatable.
Daniela: In terms of curing the condition; is this at all possible? Would lifestyle changes help in this regard?
Dr. Fares Diarbakerli, M.D.: There is no magic pill that one can take and make PCOS disappear. It’s a metabolic syndrome. Lifestyle changes help especially weight loss in obese patients.
Daniela: That’s good to know. For the woman who has been taking birth control pills for the treatment of PCOS, should she be concerned about any long-term use side effects?
Dr. Fares Diarbakerli, M.D.: Actually, birth control pills have good protective effects for fertility. Long term use helps preserve the follicles and prevent uterine hyperplasia.
Daniela: Thank you very much for your time today Dr. Fares; it’s been a pleasure speaking with you on this very important subject. As a final question, if there’s one piece of advice that you would give to the woman suffering from PCOS, what would it be?
Dr. Fares Diarbakerli, M.D.: That would be to set up an early consultation with an OB-GYN doctor to identify the problem and set the goals, and get treated accordingly.
Daniela: Many thanks, Dr. Diarbakerli; I’m sure our readers will find this advice very helpful.