Duc H



[pic] Duc H. Do, MD, FACE |  |[pic] | |

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|PCOS: Overview | |

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|Polycystic Ovary Syndrome (PCOS) is one of the most common problems affecting women. PCOS can affect menstrual cycles, fertility, and hormone levels, as well as appearance, | |

|including acne, facial hair growth and female pattern balding (thinning of the hair on the top of the scalp with preservation of the hairline). It is also a metabolic problem | |

|that affects several body systems. The condition gets its name because there are often an increased number of small painless cysts in the ovaries (polycystic ovaries). | |

|The syndrome is defined by hormonal problems and an irregular menstrual cycle, with or without polycystic ovaries. PCOS is sometimes called "ovarian androgen excess," because | |

|the ovaries start producing male hormones (androgens) in slightly increased amounts. It is important to note the difference between ovaries with cysts and PCOS. Polycystic | |

|ovaries are often, but not always, seen in women with PCOS. | |

|The condition also can affect women's self-esteem and psychological health because of the baffling symptoms (see page 2). The first signs of PCOS may be the growth of facial | |

|and body hair, hair thinning, acne, and weight gain. However, women who are thin can also have PCOS. A woman may find that she is infertile, unable to become pregnant. Some | |

|women may suffer from depression because of the severity of these symptoms or simply because of the workings of the disease itself. | |

|A specialist familiar with this syndrome, such as an endocrinologist is the best source for diagnosing this condition. Women with PCOS may have a number of seemingly unrelated| |

|symptoms. The diagnosis of PCOS diagnosis is made in several different ways, including taking your medical history, performing a physical exam, and checking your hormone | |

|levels, (or say "and possibly looking at your ovaries by ultrasound"). | |

|The cause of PCOS is unknown, although some scientists believe people may be able to inherit the condition. There is still no cure for PCOS. Doctors can only treat symptoms. | |

|Even though there is no cure, certain treatments are helping women to lead healthier and more satisfying lives. | |

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|PCOS: Symptoms |

|PCOS is not easy for doctors to diagnose. The common symptoms of PCOS include irregular or absent menstrual cycles and evidence of excess male hormones, such as | |

|facial hair growth, acne, and hair thinning (female balding). Many, but not all, women with PCOS are overweight. Even if several of the symptoms that follow are | |

|present, a woman may not have a case of PCOS. They may have a condition that affects the adrenal gland or the thyroid gland, for example. | |

|The underlying cause of PCOS is an imbalance of hormones. This imbalance often seems to be linked with the way the body processes insulin. Insulin is a hormone | |

|produced in the pancreas that promotes use of blood sugar (glucose). Insulin problems can increase male hormone production by the ovaries. | |

|Women who think they may have PCOS should see their doctor. While PCOS may bring obvious symptoms, such as more body hair, it can also hold dangers. PCOS may put | |

|women at risk for diabetes, heart disease, and cancer of the uterus. | |

|Women who are approaching menopause, the time of life when periods begin to taper off and then stop, may notice that most of their PCOS symptoms start going away.| |

|Some may even begin to have regular cycles as they approach menopause. | |

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|Some conditions related to PCOS may not be obvious but are potentially dangerous: | |

|Diabetes - Most women with PCOS have problems using their body's insulin. About 30% of women with PCOS have a problem processing blood sugar, called glucose | |

|intolerance. This is a major risk factor for adult-onset diabetes. | |

|Heart and blood vessel disease - People with high insulin levels, as in PCOS, often have low levels of so-called good cholesterol (HDL cholesterol) and high | |

|levels of other fats, including triglycerides. These factors are known to increase the risk of heart attack or stroke later in life. Women with PCOS also can have| |

|elevated bad cholesterol (LDL) levels. | |

|Cancer of the uterus - The lining of uterus normally builds up and is shed with the menstrual period each month. Because of irregular menstrual cycles and lack of| |

|ovulation, the lining of the uterus may not shed as often as it should. If PCOS goes untreated, this may increase the risk of cancer of the uterus. | |

|In PCOS, a variety of obvious symptoms can occur. Remember, PCOS is a syndrome, and each person will have a different set of syptoms. If you have two or more of | |

|the following symptoms, you should go to your doctor for an accurate diagnosis and the right treatments. | |

|Irregular periods - Nine or fewer menstrual cycles per year may be a sign of PCOS. Bleeding may be heavier than normal. These conditions are caused by a hormone | |

|problem, because the ovaries are not working properly and producing hormones that keep the menstrual cycle regular. | |

|Infertility - Because women with PCOS don't have regular menstrual cycles, many are unable to get pregnant. With help, women with PCOS can get pregnant, however. | |

|A number of infertility treatments are available. (See section on Treatments.) | |

|Hirsutism - Hirsutism means excess hair, which can be a difficult symptom for many women. For most women with PCOS, hair in the mustache and beard areas becomes | |

|heavier and darker. Masculine hair on the arms and legs and more hair growing in the pubic region, abdomen, chest or back are also possible. This symptom is | |

|caused by high levels of male hormones (androgens), as are thinning hair and acne. | |

|Thinning hair - Just as heavier hair growth is possible, scalp hair thinning may be present. This is caused by higher levels of androgens. | |

|Acne - Acne (pimples and oily skin) can also bother women with PCOS. The acne is usually found around the face (especially along the jaw line), chest, and back. | |

|Weight gain - Many women with PCOS gain weight around their middles taking on an apple shape rather than a pear shape. Such weight gain is linked with problems | |

|with the proper use of glucose and insulin in the body. | |

|Other skin problems - Skin tags, thick lumps of skin that can be as large as raisins, can form and usually are found in the armpits or neck. These can easily be | |

|removed. Darkening and thickening of the skin also can occur around the neck, groin, underarms, or skin folds. This condition, called acanthosis nigricans, is a | |

|sign of an insulin abnormality. | |

|Depression and anxiety - Because of the nature of many of these symptoms, woman may find themselves more anxious or depressed by their appearance, or by their | |

|inability to become pregnant. | |

| |PCOS: Treatment Options | |

| |Treatments for PCOS can help to relieve distinct symptoms, like acne and weight gain. Some treatments help put your body back into balance with the proper | |

| |amounts of hormones. For the symptoms described above, the following treatment options have helped many women: | |

| |Birth control pills (oral contraceptives) that contain female hormones can bring on more regular periods and help treat the problem of irregular menstrual | |

| |cycles. These contraceptive pills help to lower levels of androgens and can improve acne and hair growth as well. | |

| |Insulin-sensitizing medications used to treat adult-onset diabetes are useful for many women with PCOS. By lowering insulin levels, they may improve the | |

| |regularity of menstrual. Metformin is the drug of choice, but doctors should prescribe the drug with caution. Ask your doctor about metformin. It may be | |

| |helpful in some women to induce ovulation and may play a role in preventing early pregnancy loss. It has been used during pregnancy but there is no consensus on| |

| |this use at present. | |

| |Ovulation Induction. In some women who wish to become pregnant, inducing ovulation (release of an egg) is necessary. This is usually accomplished by taking a | |

| |pill called clomiphene citrate for five days. Other treatments include the injection of the brain hormone GnRH or gonadotropins. Other infertility treatments | |

| |include additional medications and even surgery to induce ovulation. High-tech treatments include in vitro fertilization, in which an egg fertilized with sperm | |

| |is implanted in the uterus. | |

| |Androgen-blocking drugs can be used to treat several PCOS symptoms. Spironolactone and flutamide can help to relieve the symptoms of excessive or thinning hair | |

| |and acne. They can be taken along with oral contraceptives. | |

| |An anti-hair-growth drug also can help to slow the growth of facial hair in women with PCOS. The drug is not a depilatory that loosens and gets ride of hair. | |

| |Eflornithine hydrochloride, the active ingredient, blocks an enzyme found in the hair follicle of the skin that is needed for hair growth. This results in | |

| |slower hair growth after a few weeks of treatment. | |

| |Other treatments for excess hair include bleaching and shaving your excess hair, which are safe and easy approaches. Waxing, tweezing, depilatory creams, and | |

| |electrolysis and laser treatments to remove hair may also be effective treatments for excess hair. | |

| |Treatments for hair loss tend not to work for everyone. Some women find improvements with the use of anti-androgen pills, and others find that the same | |

| |medication that men use (Rogaine) can help too. | |

| |Sticking to a special diet is a very important aspect of PCOS care. Some women with PCOS find success by reducing their total intake of carbohydrates (cereals, | |

| |breads, pastas) and choosing to eat different types of carbohydrates that are less processed (whole wheat, brown rice, beans). Replacing manufactured | |

| |carbohydrate products with whole grains, fruits and vegetables can help to reduce your insulin response. The diet also should include enough protein to control | |

| |the amount of sugar in the blood. Exercise also can help the body use insulin better, and help with weight loss and keeping off weight. | |

| |Acne treatments sold over the counter can also help to control the skin blemishes that can arrive with PCOS. To treat skin problems other than acne, ask your | |

| |doctor. Your doctor or dermatologist can remove skin tags using just a simple anesthetic on your skin. Acanthosis nigricans (skin darkening) sometimes can be | |

| |lightened by reducing your insulin level. Other treatments include Retin-A, 15% urea, alpha hydroxy acid, and salicylic acid. | |

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