Polycystic Ovary Syndrome
Polycystic Ovary Syndrome (PCOS) - also known as Polycystic Ovarian Syndrome, Polycystic Ovary Disease and Stein-Leventhal Syndrome - is an endocrine disorder that affects 6-10% of women worldwide. Polycystic means many small cysts. Symptoms may develop in women between the ages of puberty - the onset of menstruation (menarche) - through the mid-20s.
PCOS is one of the leading causes of infertility. Additionally, researchers are learning that PCOS has far-reaching effects on a woman's overall health, including increasing her risk of developing endometrial cancer, diabetes, heart disease, hypertension and elevated cholesterol levels.
FOR ADULT APPOINTMENTS, CALL 314-286-2400, extension 1.
FOR ADOLESCENT APPOINTMENTS, CALL (314) 362-4211.
Patients may be referred by their primary care physician or obstetrician/gynecologist or may be self-referred.
Specialists who diagnose and care for patients experiencing the symptoms of PCOS include:
Emily Jungheim, MD - Adult
Sarah Keller, MD- Adult
Diane Merritt, MD - Adolescent
Kelle Moley, MD - Adult
Randall Odem, MD Adult
Kenan Omurtag, MD Adult
Valerie Ratts, MD - Adult and adolescent
COMMONLY ASKED QUESTIONS ABOUT PCOS
What is PCOS?
PCOS is a disorder of the female endocrine system. In a woman's normal menstrual cycle, an egg (ovum) develops within a follicle on the surface of the ovary. During this cycle, hormones produced by the pituitary gland - follicle-stimulating hormone (FSH) and luteinizing hormone (LH) - help the egg to mature. Ovulation occurs when the follicle ruptures and the egg is released.
However, in women with PCOS, abnormal levels of FSH and LH are secreted. The overproduction of LH causes the ovaries to overproduce androgens, which disrupts the ovulatory process. The partially developed egg dies within the follicle, forming a small cyst-like structure in the ovary. PCOS gets its name from the many small cysts (degenerated eggs) that can build up in the ovaries. These cysts are non-cancerous.
In some women, the many residual follicles or cysts can be seen on ultrasound. However, it should be noted that some women who have been diagnosed with this syndrome do not have polycystic ovaries on ultrasound. Generally, PCOS is described as a disorder that affects women who do not ovulate regularly and who also produce excessive quantities of androgens (such as testosterone).
What is the advantage of being treated for PCOS at Washington University?
Although this syndrome was first identified in 1935, physicians still do not know what causes it. Their research today, however, has been focused on the far-reaching effects of this syndrome on a woman's health, as well as its role in infertility. Researchers most recently have achieved a new understanding of the role of insulin-resistance and high levels of insulin in PCOS patients.
Investigators are developing treatments that utilize drugs (such as metformin) that normally are used to treat diabetes by helping cells use insulin more efficiently and, therefore, potentially reverse the insulin resistance in PCOS patients.
As a leading teaching and research institution, Washington University School of Medicine offers patients the opportunity to participate in a number of clinical trials - both conducted at multiple centers across the country as well as solely at Washington University.
The following research studies currently are ongoing at Washington University:
- Combining metformin (GlusophageÒ) with clomiphene citrate (ClomidÒ) to produce ovulation in women with PCOS.
- Combining metformin with gonadotropin stimulation to produce ovulation in women with PCOS.
- A study of the levels of D-chiro-inositol (DCI), a molecule thought to be involved in insulin signaling, in women with PCOS.
- Administering D-chiro-inositol (DCI), an investigational drug, to evaluate its role in treating patients with PCOS.
What are the symptoms of PCOS?
No two women with PCOS have the same symptoms. That is why doctors sometimes have difficulty diagnosing this syndrome. Common characteristics associated with PCOS include:
- Irregular menstrual cycles (oliomenorrhea) or no menstrual cycles (amenorrhea)
- Excessive facial and body hair growth (hirsutism)
- Obesity/weight gain
- Male-pattern baldness (androgenic alopecia)
- Polycystic ovaries on ultrasound imaging or at laparoscopy
- Infertility and/or miscarriage
- Dark, velvety patches on the skin (acanthosis nigricans)
What are the health effects of PCOS?
For years, PCOS was mislabeled as a cosmetic problem; or, it was considered a problem that only interfered with a woman's ability to become pregnant. Today, researchers have learned that PCOS can affect a woman's long-term health in the following ways:
Diabetes - Many women with PCOS have been found to be resistant to their own insulin. This condition can place the patient at risk for the development of diabetes.
Heart disease - Research indicates that individuals with high insulin levels often have low levels of high-density lipoproteins (HDL), the good cholesterol, as well as high levels of triglycerides. They also are susceptible to high blood pressure. All of these conditions can increase a person's chances of experiencing a heart attack or stroke and have been observed in women with PCOS
Endometrial cancer - Because women with PCOS don't ovulate regularly, the lining of the uterus isn't shed regularly. If PCOS remains untreated, these women are at risk of developing endometrial cancer.
How is PCOS diagnosed?
In diagnosing patients with PCOS, physicians as Washington University School of Medicine gather a thorough medical history from patients, then order blood tests to detect abnormal hormone levels. Sometimes ovaries are scanned by ultrasound to detect cysts.
Is PCOS a hereditary condition?
Yes. Both sisters and daughters of women diagnosed with PCOS have a 50% chance of developing this syndrome.
What types of treatments are available for PCOS?
Depending upon the patient's goals, several treatment options are available:
- If the problems of irregular menstrual periods and hair growth need to be resolved, oral contraceptives and anti-androgen medications may be ordered.
- If the patient's goal is to become pregnant, clomiphene citrate or a combination of clomiphene citrate and metformin may be used.
- Gonadotropins may also be indicated.
- In rare instances, in-vitro fertilization (IVF) is required.
- If a patient with PCOS becomes pregnant, she will require good prenatal care due to increased risks of miscarriage and gestational diabetes.
- All patients with PCOS are advised to exercise regularly and monitor their weight in an effort to prevent the development of diabetes and heart disease.
Where are patients seen?
Adult patients are seen in a private office building located at 4444 Forest Park Ave., Suite 3100, in St. Louis (at the corner of Forest Park and Newstead avenues.) Complimentary surface parking is available. Patients are issued a parking sticker.
Adolescent patients are seen at 4444 Forest Park Ave., Suite 3100, by Valerie S. Ratts, MD, and at the St. Louis Children's Hospital Pediatric Center at Missouri Baptist Medical Center, Building C, Suite 351, in West St. Louis County, by Diane F. Merritt, MD Free surface and garage parking are available at Missouri Baptist Medical Center.
Where can I get more information about PCOS?
The PolyCystic Ovarian Syndrome Association, Inc., provides education and support for PCOS patients. Visit the association's web site at www.pcosupport.org