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Polycystic ovary syndrome (PCOS) is a common cause of infertility. But PCOS involves so much more than just difficulties getting pregnant—and many people who have this condition remain undiagnosed until they try to conceive. As a provider, it’s important to understand the signs and symptoms of PCOS in order to help your patients manage symptoms and get treatment before complications arise.
“PCOS is both common and treatable, and we all need to do our part, as providers, to help patients navigate life with this condition—through education, symptom management, comorbidity treatments and referrals to specialists, when needed,” said Paul Osterdahl, D.O., an OB/GYN at Inspira Medical Group Obstetrics and Gynecology Mullica Hill.
Symptoms of PCOS
PCOS can go undiagnosed for a long period of time. The most common symptoms that point to the condition in patients are irregular or abnormal menstrual periods and signs of excess androgen. Diagnosis can often be made by clinical exam and history alone. However, prior to making the diagnosis of PCOS, other causes that may mimic the syndrome must be ruled out. This entails specific laboratory tests and, often, pelvic ultrasound.
These symptoms may sound simple, but PCOS can present differently depending on the individual. “It’s important to understand that the presence of one of these symptoms doesn’t necessarily point to PCOS,” said Dr. Osterdahl. “You can have polycystic ovaries appear on an ultrasound and not be diagnosed with PCOS and vice versa.” Anovulation in someone with PCOS can mean irregular or heavy periods, or both. In addition, hyperandrogenism can appear with varying symptoms including excess facial hair, hormonal acne or male pattern baldness.
The most common treatment for PCOS is combined oral contraceptives. “This type of birth control has a three-fold effect on PCOS: it helps to regulate periods, reduces levels of androgens and increases levels of sex hormone binding globulin (SHBG)—proteins that bind up testosterone,” said Dr. Osterdahl. “But we should be careful with the birth control that we’re prescribing to patients. It’s essential to prescribe a contraceptive that contains a progesterone with anti-androgenic effects. It is also imperative to assess the patient’s risk for blood clots when starting them on medication that contains estrogen.”
Other treatments for PCOS include lifestyle modifications like diet and exercise, androgen-blocking medications like spironolactone and fertility care for those who are trying to conceive. There are a range of specialists who treat PCOS, depending on symptoms, including nutritionists, endocrinologists and fertility physicians.
Conditions Associated with PCOS
The causes of PCOS are still unknown, but we do know that this condition affects the endocrine system with an imbalance in hormone levels. Because of this, there are a number of other conditions that often develop alongside PCOS.
“Patients with PCOS are at greater risk for developing diabetes, insulin resistance, high blood pressure, high cholesterol, coronary heart disease, sleep apnea, non-alcoholic fatty liver disease and certain types of cancer,” said Dr. Osterdahl. “It’s important for primary care providers to help patients with PCOS manage a healthy lifestyle and monitor for symptoms of diabetes or other PCOS-related disorders.” The people most at risk for these conditions are those with PCOS who have a BMI of 50 or higher, or those who are over 40 years of age.
When to Refer Patients to a Specialist
Primary care providers can diagnose and treat PCOS in their patients, but it often makes sense to refer patients to an OB/GYN to help confirm the diagnosis and initiate treatment.
“Primary care providers can help patients with PCOS keep diabetes under control, prescribe birth control, suggest healthy lifestyle changes and help in the management of other comorbid diseases. But referrals to an OB/GYN can help if patients are struggling with irregular or heavy periods, have concerns about getting pregnant or have a primary care physician who is unclear on their diagnosis,” said Dr. Osterdahl. “We can run extensive tests to rule out other conditions and help guide patients in the right direction when it comes to fertility care, contraceptive options, endocrinologist referrals and behavioral health management.”