Polycystic Ovary Syndrome (PCOS)

PCOS is another relatively common hormonal disorder affecting about 5% of women. Despite its relatively wide distribution, it remains poorly understood. It is associated with being overweight, growth of unwanted male-type body hair, irregular periods (& infertility due to lack of ovulation) and a tendency to develop diabetes. There is no single test that can be used to diagnose the condition. The cause of PCOS is not known, though increased production of male hormone (testosterone) by the ovaries and increased secretion of luteinizing hormone by the pituitary gland are seen. In addition, there is a tendency for people with Polycystic Ovary Syndrome to have insulin-resistance (one of the causes of diabetes) which leads to increased testosterone production by the ovaries.

PCOS can be treated and its symptoms reduced through a combination of lifestyle changes and medical treatments.

Weight Loss

Many women who have PCOS and who have unwanted male-type hair (hirsutism) are overweight.  Being overweight may well be a significant contributing factor, since female hormone (estrogen) is converted to male hormone (testosterone) in fat tissue.  Increased concentration of male hormone is associated with male-pattern hair growth as well as male-type hair loss (from the temporal/frontal regions of the scalp.  Weight loss reduces the amount of male hormone and thereby reduces the hair growth/loss problem.

Hair Removal (In conjunction with Hormone Therapy)

Hair can be removed by many methods, but keep in mind that the best one for a friend may not be the best for you.  Methods for management of unwanted hair include:

• Shaving
• Plucking
• Waxing
• Bleaching
• Chemical depilation (Removal of hair with chemicals)
• Laser treatment

Medication Therapy

Several medications are used to treat PCOS and its symptoms. These include:

• Spironolactone. Developed to treat a hormonal type of high blood pressure, it was found to reverse unwanted hair growth in PCOS. Can result in heavy periods and is therefore often given with other hormones to control this effect

• Medroxyprogesterone (Provera) a synthetic female hormone.  Progesterone is the other main female hormone added to estrogen after ovulation (egg release) in the middle of the menstrual cycle.  Decreases in levels of estrogen and progesterone cause the period to start. Progesterone, a natural anti-male hormone, blocks the conversion of testosterone to dihydrotestosterone.  Dihydrotestosterone is a powerful hormone which converts a hair follicle making fine hairs into one making course hair.
• Micronized progesterone is the natural form of progesterone, identical to that which the body makes after ovulation (making an egg).  Its actions are identical to those of Provera. Its one side-effect, drowsiness, can be minimized by taking at bedtime.
• Metformin a drug used for people with Type 2 diabetes, improves the action of insulin, and thereby reduces insulin levels, particularly in people who do not have diabetes.  High insulin levels are associated with increased production of testosterone (male hormone) from the ovary. For this reason metformin may be particularly helpful in women with male-pattern hair problems.

For more information about Polycystic ovary syndrome, please see handout available here.