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PCOS: What primary care physicians need to know
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Polycystic ovary syndrome affects 2.2% to 26.7% of women aged between 15 and 44 years, but up to 70% of them have not been diagnosed, according to Healthline.
September is designated as PCOS Awareness Month. To commemorate the occasion, Healio Internal Medicine spoke with Christine Carlan Greves, MD, from Orlando Health, about the causes, symptoms, risk factors and treatments for the condition.
Causes and symptoms of PCOS
“The exact cause of PCOS is unknown, but it is rooted in the fact that there are excess androgens and insulin resistance,” Greves told Healio Internal Medicine.
PCOS can present in various ways; however, health care providers should be aware of certain clinical features that can signify the condition as a potential diagnosis, she said. The signs and symptoms of PCOS include menstrual irregularity, infertility, polycystic ovaries, androgen excess, acanthosis nigricans and obesity, according to Greves.
“A patient does not have to have polycystic ovaries for the diagnosis, but if found on the ultrasound, it can help support possibility of the diagnosis,” she said.
About 70% of women with PCOS have acne and hirsutism on the face, abdomen, upper thighs and/or chest, she said. Additionally, 30% to 75% of patients with PCOS have obesity, she said.
Greves noted that patients with certain conditions, including obesity and/or insulin resistance, gestational, type 1 or type 2 diabetes or epilepsy, have an increased risk for PCOS.
Women who have a first-degree relative with PCOS also have a higher risk, she said.
Prevention of and treatments for PCOS
“The easiest recommendation to give patients to prevent PCOS is to adopt a healthy lifestyle,” Greves said. “However, giving that recommendation and being able to actually execute those recommendations are not that easy.”
Physicians should advise at-risk patients to exercise regularly, maintain a healthy diet and weight and not smoke, she said.
“Assess the patient’s goals first and aim to address the symptoms and signs individually,” Greves advised.
The use of combined oral contraceptives can help to control acne and hirsutism, she said. Spironolactone can be added if the patient does not response well to combined oral contraceptives, she said.
Combined oral contraceptives can also alleviate irregular, heavy menses or no menstruation, according to Greves. If a patient has contraindication to estrogen, progesterone-only pills can be prescribed, she said.
“Ovulatory cycles can possibly be restored with weight loss,” she said. “If a patient is not overweight, refer her to an OB-GYN to get further assistance with, possibly, ovulation induction with letrozole or clomiphene citrate.”
Patients with PCOS must be protected from developing endometrial hyperplasia, which could ultimately lead to uterine cancer if unrecognized, Greves noted. – by Alaina Tedesco
Disclosure: Greves reports no relevant financial disclosures.