New Directions in the Treatment of Polycystic Ovarian Syndrome
by Ellen Friedman Bender

Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder affecting between 5 percent and 10 percent of women of reproductive age. Although many people correctly associate PCOS with impaired fertility - chronic anovulation and hyperandrogenism (elevated male hormones) are two of its cardinal symptoms, it is more than an infertility disorder. Increasingly, PCOS is being recognized as a major women's health problem because of the havoc it wreaks on the endocrine system. Many women with PCOS suffer from endocrine abnormalities including insulin resistance which affects the bodies ability to metabolize sugar and fat.

Significantly, according to a research study, premenopausal women who have the disorder are seven times more likely to suffer from adult onset diabetes than women without PCOS. In addition, over time, many women with PCOS develop elevated levels of cholesterol and triglycerides so that here is a greater risk of heart attack and stroke for women in their forties and fifties. Moreover, because of their irregular menstrual cycles, women with PCOS are at greater risk for endometrial cancer. Women with PCOS also frequently encounter self-esteem and body-image issues arising from other frequent symptoms of the disorder including hirsutism (excess facial and body hair), obesity, acne and male-pattern baldness.

Traditionally, treatment for PCOS has focused on individual symptoms instead of the syndrome as a whole. Thus, a woman with PCOS who was trying to get pregnant might be given fertility drugs such as clomid or pergonal. A woman in her twenties might be given oral contraceptives to regulate her menstrual cycle or provera to periodically shed the lining of her uterus. Another woman might be given spironolactone to inhibit hair growth. But recent research suggests that there may be lifestyle changes and medications that by attacking the insulin resistance, actually treat the syndrome as a whole.

At the very least, some doctors recommend that their PCOS patients follow a carbohydrate-restricted diet and increase their exercise level. But the cutting edge research in PCOS is in the area of insulin sensitizing drugs. Recent studies have found that insulin sensitizing drugs given to type 2 diabetics, such as metformin, may also benefit women with PCOS. In one study, recently reported in the New England Journal of Medicine, an insulin sensitizing drug called INS-1 not only induced ovulation in 86% of the PCOS patients in the study, it also reduced their triglyceride and blood pressure levels, lowering their risk for cardiovascular disease. At the moment, however, none of these insulin sensitizing agents are FDA approved for the treatment of PCOS and some of them have unpleasant side effects.

Ellen Friedman Bender co-chaired the American Infertility Association's recent conference on PCOS, "Understanding Polycystic Ovarian Syndrome: A Reproductive and Metabolic Disorder." A version of this article appeared in the November 1999 issue of the Women's O.W.N. of NYU Medical Center newsletter.