Polycystic Ovary Syndrome

Q. I have been trying to get pregnant for the past two years. The hysterosalpingogram showed my fallopian tubes were open and my husband was told he is okay. I don’t get my periods very often but when I do they are very heavy and painful. What should I do next?

A. The most common cause of irregular menstrual cycles is polycystic ovary syndrome or PCOS. This is the most common endocrine disorder affecting reproductive aged women and is often associated with irregular cycles, polycystic appearing ovaries on ultrasound, and frequently signs or symptoms of excessive male hormone, testosterone. This can include acne or excessive hair growth, although this does not have to be present to make the diagnosis. Importantly, we like to exclude other conditions that could cause the irregular cycles including thyroid disease, high levels of prolactin, or disorders of the adrenal glands. PCOS has a genetic component and can lead to insulin resistance and diabetes if left untreated. There is also a risk for endometrial disease including endometrial polyps or even hyperplasia or cancer if left untreated for many years. The good news is that this is a recognized cause for infertility and can be adequately treated with diet, exercise, although medications are often helpful as well. It is surprising how many women have PCOS, perhaps reflecting changes in our society regarding weight, excerise and eating patterns.