Understanding and managing Polycystic Ovarian Syndrome (PCOS) by Sam Thatcher, M.D., Ph.D.

Understanding and managing Polycystic Ovarian Syndrome (PCOS) 
by Sam Thatcher, M.D., Ph.D.


It's in the genes

It is a near universal finding that PCOS is genetic, but the heritage is complex. This genetic predisposition is not as simple as brown eyes or blue. The tendency to develop PCOS may be of be inherited from either the mother's side (maternal origin), from the fathers side (paternal origin), or from both sides.

PCOS and insulin resistance

Insulin resistance (IR) is a condition whereby the body steadily becomes less responsive to the actions of insulin. A primary action of insulin is to regulate --lower -- sugar, glucose, levels in the blood.


In short, the cause of PCOS is unknown. However, the story is starting to unravel and several important lines of evidence have emerged that offer clues about a central mechanism. The central question remains whether PCOS is a single entity.

Insulin altering agents

By treating the insulin resistance, PCOS may be also treated, possibly reversed. While preliminary studies have been very encouraging, there is much to be learned. A major benefit of these medications is that the entire spectrum of problems arising in PCOS appears to be improved.


The physical removal of unwanted hair is a useful, if not necessary, adjunctive therapy. Permanent hair removal can be accomplished by electrolysis, which destroys the hair's regeneration mechanism.

Surgical therapy

In the past, ovarian wedge resection, a procedure whereby a portion of the ovary is removed and the ovary sewn back together, resulted a significant reduction in LH and androgen production, reestablishment of regular menses in more than 75 percent of patients and a pregnancy rate of about 60 percent.

Fertility Therapy

CC probably is the first-line therapy in PCOS patients who want to become pregnant. In comparison, it is quite safe, inexpensive, easy to use and offers chance of pregnancy in the initial month of use. It works by a pharmacological trick that promotes the release of the pituitary gland's own storage of gonadotropins (FSH and LH).

GnRH Analogs

Gonadotropin releasing hormone (GnRH) is a hormone that is released from the hypothalamus and promotes production and release of the gonadotropins (LH and FSH) from the pituitary gland.


This group of medications can be used only when not attempting a pregnancy and with some form of adequate birth control. There is at least a theoretical, risk of feminizing the genitals of a male fetus. The value of the agents for PCOS patients is to improve the skin problems that occur with PCOS.


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