Polycystic Ovary Syndrome

by Dr. Henry Bohler

If you have been diagnosed with PCOS you are not alone. We think it is the most common hormone problem in women of reproductive age. It classically starts a little after the time you start your menstrual periods, beginning with irregular cycles. Many if not most patients with PCOS have either short cycles (< 21 days a part) or they have long cycles (> 35 days a part). Missing a period during a given month is also characteristic. Some of my patients have one or two periods a year! Some have none without the use of hormonal therapy, like birth control pills or ‘Provera’.

This type of cycle irregularity is usually a sign that ovulation is somewhat sporadic or just doesn’t occur, when means that becoming pregnant will be a challenge when it shouldn’t be. What’s worse is that PCOS is often accompanied by an increase in acne or hair growth in undesirable places like your face and chin. That’s because there is an increase in androgen production by the ovaries which is usually not the dominant hormone but in PCOS it may be.

Not ovulating (anovulation) regularly also places PCOS patients at increased of heavy, unpredictable uterine bleeding and uterine cancer. Estrogen made by a growing follicle in ovulatory women stimulates the lining (endometrium) of the uterine cavity. The endometrium thickens and then changes after ovulation because of progesterone made by the corpus luteum which is the body in the ovary left behind by the egg or oocyte. Since PCOS patients don’t always ovulate, then only estrogen is made and this constant estrogen effect causes abnormal bleeding and possibly uterine cancer if left unchecked.

The risk of uterine cancer is minimized by taking a progestin or a birth control pill. In fact, women on birth control pills have a decreased risk of uterine cancer compared to women without PCOS!

We call it polycystic ovary syndrome because often there is an overabundance of small follicles (each with an egg) in the ovaries. These small follicles fail to grow to maturity (usually much larger) and the ovaries are large and smooth in appearance.

In summary, any 2 of 3 criteria make the diagnosis-as long as other things which can also throw off your cycles are excluded, such as thyroid disease. The criteria are: 1. polycystic ovaries (usually noted by ultrasound); 2. lack of ovulating consistently; and 3. signs of increased androgen production demonstrated by blood testosterone levels or by the presence of increased hair growth and acne.

Henry Bohler, Jr., M.D. received his medical school training from Columbia University College of Physicians and Surgeons, one of the perennially top-ranked medical schools in the country located in New York City. His obstetrics and gynecology training was done at one of its affiliated hospitals, St. Luke’s-Roosevelt. He became ‘Major’ Bohler while serving as chief of OB/GYN in the United States Air Force, Whiteman AFB, MO, and then he was honored with a National Research Scholarship enabling him to do his subspecialty training in Reproductive Endocrinology and Infertility at Walter Reed Army Medical Center and the National Institutes of Health in the Washington, D.C.-Maryland area. Afterward he continued his research experience at Yale University after receiving the prestigious Mellon Fellowship.

Dr. Bohler is Board Certified in Obstetrics and Gynecology and Reproductive Endocrinology and Infertility and a Fellow of the American College of College of Obstetrics and Gynecology. He is also a member of the American Society of Reproductive Medicine and the Society of Reproductive Endocrinology and Infertility.

As Medical Director, Dr. Bohler has helped maintain very high standards and pregnancy rates at the University of Louisville’s infertility practice. Their pregnancy rates for patients in the Attain IVF program are among the highest in the national Attain-Network. Besides having a keen interest in IVF, Dr. Bohler other interests include polycystic ovary syndrome, recurrent pregnancy loss, obesity-related infertility problems and endometriosis.