Polycystic Ovary Syndrome Health Article

Definition

Polycystic ovary syndrome (PCOS) is a condition characterized by the accumulation of numerous cysts (fluid-filled sacs) on the ovaries associated with high male hormone levels, chronic anovulation (absent ovulation), and other metabolic disturbances. Classic symptoms include excess facial and body hair, acne, obesity, irregular menstrual cycles, and infertility.

Description

PCOS, also called Stein-Leventhal syndrome, is a group of symptoms caused by underlying hormonal and metabolic disturbances that affect about 6% of premenopausal women. PCOS symptoms appear as early as adolescence in the form of amenorrhea (missed periods), obesity, and hirsutism, the abnormal growth of body hair.

A disturbance in normal hormonal signals prevents ovulation in women with PCOS. Throughout the cycle, estrogen levels remain steady, luteinizing hormone (LH) levels are high, and follicle stimulating hormone (FSH) and progesterone levels are low. Since eggs are rarely or never released from their follicles, multiple ovarian cysts develop over time.

One of the most important characteristics of PCOS is hyperandrogenism, the excessive production of male hormones (androgens), particularly testosterone, by the ovaries. This accounts for the male hair-growth patterns and acne in women with PCOS. Hyperandrogenism has been linked with insulin resistance (the inability of the body to respond to insulin) and hyperinsulinemia (high blood insulin levels), both of which are common in PCOS.

Causes and symptoms

While the exact cause of PCOS is unknown, it runs in families, so the tendency to develop the syndrome may be inherited. The interaction of hyperinsulinemia and hyperandrogenism is believed to play a role in chronic anovulation in susceptible women.

The numbers and types of PCOS symptoms that appear vary among women. These include:

• Hirsutism. Related to hyperandrogenism, this occurs in 70% of women.
• Obesity. Approximately 40–70% of persons with PCOS are overweight.
• Anovulation and menstrual disturbances. Anovulation appears as amenorrhea in 50% of women, and as heavy uterine bleeding in 30% of women. However, 20% of women with PCOS have normal menstruation.
• Male-pattern hair loss. Some women with PCOS develop bald spots.
• Infertility. Achieving pregnancy is difficult for many women with PCOS.
• Polycystic ovaries. Most, but not all, women with PCOS have multiple cysts on their ovaries.
• Skin discoloration. Some women with PCOS have dark patches on their skin.
• Abnormal blood chemistry. Women with PCOS have high levels of low-density lipoprotein (LDL or "bad") cholesterol and triglycerides, and low levels of high-density lipoprotein (HDL or "good") cholesterol.
• Hyperinsulinemia. Some women with PCOS have high blood insulin levels, particularly if they are overweight.

Diagnosis

PCOS is diagnosed when a woman visits her doctor for treatment of symptoms such as hirsutism, obesity, menstrual irregularities, or infertility. Women with PCOS are treated by a gynecologist, a doctor who treats diseases of the female reproductive organs, or a reproductive endocrinologist, a specialist who treats diseases of the body's endocrine (hormones and glands) system and infertility.

PCOS can be difficult to diagnose because its symptoms are similar to those of many other diseases or conditions, and because all of its symptoms may not occur. A doctor takes a complete medical history, including questions about menstruation and reproduction, and weight gain. Physical examination includes a pelvic examination to determine the size of the ovaries, and visual inspection of the skin for hirsutism, acne, or other changes. Blood tests are performed to measure levels of luteinizing hormone, follicle stimulating hormone, estrogens, androgens, glucose, and insulin. A glucose-tolerance test may be administered. An ultrasound examination of the ovaries is performed to evaluate their size and shape. Most insurance plans cover the costs of diagnosing and treating PCOS and its related problems.

Treatment

PCOS treatment is aimed at correcting anovulation, restoring normal menstrual periods, improving fertility, eliminating hirsutism and acne, and preventing future complications related to high insulin and blood lipid (fat) levels. Treatment consists of weight loss, drugs or surgery, and hair removal, depending upon which symptoms are most bothersome, and whether a woman desires pregnancy.

Weight loss

In overweight women, weight loss (as little as 5%) through diet and exercise may correct hyperandrogenism, and restore normal ovulation and fertility. This is often tried first.