Polycystic Ovary Syndrome
Also known as: PCOS
What is it?
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 level, chronic
anovulation (absent ovulation) and other metabolic
disturbances. There is no known way to prevent
PCOS, but if diagnosed and treated early, risks
for complications such as heart disease and
diabetes may be minimized. Weight control through
diet and exercise stabilizes hormones and lowers
insulin levels.
Who gets it and what are its causes?
Women in their childbearing years can get PCOS.
It often begins in the teenage years. It doesn’t
go away. Usually women with PCOS have irregular
menstrual periods. After a while, some women stop
having any periods. Women with PCOS may have
trouble getting pregnant. Most women with PCOS
have a characteristic appearance to their ovaries,
known as polycystic ovaries. These consist of
multiple small "cysts" or follicles less
than ½ inch in diameter that form in the ovary.
During the normal maturation process of a
woman’s egg (ovum), the egg develops within a
cyst inside the ovary. The rupture of the follicle
and release of the mature ovum is called
ovulation. The multiple small cysts seen in the
polycystic ovary are the result of eggs that only
partially develop within the ovary. It is thought
that a slight elevation of male hormones may
inhibit the egg’s development. The egg’s
failure to mature leads to a lack of ovulation (anovulation)
in women with PCOS.
What are the symptoms?
The primary symptoms include menstrual
irregularities, hirsutism (increased body and
facial hair), acne and infertility. PCOS is a very
common condition among women, up to 10% of women
may be affected with some form of this syndrome.
Despite its high incidence, the long-term effects
of this syndrome are only now beginning to be
understood. Other symptoms may be as follows:
- Ovulation may not occur or it may occur
infrequently in women with PCOS, such that it is
unpredictable. This irregularity can make
achieving pregnancy difficult. Medications are
now available to help women with PCOS ovulate
more regularly.
- Irregular periods: In women with regular
menstrual cycles, the monthly period results
from shedding the inner lining of the uterus.
Without ovulation, the uterus does not receive
the regular signals to properly develop and shed
this lining. There can be long intervals of no
bleeding, episodes of heavy bleeding or
persistent spotting or flow. In addition to the
inconvenience this causes, there is also an
increased risk of uterine cancer. Hormonal
medication exists to regulate flow and reduce
the risk of uterine cancer.
- Hirsutism and Acne: Some women with PCOS may
experience symptoms of hirsutism and acne
because of the constant and elevated levels of
male hormones associated with anovulation. This
elevation in male hormones, however, rarely ever
approaches the normal male levels. Rather, it
represents an imbalance between a woman’s male
and female hormones. These conditions can be
treated with medication.
- Insulin Resistance and Diabetes: It has
become clearer that women with PCOS are
predisposed to a pre-diabetic condition and an
increased chance for diabetes later in life.
These are conditions that involve problems
regulating blood sugar in the body. It is
important to control blood sugar because
diabetes has many potential long-term
complications. Weight loss, diet, and
medications are often successful in treating
pre-diabetic and diabetic states.
- Cardiovascular disease: Women with PCOS, may
also face an increased cardiovascular risk due
to a variety of reasons including obesity,
hypertension and blood lipid abnormalities.
- Obesity: Excess body weight can be a strain
on the heart but the distribution of the body
weight also appears to be important. When fat is
deposited in the upper body, particularly around
the waist (central obesity), women are at
increased risk for diabetes, hypertension and
heart disease. Women with PCOS tend to have this
central obesity (an apple-shape instead of a
pear-shape.)
- Hypertension: Some studies have found that
women with PCOS have a greater risk for
developing hypertension (high blood pressure)
compared to women of the same age.
- Lipid Abnormalities: Women with PCOS often
have changes in their blood lipids (such as
cholesterol) that increase their risk for heart
disease. There are a variety of interventions
including weight loss, diet changes, behavioral
modifications, and medications available to
lower these risk factors.
- Gynecological cancers: Uterine Cancer -The
endometrium is the inner lining of the uterus.
With regular ovulation, it grows and is shed
monthly. Irregular or absent ovulation causes
the endometrium to continue to grow without
being shed. This continuous growth of the
endometrium can lead to endometrial cancer.
Consequently, women with PCOS who have absent or
irregular periods are at increased risk for
endometrial cancer. Hormonal treatments can
lower this risk. At this time, there is no clear
evidence to suggest that women with PCOS are at
any increased risk for ovarian or breast cancer.
Diagnosis
PCOS can be difficult to diagnose since its
symptoms are similar to those of other diseases,
and since all of its symptoms may not occur. The
doctor will take 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 for
hirsutism, acne or other changes. Blood tests that
measure levels of LH, FSH, estrogens, androgens,
glucose and insulin may be performed. An
ultrasound examination will help determine the
size and shape of the ovaries.
Medical 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.
Treatments consist of weight loss, drugs or
surgery and hair removal, depending upon which
symptoms are the most bothersome and whether the
patient desires pregnancy.
Surgical Treatment
Surgical treatment may be performed if drug
treatment fails, but it is not common. A wedge
resection, the surgical removal of part of the
ovary and cysts through a laparoscope, or an
abdominal incision, reduces androgen production
and restores ovulation. Although laparoscopic
surgery is less likely to cause scar tissue
formation than abdominal surgery, both are
associated with the potential for scarring that
may require additional surgery. Laparoscopic
ovarian drilling is another type of laparoscopic
surgery used to treat PCOS. The ovarian cysts are
penetrated with a laser beam and some of the fluid
is drained off. Hysterectomy and removal of the
ovaries, followed by estrogen replacement therapy
treat some severe cases of hirsutism.
Physician's Who Treat Polycystic Ovary Syndrome
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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