THE BASICS OF POLYCYSTIC OVARY SYNDROME

Polycystic ovary syndrome (PCOS) is a female hormonal imbalance commonly observed during a woman’s reproductive years. The ovaries appear enlarged in most cases with the presence of multiple cysts on the exterior. Alternative names of this condition are polycystic ovaries, polycystic ovary disease, Stein-Leventhal syndrome and polyfollicular ovarian disease.

Prevalence

PCOS is estimated to affect 5 – 10 % of premenopausal women.  Almost 5 million women in the US may have PCOS. The symptoms could appear as early as 11 years of age.

Symptoms

PCOS signs may appear in young adolescents, following the start of menstruation. Typical symptoms include:

• abnormalities in menstruation—e.g., such as missed menstrual periods (secondary amenorrhea), longer intervals between periods, prolonged periods

• excess hair growth (hirsutism) on body and face from excessive androgen production

• acne

• virilization, or the development of male-like characteristics, such as male-pattern baldness, decreased breast size and enlarged clitoris

• obesity and unexplained weight gain

• Infertility: Under normal circumstances, a woman’s ovaries release one egg per cycle. However, in PCOS patients, mature eggs cannot be released, and instead forms cysts on the surface of the ovary. Women with PCOS experience difficulty in becoming pregnant.

Diagnosis

A physical examination of the pelvic region may reveal swollen ovaries. PCOS can be visualized by the ultrasound examination of the ovaries. Most cases need to be further confirmed by the presences of additional symptoms, such as menstrual changes and excessive body hair.

Blood tests for hormone levels of estrogen, FSH, LH and androgen may be performed to diagnose PCOS. Other tests for PCOS include fasting glucose, lipid levels, thyroid functions and prolactin levels.

Causes

Although the exact cause of PCOS is unclear, prompt detection and treatment are essential to prevent complications including Type 2 diabetes, cardiovascular and metabolic diseases, sleep apnea, abnormal uterine bleeding and endometrial cancer.

Hormonal changes in estrogen, progesterone and androgen levels in women are generally found in PCOS. The pathogenesis of PCOS is also related to the following:

• Insulin resistance can lead to insulin over secretion in the body, resulting in increased androgen production by the ovaries. The high levels of insulin and testosterone in turn affect ovarian follicular development, leading to the inability to ovulate with each cycle.

• Chronic low-grade inflammation is present in PCOS patients, and may contribute to insulin resistance.

• Family medical history: Some evidence suggest that PCOS may have a genetic component.

• Abnormal fetal development due to excess exposure to androgens of the fetus.

Treatment

• Weight loss is recommended for PCOS patients. By losing weight, a woman can help relieve symptoms associated with hormonal imbalances, diabetes, high cholesterol, or high blood pressure.

• Medications: Birth control pills can be given to regularize a patient’s periods. Diabetes medications, such as Metformin, may be prescribed to prevent Type 2 diabetes, and help regulate periods. Women with PCOS who want to conceive may be given LH-releasing hormone analogs and clomiphene citrate, to help ovulation. Medications to prevent abnormal hair growth include spironolactone, flutamide and eflornithine cream. Women can also undergo electrolysis, or laser treatment to permanently remove unwanted hair.

• Laparoscopy is a surgical intervention that may temporarily alleviate symptoms of PCOS.

The prognosis of PCOS patients is generally positive after proper treatment. Women can successfully get pregnant, although the risk of developing high blood pressure and diabetes during pregnancy is higher than normal.