Polycystic Ovary Syndrome (PCOS, Stein Leventhal Syndrome, Polyfollicular Ovarian Appearance, Hyperandrogenic Anovulation, Polycystic Ovarian Disease, PCO, PCOD) |
Polycystic ovary syndrome (PCOS) is a chronic endocrine disorder in women. Characteristics of PCOS are:
- High levels of male hormones (androgens)
- Infertility
- Obesity
- Insulin resistance
- Hair growth on face and body
- Anovulation—when the ovaries make few or no eggs
Ovaries make follicles that develop into eggs. With PCOS, the ovaries make the follicles, but the eggs do not mature or leave the ovary. The immature follicles can develop into fluid-filled sacs called cysts. Most women with PCOS have cysts, but all women with ovarian cysts do not necessarily have PCOS. The cause of PCOS is unknown. Genes may play a role. The problem might be related to insulin resistance with high levels of insulin. These high insulin levels cause too much androgen from the ovaries. This prevents ovulation and leads to enlarged, polycystic ovaries.
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
- Obesity
- Sedentary lifestyle
- Family members with PCOS
- Age at onset: 15-30 years old
PCOS symptoms vary and can occur in any combination.
Symptoms include:
- Irregular menstrual periods or no menstrual period (amenorrhea)
- Infertility
- Hair growth on face and body
- Weight gain
- Obesity
- Acne
- Dark patches of skin on neck, groin, and arm pit
Rarely, symptoms include:
- Deep voice
- Temporal (right or left side of forehead) balding
Women with PCOS are also at increased risk for:
The doctor will ask about your symptoms and medical history, including the regularity of your periods and when they first started. The doctor will also perform a physical exam, including a pelvic exam. The doctor evaluates a range of test results and symptoms. Tests may include: -
Blood tests
- Androgen–free testosterone, or total testosterone, DHEAS
- Prolactin and thyroid function tests are often done
- Fasting blood sugar level and fasting insulin are recommended
- Fasting lipid profile is recommended
- Other tests—to look for related conditions
Treatment differs according to whether the patient wishes to conceive or not. Management currently is targeted at the underlying insulin resistance that accompanies PCOS diagnosis.
Treatment includes:
- Managing symptoms
- Weight loss if overweight, nutrition consultation
- Exercise
-
Insulin resistance, glucose intolerance, and prediabetes management
-
Use of oral agents such as:
Metformin, Glucophage,
Actos,
Avandia
- Oral contraceptive
-
Inducing ovulation (if you wish to get pregnant)
- Metformin with or without Clomiphene citrate
- Advanced reproductive technologies
- Preventing complications
-
Anti-androgenic medications for blocking future
hirsutism
(unwanted hair growth)
To lower cholesterol levels and reduce the risk of type 2 diabetes, high blood pressure, and heart disease:
- Get regular screenings for diabetes, high blood cholesterol, and fat levels.
- Exercise regularly.
- Eat a low-fat diet.
- Maintain a healthy weight.
Birth control pills regulate periods. Also, by causing the endometrium (uterine lining) to shed regularly, they reduce the risk of overgrowth or cancer. They also help control abnormal hair growth and acne. Other hormones (called progestins) may also be used to regulate menstruation. They can be used monthly or intermittently. Fertility drugs may be given instead to stimulate ovulation in women who want to become pregnant. PCOS can be prevented by recognizing those at risk in adolescence—due to family history, irregular periods, and obesity. If the causes of obesity are addressed successfully, and you follow a special diet and exercises, it is possible to avoid PCOS. The American College of Obstetricians and Gynecologists
http://www.acog.org/ The InterNational Council on Infertility Information Dissemination, Inc.
http://www.inciid.org/ Polycystic Ovarian Syndrome Association
http://www.pcosupport.org/ The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/ Women's Health Matters
http://www.womenshealthmatters.ca/
American College of Obstetrics and Gynecologists.
American College of Obstetrics and Gynecologists
website. Available at:
http://www.acog.org. Accessed June 15, 2008.
American College of Obstetricians and Gynecologists Practice Bulletin: polycystic ovary syndrome.
Obstet Gynecol. 2002;100:1389-1402.
The American Fertility Association. The American Fertility Association website. Available at:
http://www.theafa.org/. Accessed June 15, 2008.
Baillargeon JP. Use of insulin sensitizers in polycystic ovarian syndrome.
Curr Opin Invetig Drugs. 2005:6:1012-1022.
Dambro MR, Griffith HW.Griffith's 5-Minute Clinical Consult. 1999 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1999.
The InterNational Council on Infertility Information Dissemination. The InterNational Council on Infertility Information Dissemination website. Available at:
http://www.inciid.org. Accessed June 15, 2008.
Polycystic ovary syndrome. American Academy of Family Physicians website. Available at:
http://familydoctor.org/online/famdocen/home/women/reproductive/gynecologic/620.html. Published September 2000. Updated June 2005. Accessed June 15, 2008.
Polycystic Ovarian Syndrome Association.
Polycystic Ovarian Syndrome Association website. Available at:
http://www.pcosupport.org. Accessed June 15, 2008.
Stadmauer L, Oehninger S. Management of infertility in women with polycystic ovary syndrome: a practical guide.
Treat Endocrinology. 2005;4:279-292.
Stout DL, Fugate SE. Thiazolidinediones for treatment of polycystic ovary syndrome.
Pharmacotherapy. 2005;25:244-252.
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[an error occurred while processing this directive]February 2008 | 
