Polycystic Ovary Syndrome (PCOS, Stein Leventhal Syndrome, Polyfollicular Ovarian Appearance, Hyperandrogenic Anovulation, Polyc

Definition

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.

Causes

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.

Risk Factors

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

Symptoms

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:

• Type 2 diabetes due to insulin resistance (also glucose intolerance and prediabetes)
• Hyperlipidemia—increased fat and cholesterol in the blood
• Overgrowth and thickening of uterine lining—endometrial hyperplasia, a precancerous condition
• Endometrial cancer
• High blood pressure
• Heart disease
• Metabolic syndrome—a combination of obesity, insulin resistance, high blood pressure, dyslipidemia, and increased tendency to blood clotting and inflammatory states

Diagnosis

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

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)

Prevention

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.