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Polycystic Ovary Syndrome
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Polycystic Ovary Syndrome

(PCOS; Stein Leventhal Syndrome; Polyfollicular Ovarian Appearance; Hyperandrogenic Anovulation; Polycystic Ovarian Disease; PCO; PCOD)

En Español (Spanish Version)

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 hold eggs. With PCOS, the ovaries make the follicles, but the eggs do not mature or leave the ovary. The immature follicles can turn into fluid-filled sacs called cysts . Most women with PCOS have cysts. But women with ovarian cysts do not necessarily have PCOS.

Ovary and Fallopian Tube

Ovarian Cyst

© 2008 Nucleus Medical Art, Inc.

Causes

The cause 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

These factors increase your chance of developing PCOS. Tell your doctor if you have any of these risk factors:

  • Obesity
  • Sedentary lifestyle
  • Family members with PCOS
  • Age at onset: 15-30 years old

Symptoms

If you have any of these symptoms do not assume it is due to PCOS. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

  • 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:

Diagnosis

The doctor will ask about your symptoms and medical history. She will ask questions about your periods and when they first started. The doctor will also perform a physical exam, including a pelvic exam. She will evaluate a range of test results and symptoms:

  • 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

Treatment

Treatment differs according to whether you want to conceive or not. Treatment targets 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)

Lifestyle Measures

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.

Hormonal Therapy

Birth control pills regulate periods. Also, by causing the uterine lining to shed regularly, they reduce the risk of overgrowth or cancer. They also 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.

Prevention

PCOS can be prevented by recognizing those at risk during their teen years—due to family history, irregular periods, and obesity. It is possible to avoid PCOS if the causes of obesity are addressed successfully, and you follow a special diet and exercises.

RESOURCES:

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/

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/

Women's Health Matters
http://www.womenshealthmatters.ca/

References:

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.

Vibikova J, Cibula D. Combined oral contraceptives in the treatment of polycystic ovary syndrome. Hum Reprod Update . 2005;11: 277-291.



Last reviewed February 2008 by Ganson Purcell Jr., MD, FACOG, FACPE

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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