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Polycystic Ovary Syndrome

Polycystic Ovary Syndrome

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

Definition

Polycystic ovary syndrome (PCOS) is a chronic endocrine disorder in women. 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 .
Ovary and Fallopian Tube
Ovarian Cyst
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Causes

The cause is not exactly known. Genes may play a role. The problem appears related to insulin resistance that creates high levels of insulin. These high insulin levels cause too much androgen from the ovaries. This prevents ovulation and leads to enlarged, polycystic ovaries. Excess androgen is also associated with:
  • Hirsutism —undesired hair growth on face and body
  • Insulin resistance
  • Acne

Risk Factors

Factors that may increase your chances of developing PCOS include:
  • Family members with PCOS
  • Irregular menstrual cycles
  • Obesity
  • Sedentary lifestyle

Symptoms

Some women may not have symptoms. In others, they may appear between the ages of 15-30 years. In women who have symptoms, PCOS may cause:
  • Infertility
  • Amenorrhea —irregular menstrual periods or no menstrual period
  • Obesity
  • Dark patches of skin on neck, groin, and arm pit
  • Hair loss
Women with PCOS are also at increased risk for:

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. An ultrasound may be done to look for multiple cysts on the ovaries.
Urine and blood tests may be done to look for potential causes or check for pregnancy.

Treatment

Treatment differs according to whether you want to conceive or not. The goal of treatment is to target the underlying insulin resistance that accompanies PCOS diagnosis.
Other treatment steps may include:
  • Managing symptoms
  • Weight loss if overweight
  • Healthy eating
  • Exercise
  • Medications to improve insulin resistance, glucose intolerance, and prediabetes management
  • Oral contraceptive
  • Inducing ovulation (if you want to get pregnant)
    • Metformin or clomiphene citrate
    • Advanced reproductive technologies
  • Preventing complications
  • Anti-androgenic medications for blocking future hirsutism (unwanted hair growth)

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 by suppressing androgen. Fertility drugs may be given instead to stimulate ovulation in women who want to become pregnant.

Prevention

There are no current guidelines to prevent PCOS.

RESOURCES

The American Congress of Obstetricians and Gynecologists http://www.acog.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

ACOG Committee on Practice Bulletins--Gynecology. ACOG Practice Bulletin No. 108: Polycystic ovary syndrome. Obstet Gynecol . 2009;114(4):936-949.

Baillargeon JP. Use of insulin sensitizers in polycystic ovarian syndrome. Curr Opin Invetig Drugs . 2005:6:1012-1022.

Polycystic ovary syndrome. American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/polycystic-ovary-syndrome.html . Updated August 2010. Accessed July 26, 2013.

Polycystic ovary syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated June 17, 2013. Accessed July 26, 2013.

Polycystic ovary syndrome (PCOS). The Endocrine Society Hormone Health Network website. Available at: http://www.hormone.org/diseases-and-conditions/womens-health/polycystic-ovary-syndrome . Reviewed May 2013. Accessed July 26, 2013.

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.

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