What is polycystic ovarian syndrome?
Polycystic ovarian syndrome (PCOS), also known by the name Stein–Leventhal syndrome, is a hormonal problem that causes women to have a variety of symptoms
Polycystic ovary syndrome is a common condition characterized by irregular menstrual periods, excess hair growth and obesity, though it can affect women in a variety of ways.
The(PCOS) affects about one in 10 women in the United States and is the leading cause of infertility in women. Early diagnosis and treatment of polycystic ovary syndrome can help reduce the risk of long-term complications, which include diabetes and heart disease.
In PCOS, the ovaries are bigger than average, and the outer surface of the ovary has an abnormally large number of small follicles (the sac of fluid that grows around the egg under the influence of stimulating hormones from the brain).
In PCOS, these follicles remain immature, never growing to full development or ovulating to produce an egg capable of being fertilized. For the woman this means that she rarely ovulates (releases an egg) and so is less fertile. In addition, she does not have regular periods and may go for many weeks without a period. Other features of the condition are excess weight and excess body hair.
The condition is relatively common among infertile women and particularly common among women with ovulation problems (an incidence of about 75 per cent). In the general population, around 25 per cent of women will have polycystic ovaries seen on ultrasound examination but most have no other symptoms or signs of PCOS and are perfectly healthy. The ultrasound appearance is also found in up to 14 per cent of women on the contraceptive pill.
What causes PCOS?
The exact cause of polycystic ovary syndrome is unknown, but the condition stems from a disruption in the monthly reproductive cycle. The name polycystic ovary syndrome comes from the appearance of the ovaries in some women with the disorder — large and studded with numerous cysts (polycystic).
While it is not known if women are born with this condition, PCOS seems to run in families. This means that something that induces the condition is inheritable, and thus influenced by one or more genes.
Interestingly, when PCOS is passed down the man’s side of the family, the men are not infertile, but they do have a tendency to become bald early in life, before the age of 30. Ongoing research is trying to clarify whether there is a clearly identifiable gene for PCOS. It seems likely that in the future one or two genes will be identified that play a fundamental role in determining a woman’s likelihood of developing this condition.
Signs and symptoms
Women with polycystic ovary syndrome usually have at least several of the many signs and symptoms associated with PCOS, including:
- Irregular or no menstruation. This is the most common characteristic. Irregular menstruation means having menstrual cycles that occur at intervals longer than 35 days or fewer than eight times a year. The condition may begin in adolescence with the onset of menstruation, or it may appear later after a weight gain.
- Signs of excess androgen. Elevated levels of male hormones may result in physical signs, such as long, coarse hair on your face, chest, lower abdomen, back, upper arms or upper legs (hirsutism); acne; and male-pattern baldness (alopecia). However, not all women who have polycystic ovary syndrome have physical signs of androgen excess.
- Enlarged ovaries with multiple cysts. Your doctor may detect ovarian cysts by ultrasound. However, you may have ovaries with multiple cysts but still not have polycystic ovary syndrome. And you may have PCOS but have ovaries that appear normal.
- Infertility. Polycystic ovary syndrome is the most common cause of female infertility in the United States.
- Obesity. It’s estimated that about half of women with polycystic ovary syndrome are obese.
- Skin tags. These small, excess growths of skin that are usually found on your neck or in your armpit are common in women with PCOS.
- Pre diabetes or type 2 diabetes. The ability to use insulin effectively is impaired in PCOS and can result in high blood sugar levels and diabetes. Pre diabetes is also called impaired glucose tolerance.
- Acanthosis nigricans. This is the medical term for darkened, velvety skin on the nape of your neck, armpits, inner thighs, vulva or under your breasts.
Additionally, the following are more likely to occur in women with PCOS:
- High blood pressure.
- High blood cholesterol.
- Elevated levels of C-reactive protein, which may be associated with cardiovascular problems.
- Nonalcoholic steatohepatitis, a liver disease.
- Sleep apnea.
Women with PCOS are at risk for the following:
- Endometrial hyperplasia and endometrial cancer (cancer of the uterine lining) are possible, due to over accumulation of uterine lining, and also lack of progesterone resulting in prolonged stimulation of uterine cells by estrogen.
- Insulin resistance/Type II diabetes.
- High blood pressure.
- Dyslipidemia (disorders of lipid metabolism — cholesterol and triglycerides).
- Cardiovascular disease.
- Weight gain.
Treatment of Polycystic Ovary Síndrome
The goals in treating PCO disease are to protect the patient from the adverse long-term effects that persistent estrogen exposure in the absence of ovulation may have on the uterus and breasts, and to help control the specific symptoms the patient may be having. These goals can be accomplished by:
- Treatment to induce ovulation.
- Hormone medication to suppress ovary production of estrogen and male hormones.
- Intermittent treatment with progesterone hormone to interrupt the effects of steady estrogen exposure.
If one wants to become pregnant, then ovulation induction is the obvious choice. Treatment with clomiphene is successful in inducing ovulation for approximately 80 percent of patients, and if this is unsuccessful, injections of human menopausal gonadotropin may be a reasonable option.
All of the treatments designed to induce ovulation involve fairly extensive medical supervision and significant medical costs; although ovulation is the real “cure” for PCO problems, these treatments are not recommended unless the patient is actively trying to conceive.
Hormone treatment to suppress ovarian activity is a reasonable choice if the patient does not want to conceive now, and is having problems with excessive hair growth. This treatment also provides the added benefit of contraceptive protection. Regular birth control pills effectively suppress ovarian hormone production, but if these pills are unwise or contraindicated because of other medical problems, then similar suppression can be achieved with daily progesterone tablets or long-acting progesterone injections.
Intermittent progesterone treatment is a reasonable choice if the patient is not trying to conceive, does not need birth control protection, and is not having hair problems. Progesterone tablets such as Provera can protect against the development of precancerous uterine lining abnormalities, can reverse abnormalities already present, and should also control problems with irregular bleeding.
Can PCOS be prevented?
If there is a genetic influence, then some people are more likely to get PCOS than others. However, it seems likely that you cannot alter your predisposition to PCOS. There is no current proof of any benefit of preventative weight loss, but the best advice for overall health is to maintain a normal weight or BMI, especially if you have strong indicators that PCOS could affect you. These indicators are:
- a tendency in the family towards non-insulin dependent (Type 2) diabetes.
- a tendency towards early baldness in the men in the family (before 30 years of age).