Polycystic ovary syndrome

Definition

Polycystic ovary syndrome is a condition in which a woman has an imbalance of a female sex hormones. This may lead to menstrual cycle changes, cysts in the ovaries, trouble getting pregnant, and other health changes.

Alternative Names

Polycystic ovaries; Polycystic ovary disease; Stein-Leventhal syndrome; Polyfollicular ovarian disease

Causes, incidence, and risk factors

PCOS is linked to changes in the level of certain hormones:

• Estrogen and progesterone, the female hormones that help a woman's ovaries release eggs
• Androgen, a male hormone found in small amounts in women

It is not completely understood why or how the changes in the hormone levels occur. The changes make it harder for a woman's ovaries to release fully grown (mature) eggs.  Normally, one or more eggs are released during a woman's period. This is called ovulation. In PCOS, mature eggs are not released from the ovaries. Instead, they can form very small cysts in the ovary.

These changes can contribute to infertility. The other symptoms of this disorder are due to the hormone imbalances.

Most of the time, PCOS is diagnosed in women in their 20s or 30s. However, it may also affect teenage girls. The symptoms often begin when a girl's periods start. Women with this disorder often have a mother or sister who has symptoms similar to those of polycystic ovary syndrome.

Symptoms

Symptoms of PCOS include changes in your period (menstrual cycle).  Some changes are:

• No period after you have had one or more normal ones during puberty (secondary amenorrhea)
• Irregular periods, that may come and go and may be very light to very heavy

PCOS can cause you to develop male-like characteristics. This is called virilization. Symptoms include:

• Body hair growing on the chest, belly, face, and around the nipples
• Decreased breast size
• Enlargement of the clitoris
• Thinning of the hair on the head, called male-pattern baldness
• Voice gets deeper

You may also have skin changes:

• Acne that gets worse
• Dark or thick skin markings and creases around the armpits, groin, neck, and breasts

Signs and tests

Your doctor or nurse will perform a physical exam. This will include a pelvic exam. This may reveal:

• Swollen ovaries
• Swollen clitoris (very rare)

The following health conditions are common in women with PCOS:

• Diabetes
• High blood pressure
• High cholesterol
• Weight gain and obesity

Your doctor or nurse will check your weight and body mass index (BMI) and measure your belly size.

Blood tests can be done to check hormone levels. These tests may include:

• Estrogen level
• FSH level
• LH level
• Male hormone (testosterone) level
• 17-ketosteroids

Other blood tests that may be done include:

• Fasting glucose (blood sugar) and other tests for glucose intolerance and insulin resistance
• Lipid level
• Pregnancy test (serum HCG)
• Prolactin level
• Thyroid function tests

Your doctor may also order the following imaging test or surgeries to look at your ovaries:

• Vaginal ultrasound
• Pelvic laparoscopy

Treatment

Weight gain and obesity is common in women with PCOS. Losing weight can help treat the hormone changes and health conditions such as diabetes, high blood pressure, or high cholesterol.

Losing just 5% of your body weight can help your hormone imbalance and may make it easier to get pregnant. For an 160 pound woman, that's just 8 pounds!

Your doctor may recommend birth control pills to make your periods more regular. Such medicines may also help reduce abnormal hair growth after you take them for a few months.

A diabetes medicine called glucophage (metformin) may also be recommended to:

• Make your periods regular
• Prevent type 2 diabetes
• Help you loss weight when you follow a healthy diet

Other medicines that may be prescribed to help make your periods regular and help you get pregnant are:

• LH-releasing hormone (LHRH) analogs
• Clomiphene citrate, which helps your ovaries grow and release eggs

Your doctor or nurse may also suggest other treatments for abnormal hair growth. Some are:

• Spironolactone or flutamide pills
• Eflornithine cream

Permanent hair removal options include:

• Electrolysis
• Laser hair removal - works best on very dark hair that covers large areas

Treatments can expensive and multiple treatments may be needed.

A pelvic laparoscopy may be done to remove to remove or alter an ovary to treat infertility. The effects are temporary.

Support Groups

Expectations (prognosis)

With treatment, women with PCOS are usually able to get pregnant. There is an increased risk of high blood pressure and gestational diabetes during pregnancy.

Complications

Women with PCOS are more likely to develop:

• Endometrial cancer
• Infertility
• Breast cancer (slightly increased risk)

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of this disorder.

Prevention

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References

Bulun SE, Adashi EY. The physiology and pathology of the female reporductive axis. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 17.

Radosh L. Drug treatments for polycystic ovary syndrome. Am Fam Physician. 2009;79:671-676.

Lobo RA. Hyperandrogenism: Physiology, etiology, differential diagnosis, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 40.