Definition
Polycystic ovary syndrome (PCOS) is one of the most common female endocrine disorders. PCOS is a complex, heterogeneous disorder of uncertain etiology (cause), but there is strong evidence that it can, to a large degree, be classified as a genetic disease.
PCOS produces symptoms in approximately 5% to 10% of women of reproductive age (12–45 years old). It is thought to be one of the leading causes of female subfertility and the most frequent endocrine problem in women of reproductive age.
The principal features are:
- anovulation, resulting in irregular menstruation, amenorrhea, ovulation-related infertility;
- excessive amounts or effects of androgenic (masculinizing) hormones, resulting in acne and hirsutism; and
- insulin resistance, often associated with obesity, Type 2 diabetes, and high cholesterol levels.
Finding that the ovaries appear polycystic on ultrasound is common, but not an absolute requirement in all definitions of the disorder. The symptoms and severity of the syndrome vary greatly among affected women.
Causes
PCOS is a heterogeneous disorder of uncertain etiology (cause). There is strong evidence that it is a genetic disease.
The clinical severity of PCOS symptoms appears to be largely determined by factors such as obesity.
Diagnosis/Evaluation Recommended:
Not all women with PCOS have polycystic ovaries (PCO), nor do all women with ovarian cysts have PCOS; although a pelvic ultrasound is a major diagnostic tool, it is not the only one. Other diagnostic criteria can be:
- oligoovulation and/or anovulation
- excess androgen activity
(Illustration from www.medicinenet.com)
Tests and evaluations can cover all or some of the following:
- Complete history and physical examination
- Gynecologic ultrasonography, specifically looking for small ovarian follicles.
- Serum (blood) levels of androgens (male hormones), including androstenedione and testosterone may be elevated.
- Some other blood tests are suggestive but not diagnostic. The ratio of LH (Luteinizing hormone) to FSH (Follicle stimulating hormone), when measured in international units, is greater than 1:1 (sometimes more than 3:1), as tested on Day 3 of the menstrual cycle.
Treatment
Not all women with PCOS have difficulty becoming pregnant. For those who do, anovulation or infrequent ovulation is a common cause.
There are treatments available for women with PCOS. These treatments do not cure the disease but rather help improve the symptoms of PCOS
For overweight, anovulatory women with PCOS, weight loss and diet adjustments, especially to reduce the intake of simple carbohydrates, are sometimes associated with resumption of natural ovulation.
For those who after weight loss still are anovulatory or for anovulatory lean women, then ovulation-inducing drugs are the principal treatments used to promote ovulation.
For patients who do not respond to ovulation induction, diet and lifestyle modification, there are options available including assisted reproductive technology procedures such as controlled ovarian hyperstimulation with follicle-stimulating hormone (FSH) injections followed by in vitro fertilisation (IVF) or Intrauterine Insemination (IUI).
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