Polycystic Ovary Syndrome

Overview

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PCOS is the most common hormonal disorder affecting women of reproductive age. It may occur in up to 10% of all women, and escapes diagnosis, as symptoms may be subtle. PCOS is the underlying disorder in two-thirds of women who report irregular menstrual cycles. There is clearly a spectrum of severity to the disorder, with mild cases often undiagnosed. Fewer women experience the severe form, where all aspects of the disorder are manifest (irregular cycles, hormonal and metabolic imbalances).

Causes

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No absolute cause has been found for PCOS, although there is a strong familial or genetic tendency. It is likely that both genetic and environmental factors are involved. Certain conditions, particularly excessive weight gain, make the disorder more severe, and can turn a subtle case into one which is more obvious and symptomatic.

Risk Factors

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Risk factors include a family history of menstrual disorders, diabetes, and being overweight or gaining weight rapidly.

Symptoms

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Symptoms include irregular periods, which can lead to difficulty in getting pregnant, skin problems such as acne, and increased body hair. More rarely, some women also complain of balding, which can be due to other disorders. In some women, increased body weight or the inability to lose weight is the primary sympton.

Diagnosis

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In the past, the diagnosis of PCOS was based on blood tests. Though there are certain hormonal findings characteristic of PCOS, blood tests are not reliable. The condition is usually diagnosed according to symptoms. Women need to have two of the following three findings:

  1. irregular menstrual cycles
  2. an imbalance of hormones favoring male-type hormones such as testosterone, and/or skin problems such as acne or increased body hair
  3. ovaries which have a characteristic “polycystic” appearance (enlargement with many tiny cysts arranged around the perimeter of the ovary) on ultrasound.

Most women with PCOS also have metabolic problems, especially excessive body weight. This metabolic problem is associated with higher levels of insulin, a hormone which controls blood sugar. As women with PCOS age, some are more susceptible to developing diabetes, high blood pressure, and heart disease.

Treatments

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Because of the wide spectrum of symptoms and findings in women with PCOS, and the fact that these characteristics need not all be present at the same time, treatment must be tailored to the particular needs of each woman diagnosed with PCOS. For women with irregular periods, who missed periods or bleed more heavily and irregularly, hormonal treatments with a progesterone-like medication or birth control pills are prescribed. If women with irregular periods wish to become pregnant, other medications are may be needed to induce ovulation. Birth control pills, with or without other agents, are prescribed for women with acne or excessive body hair growth. Medications, such as metformin, are prescribed for women who have problems with weight and metabolic abnormalities such as high levels of insulin and/or high blood sugar levels. Healthy lifestyle management, including a nutritious diet and regular exercise should be adopted by all women with PCOS.

Prognosis

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Though many women with PCOS do not believe they will be able to get pregnant, their prognosis for pregnancy is actually very good. There are many treatments to enhance fertility in women with PCOS. The treatments for menstrual irregularity and acne are also very successful. Treatments for excessive hair growth have a moderate degree of success, and only limited success in those more rarely affected by balding. Although women with PCOS are at increased risk for other medical conditions associated with aging (such as diabetes), with proper management and healthy lifestyle adjustments, this risk remains low from a long-term perspective.

Prevention

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Since many cases of PCOS are likely genetic in origin, there is no realistic way to prevent the disorder. However, many of the symptoms can be minimized or eliminated by weight management and a healthy lifestyle.