Polycystic ovary syndrome

PCOS, Polycystic Ovarian Syndrome, Polycystic Ovaries, Stein-Leventhal Syndrome

What is Polycystic ovary syndrome?

Polycystic ovary syndrome is an endocrine disturbance that causes both ovaries to become enlarged and have multiple cysts. Also known as Stein-Leventhal syndrome, it is characterized by oligomenorrhea (scanty menstruation) or amenorrhea (absence of menstruation), infertility, hirsutism (excessive hairiness), and obesity. The disorder affects women of reproductive age and is due to an imbalance between the pituitary gonadotropin luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Rather than fluctuating levels, there is excessive stimulation by the ovaries of LH and a relative deficiency of FSH. This results in increased testosterone production by the ovaries, causing a lack of ovulation.

How is it diagnosed?

PCOS signs and symptoms

  • Irregular menstrual bleeding, resulting in periods of light flow and heavy flow.
  • Increased time between periods, often up to several months.
  • Increased hair growth on the face, arms, legs and from pubic area to navel.
  • Higher energy level.
  • Obesity.
  • Acne.

History: Most women with polycystic ovaries will have a history of menarche (onset of menstruation) at the normal age with reasonably regular menstrual cycles, followed by menstrual cycles that become increasingly irregular or eventually cease altogether. Individuals may notice excessive body hair.

Physical exam: Individuals may have excess body hair (hirsutism) and may also be overweight (obese). Enlarged ovaries are identifiable on pelvic examination in 50% of the individuals.

Tests: The blood and urine are checked for abnormal hormone levels from the ovaries and the pituitary gland. Tissue samples from the lining of the uterus (endometrial biopsy) can confirm abnormal functioning of the ovaries (anovulation). Diagnosis can be confirmed by an ultrasound scan and/or laparoscopy (inserting a viewing instrument through a small incision in the abdomen in order to visually examine the ovaries).

How is Polycystic ovary syndrome treated?

The method of treatment depends on the severity of the symptoms and on whether the woman wishes to become pregnant. Medications directed at restoring ovulation include fertility agents, progestins, luteinizing hormone-releasing hormones, or oral contraceptives. In obese individuals, weight loss is often effective in restoring ovulation. When medication is ineffective, removing the diseased part of the ovaries (wedge resection) has been found to be very successful in restoring ovulation and fertility.

Medications

Aldactone (Spironolactone), Ambien (Zolpidem), Alesse (Levonorgestrel), Apri (Desogestrel), Ovral (Norgestrel), Femara (Letrozole)

What might complicate it?

Cancer of the uterus (endometrial cancer) has been associated with this disease due to prolonged hormone stimulation and high estrogen levels.

Predicted outcome

Hormone treatment is usually successful at restoring hormonal balance and ovulation. If medication is ineffective, removing the diseased part of the ovaries (wedge resection) has been found to be very successful.

Alternatives

Tumors or abnormal growth (adrenocortical hyperplasia) of the adrenal glands can be mistaken for polycystic ovaries.

Appropriate specialists

Gynecologist and endocrinologist.

Notify your physician if

  • You or a family member has symptoms of polycystic ovarian syndrome.
  • Your periods become profuse or less frequent than usual.
  • You develop a lump or swelling in the breast.
  • Symptoms recur after treatment or surgery.
  • You want a referral to remove excess body hair.

Last updated 8 August 2011


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