Polycystic ovary syndrome (PCOS) - symptoms and treatment
What is Polycystic Ovary Syndrome
A condition in which the OVARIES produce excessive ANDROGENS, the male sex hormones, resulting in irregular menstrual cycles and often anovulation (absence of egg maturation and release). A common characteristic of PCOS is the formation of multiple and often numerous cysts within the follicles of the ovaries. Polycystic ovary syndrome, sometimes called Stein-Leventhal syndrome or hyperandrogenic anovulation, is a common cause of INFERTILITY in women.
Researchers believe INSULIN RESISTANCE, an endocrine disorder in which the cells in the body do not appropriately respond to INSULIN, is a key factor in the development of PCOS though do not know the mechanisms of the relationship between the two conditions. PCOS commonly appears among a constellation of symptoms associated with insulin resistance including OBESITY, HYPERLIPIDEMIA (elevated levels of fatty acids in the BLOOD circulation), ATHEROSCLEROSIS (accumulations of fatty plaques within the walls of the arteries), CORONARY ARTERY DISEASE (CAD), and type 2 DIABETES.
Symptoms of Polycystic ovary syndrome (PCOS) and Diagnostic Path
The symptoms of Polycystic ovary syndrome - PCOS include
- irregular menstrual cycles
- AMENORRHEA (absence of MENSTRUATION) or frequent skipped menstrual periods
- excessive or male pattern body HAIR (HIRSUTISM)
- male pattern thinning of the hair on the head (ALOPECIA)
- pelvic discomfort or PAIN
- inability to conceive (infertility)
- excessive or persistent ACNE
In addition, many women who have PCOS also have HYPERTENSION (high BLOOD PRESSURE) along with other health conditions in the insulin resistance constellation (notably diabetes, hyperlipidemia, and obesity). Though some women who have PCOS have irregular menstrual cycles from MENARCHE (the onset of menstruation) or fail to start menstruating (primary amenorrhea), many women do not suspect they have PCOS until they are unsuccessful in their attempts to become pregnant.
The diagnostic path begins with a comprehensive medical examination including blood tests to measure HORMONE levels, GLUCOSE tolerance test, and PELVIC EXAMINATION, during which the doctor often can palpate (feel) the enlargement and irregular shape of the ovaries that is typical with multiple cysts. Transvaginal or pelvic ULTRASOUND provides visual representation of the ovaries that can confirm the diagnosis.
Polycystic ovary syndrome (PCOS) Treatment Options and Outlook
Though there is no cure for Polycystic ovary syndrome, medical treatments to regulate the balance of hormones in the body often can restore normal OVULATION and menstruation. For women who are not trying to become pregnant, the medication of choice is an oral contraceptive (birth control pills). Some oral ANTIDIABETES MEDICATIONS that affect how cells respond to insulin are also effective at improving symptoms.
For women who are trying to become pregnant, FERTILITY medications may stimulate ovulation though the risk for multiple pregnancy becomes significant. Some doctors recommend in vitro fertilization (IVF), a method of ASSISTED REPRODUCTIVE TECHNOLOGY (ART), rather than fertility medications for women who have PCOS and wish to become pregnant because IVF allows control over the number of potential fetuses. During pregnancy women who have PCOS have increased risk for spontaneous ABORTION, GESTATIONAL DIABETES, PREECLAMPSIA, and PREMATURE BIRTH, though diligent PRENATAL CARE keeps these risks to a minimum.
A surgical treatment option is ovarian drilling, a laparoscopic OPERATION in which the surgeon uses electrocautery to burn selected ovarian follicles to destroy the cysts they contain. Ovarian drilling typically restores normal ovulation for a limited time, which reduces symptoms overall. However, the effectiveness of ovarian drilling eventually diminishes as cysts continue to grow in the remaining ovarian follicles.
Nonmedical approaches such as electrolysis or laser hair removal can improve excessive hair growth. Daily physical exercise improves cell sensitivity to insulin, as does maintaining appropriate body weight. Weight loss of 10 to 15 percent often is enough to restore normal menstrual cycles. Weight management also improves conditions that may co-exist with PCOS such as hypertension and diabetes. Women in whom hormonal balance continues such that amenorrhea persists long term (as may occur in untreated PCOS) have increased risk for ENDOMETRIAL HYPERPLASIA and ENDOMETRIAL CANCER (overgrowth and cancer of the endometrium, the lining of the UTERUS).
Risk Factors and Preventive Measures
The primary risk factor for PCOS appears to be insulin resistance. Lifestyle measures to maintain healthy body weight and regulate the insulin–glucose balance often reduce symptoms of PCOS, though there are no certain measures to prevent PCOS. PCOS does appear to run in families, suggesting a genetic role in its development.
See also CONCEPTION; CONTRACEPTION; EXERCISE AND HEALTH; MENSTRUAL CYCLE; OVA; PREMATURE OVARIAN FAILURE (POF); WEIGHT LOSS AND WEIGHT MANAGEMENT.
