Polycystic Ovary Syndrome

A Common Cause of Obesity, Hirsutism, and Menstrual Irregularities

Sep 22, 2009

Polycystic ovary syndrome is a relatively common hormonal abnormality in women. Diagnosis is based on signs and symptoms; cystic ovaries are not always present.

Polycystic ovary syndrome (PCOS), also known as Stein-Leventhal syndrome, sclerocystic ovarian disease, or hyperandrogenic chronic anovulation, is a condition characterized by an accumulation of incompletely developed follicles in the ovaries (failure to ovulate) and the overproduction of androgens (male hormones) by the ovaries.

The cause of PCOS is unknown, but genetic factors appear to be involved: The sisters and mothers of women with PCOS are more likely to have the condition.

PCOS occurs in up to 10% of women who visit gynecology clinics in industrialized countries; its true worldwide prevalence is unknown. Following the development of a set of diagnostic criteria to assist physicians in diagnosing the syndrome, PCOS has been found in at least 20% of overweight and obese women. (Cahill D. PCOS. Clin Evid Handbook. 2009:620-21)

How Ovaries Make an Egg (Ovum)

Normally, an ovarian follicle matures under the influence of follicle stimulating hormone (FSH) produced by the pituitary; the follicle ruptures and releases an ovum when another pituitary hormone (luteinizing hormone, or LH) rises to a “trigger-point” level.

Following ovulation (rupture of the follicle), the follicle forms a corpus luteum that temporarily produces estrogen and progesterone. These two hormones help to support an early pregnancy, should fertilization occur.

Estrogen and progesterone from the corpus luteum also send inhibitory signals to the pituitary, where the production of LH and FSH decreases.

If fertilization does not occur, the corpus luteum shrinks away, FSH and LH begin to rise again, and the cycle repeats.

How Failure to Ovulate Leads to Abnormal Hormone Production

When ovulation does not occur, the pituitary produces more LH in an effort to trigger ovulation. The follicular cells respond by secreting ever-increasing levels of androgens.

Androgenic hormones cause many of the signs and symptoms of PCOS. However, androgens are converted to female hormones (estrone and estradiol) in fat tissue. Thus, women with PCOS – most of whom are overweight – may exhibit a surplus of both androgens and estrogens.

While an excess of androgens may be responsible for the more obvious signs and symptoms of PCOS, high estrogen levels can lead to “estrogen dominance” in certain tissues. Women with PCOS, therefore, have a higher risk for endometrial cancer.

Signs and Symptoms of Polycystic Ovary Syndrome (PCOS)

PCOS typically begins in puberty and worsens over time. Following the publication of an international consensus statement that defines PCOS, the syndrome is now diagnosable when at least two of the following are present:

Although other conditions must be ruled out, the following signs and symptoms – especially when they occur in combination – coincide with the above diagnostic criteria and should raise one’s suspicion for PCOS:

Treatment of Polycystic Ovary Syndrome (PCOS)

For women who are not ovulating (or are ovulating irregularly), who are not hirsute, and who do not wish to become pregnant, pulsed therapy with progestins (e.g., Provera) or oral contraceptives will help to reduce the levels of circulating androgens (by suppressing LH production) and to reduce the risk of endometrial cancer.

Those women who are hirsute and who do not wish to become pregnant are treated to reduce hirsutism. This may involve the use of metformin (Glucophage), finasteride (Proscar), non-androgenic birth control pills, progestin, spironolactone (Aldactone), eflornithine (Vaniqua), or combinations of these agents. Oral medications for hirsutism are rarely completely effective and usually take months to show any benefit.

Hirsutism can also be treated with physical treatments (e.g., bleaching, depilatories, waxing, electrolysis, etc.).

Infertile women with PCOS who desire pregnancy are usually treated similarly to other infertile women.

Metformin is probably one of the most useful medications for treating PCOS, because it helps to address weight gain, insulin resistance, hirsutism, infertility, and menstrual irregularities. (Radosh L. Drug treatments to polycystic ovary syndrome. Am Fam Phys. 2009;79[8]:671-76)

Polycystic ovary syndrome is a common hormone disorder among women. Because its manifestations can be vague or take years to develop, PCOS may go undiagnosed for a long time. Treatment is aimed at dealing with androgen excess, infertility, and the metabolic problems associated with the syndrome.

The copyright of the article Polycystic Ovary Syndrome in Gynecological Health is owned by Stephen Allen Christensen. Permission to republish Polycystic Ovary Syndrome in print or online must be granted by the author in writing.