PCOS (Polycystic Ovary Syndrome)

PCOS overview

  • Polycystic ovary syndrome (PCOS) is a hormonal and reproductive disorder that affects an estimated 1 in 10 women and is said to be the most common endocrine abnormality in reproductive-age women.
  • It is characterized by hyperandrogenism – an elevation of androgens, or male hormones, that exceed normal female levels.
  • PCOS affects a woman’s ovulation and thus fertility (ability to become pregnant).
  • There is no cure, but medical treatments and changes to lifestyle, such as diet and regular exercise, can help manage symptoms of the disorder by reducing testosterone production.

What is polycystic ovary syndrome (PCOS)?

PCOS is a hormonal and reproductive disorder that affects an estimated 1 in 10 women and is said to be the most common endocrine abnormality in reproductive-age women. Polycystic ovaries will commonly disrupt the menstrual cycle and normal ovulation, leaving a majority of symptomatic patients infertile.

PCOS is characterized by hyperandrogenism – an elevation of androgens, or male hormones, that exceed normal female levels. This impacts a woman’s ovaries, causing eggs to never reach maturity and instead turn into cysts inside the ovaries. As the number of cysts increases, the hormone imbalance worsens and leads to additional symptoms.

Causes

For reasons not fully understood (though a growing body of research suggests that the disorder may be linked to genetic abnormality), the hormonal imbalance in patients with PCOS is a result of either the overproduction of male hormones by the ovaries or a deficiency in insulin level regulation, known as “insulin resistance.”

In the case of insulin resistance, a peptide hormone that regulates fat and carbohydrate metabolism is barred from entering cells and in compensation, the body increases production of the hormone and additional androgens.

Symptoms

With the abundance of male hormones and consequential abnormal female reproductive functions, PCOS creates undesired physical outcomes beyond infertility. Women who are diagnosed with this disorder may present signs or symptoms that include:

  • Rapid weight gain and obesity
  • Irregular ovulation
  • Depression
  • An increase in irregular hair growth especially on the face, arms, back and legs
  • Ovarian cysts
  • Male pattern baldness
  • Diabetes
  • Acne
  • Acanthosis nigricans, a skin condition that produces areas of dark discoloration in folds and creases of the body

Diagnosing PCOS

The majority of patients with PCOS will have evidence of elevated male hormone levels and infrequent or no ovulation. The issues with ovulation will lead to irregular menses (periods).

Women seeking answers regarding infertility or disrupted menstrual cycles may discover that they have PCOS through a variety of fertility testing.

A thorough examination includes height, weight, blood pressure, evaluation of thyroid size, breast and genitalia development, as well as testing of the ovaries and uterus for tenderness and position. Further blood testing may also be required.

An ultrasound may also be performed to evaluate ovarian and uterine anatomy.

Treatment of PCOS

While there is no cure for PCOS, medical treatments and changes to lifestyle, such as diet and regular exercise, can help manage symptoms of the disorder by reducing testosterone production.

Significant advances in fertility medication have reversed the effects of PCOS for women seeking pregnancy. A woman’s ovaries can often be stimulated with fertility medication to produce ovulation, and then the patient can pursue additional fertility treatments such as in vitro fertilization (IVF).

Conversely, patients not looking to become pregnant may be prescribed birth control to slow the production of androgens, helping to maintain regular periods and reducing adverse effects, such as unusual hair growth.

More invasive treatments, such as “ovarian drilling” (a surgery that removes part of the ovary to inhibit ovulation and lower testosterone levels), have also proven successful.