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Updated 13 February 2013

Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is an illness characterised by irregular or no periods, acne, obesity, and excessive hair growth.

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Summary

  • Polycystic ovary syndrome (PCOS) is an illness characterised by irregular or no periods, acne, obesity, and excessive hair growth
  • Women with PCOS are at a higher risk for uterine cancer (endometrial cancer), diabetes, high blood pressure, and heart disease
  • With proper treatment, risks can be minimised

Description

Polycystic ovary syndrome (PCOS), also previously known by the name Stein-Leventhal syndrome, is a hormonal disorder that causes women to have a variety of symptoms including:

 

  • Irregular or no periods
  • Acne
  • Obesity, and
  • Excessive hair growth.

Any of the above symptoms and signs may be absent with the exception of irregular or no periods. All women with PCOS will have irregular or no menses. Women who have PCOS do not ovulate; that is, they do not release an egg every month. This is why they do not have regular periods.

Cause

No one is quite sure what causes PCOS. However, the ovaries of women with PCOS frequently contain a number of small cysts, hence the name poly (many) cystic ovary syndrome . A similar number of cysts may occur in women without PCOS. Therefore, the cysts themselves do not seem to be the cause of the problem.

Prevalence

In the normal population, a prevalence of 16–22% has been reported. Women with PCOS are at a higher risk for a number of illnesses, including high blood pressure, diabetes, heart disease, and cancer of the uterus (endometrial cancer). Much of this risk can be reversed by exercise and weight loss. Additionally, it is important for women with PCOS to have regular periods. If a woman does not have regular periods, her risk of cancer of the uterus (endometrial cancer) is increased. Medication is generally prescribed to induce regular periods.

Diagnosis

The diagnosis of PCOS is generally made on the basis of clinical signs and symptoms as discussed above, together with a typical ultrasound picture showing multiple small cysts in the periphery of the ovaries. Ultrasound imaging employs no injected dyes or radiation and is safe for all patients including pregnant women. The cysts in the ovaries are fluid-filled sacs which can easily be identified with ultrasound but also with other imaging technologies. More powerful and expensive imaging methods such as computerised axial tomography (CAT scan) and magnetic resonance imaging (MRI) can detect cysts as well, but these methods usually are not required for PCOS because ultrasound provides adequate information.

 

The doctor will want to exclude other illnesses that have similar symptoms, such as low thyroid hormone blood levels (hypothyroidism) or elevated levels of a milk producing hormone (prolactin).

Other laboratory tests can be helpful in making the diagnosis of PCOS. Serum levels of male hormones (DHEA and testosterone) may be elevated. Additionally, levels of a hormone released by the pituitary gland in the brain (LH) is elevated.

Treatment

This depends on the woman's stage of life. For younger women who desire birth control, the birth control pill, especially those with low "androgenic" (male hormone-like) side-effects can cause regular periods and prevent the risk of uterine cancer. For women who do not require birth control, causing a woman to have a period 4 times a year is usually all that is required.

 

For acne or excessive hair growth (hirsutism), a water pill (diuretic) called spironolactone may be prescribed to help reverse these problems. In more severe cases, drugs called cyproterone acetate and finasteride can be prescribed. For women who desire pregnancy, a medication called clomiphene (such as Clomid) can be used to induce ovulation (to cause maturation and release of an egg).

More recently, studies have indicated that medications that improve the action of the body's natural blood sugar control hormone, insulin, could benefit women with PCOS. Longterm studies of these insulin-sensitising drugs for PCOS patients are underway.

Finally, surgical procedures called "wedge resection" (in which a piece of the ovary is removed) and ovarian cautery are only of temporary help and indicated when infertility due to failure of ovulation is an immediate problem and all other therapy has proven unsuccessful.

In conclusion, women with PCOS should be able to have children and lead an active normal life. Contact your medical practitioner if you have irregular periods and think that you might have PCOS.

 
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