Polycystic ovary syndrome

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 29, 2016
StartDiseasesPolycystic ovary syndrome

It is estimated that nearly five million women in the US have polycystic ovary syndrome or PCOS. It typically affects females during the childbearing years and can affect girls as young as 11 years of age.

Contents

Definition & Facts

Most women find that they have PCOS when they try to start a family but can't due to infertility, or they may discover it by noticing the absence of their menstruation cycle. They may experience a menstrual cycle but have heavier than normal flow, or a period that endures for an unusually long time.

The problems from PCOS occur inside the ovaries, where the woman's eggs are produced. Excess androgen causes tiny fluid-filled sacs to form on the lining. These are known as cysts. PCOS affects a woman ability to have children, her menstrual cycles, her hormones and even her heart.

Symptoms & Complaints

There are numerous complaints from those who suffer from PCOS. The most common complaint is infertility. The second most common concern with this condition is the irregular nature of the menstrual cycle. Hirsutism is excess hair growth on the face, chest, back, toes, stomach and arms; this is another common complaint of PCOS.

The excess of hormones causes the skin to be oily and the scalp to be flaky. Most women gain weight around their stomach and become obese. It is also not uncommon for a woman to experience hair loss, or even have male-pattern hair loss. Skin tags, or extra flaps of skin, may form in the armpits and around the neck. Along with all these physical symptoms come a few psychological symptoms too. Anxiety and depression are often a significant issue with PCOS because of the way its physical symptoms affect a person's self-image.

Causes

Typical ovulation involves the egg growing and the ovarian follicles continuing to build up fluid, breaking open and releasing the egg. The egg will then travel through the Fallopian tubes and to the uterus where it can be fertilized. When the egg is not fertilized, it breaks down and is released. When a woman presents with PCOS, she doesn't have all the hormones she needs for the egg to develop fully. The follicle may grow, but it doesn't have enough fluid buildup for ovulation to happen. Rather, the follicles remain and become cysts.

Because ovulation doesn't happen, the vital hormone progesterone is not created. When the body is without progesterone, the menstrual cycle will be either irregular or absent. Also, the ovaries generate too much androgen, which also stops ovulation from occurring. The excessive amount of androgen causes many of the symptoms including excessive hair growth, weight gain, and acne.

Diagnosis & Tests

Since there is no single test to diagnosis PCOS, a doctor will do a battery of tests. First, a physician will obtain a medical history, asking about the menstrual cycle and its regularities. The physician will also want to know about any weight changes that have occurred.

A physical examination will be conducted where they will check for evidence of excess androgen. They will look for excess hair growth in unusual places, as well as check the body mass index (BMI) and waist size. An increase in blood pressure is also an indication of an issue and is taken into consideration when making a PCOS diagnosis.

The pelvic examination is one of the best ways to see if the ovaries are enlarged. An enlarged ovary could indicate the presence of cysts. Blood tests can be helpful to find higher than usual levels of androgens and also an increased glucose level.

Lastly, the physician will order a transvaginal ultrasound. The ultrasound takes pictures of the inside of the pelvic area and will show cysts or a thickened endometrium. When the lining of the womb is thick, it is an indication that the menstrual cycles are not regular.

Treatment & Therapy

There is no cure for PCOS, so the goal is to manage the symptoms. For those who wish to have a family, the management may include taking fertility drugs and also a drug to reduce insulin resistance. If excess body hair is a problem, some medications will slow the progression. Laser hair removal seems to be the most successful in getting rid of the extra hair.

Birth control pills are excellent for regulating the menstrual cycle and helping with hormonal imbalances. Though they may be beneficial, they shouldn't be used by those who are at risk of a heart attack or stroke.

Lifestyle modification seems to be very beneficial. Losing about 10 percent of the overall body weight can be enough to regulate menstrual cycles. To help lose weight, limit processed foods and add whole grains and vegetables to the diet.

Lastly, for those who want a child, ovarian drilling is a rather new option that has shown promising results. A surgeon will puncture the ovary to destroy portions of it with electric currents, which helps to lower the male hormone levels and help the woman to ovulate.

Prevention & Prophylaxis

There is no way that PCOS can be prevented. However, getting an early diagnosis and starting on the right treatment path can help prevent any long-term complications. It is important to see a doctor when concerns of abnormal menstrual cycles occur. Also, infertility problems should be evaluated immediately. Getting regular check-ups from a physician is imperative for proper health. Allowing PCOS to continue untreated can cause obesity, metabolic syndrome, diabetes and even heart disease.