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Polycystic Ovarian Syndrome
- What is Polycystic Ovarian Syndrome (PCOS)
- What are the symptoms of PCOS
- Conditions with symptoms similar to PCOS
- Health risks of PCOS
- When to call a doctor
- Infertility and PCOS
What is Polycystic Ovarian Syndrome?
Polycystic Ovarian Syndrome (PCOS) affects an estimated 6-10% of all women. PCOS interferes with normal ovulation and results in an increase in male hormone levels, which causes many of the symptoms of PCOS. Irregular ovulation causes irregular menstrual cycles. Abnormal insulin production and metabolic problems also contribute to the development of PCOS. The increase of male hormones (androgens) in PCOS leads to acne and abnormal hair growth (hirsutism). Many women with PCOS have multiple cysts on their ovaries (polycystic ovaries). A polycystic ovary may be up to three times larger than normal. Because women with PCOS usually experience significant ovulation problems, there is an increased difficulty in achieving pregnancy.
Recent studies have demonstrated that PCOS is due to an underlying metabolic problem known as insulin resistance. When the body's muscles and fat tissues become resistant to insulin action, the pancreas produces increased amounts insulin, leading to high insulin levels. In a woman with PCOS, these high insulin levels can set into play a vicious cycle that makes weight loss extremely difficult. Because the high insulin levels tend to produce food cravings, particularly in the form of carbohydrates, the woman often finds herself in a state of overnourishment. These high insulin levels also drive the ovary to produce high amounts of male hormones (androgens) leading to Ovarian Confusion. This unhealthy environment in the ovary causes follicles to literally die before they release mature eggs resulting in Ovulation Disruption.
The cause of the hormone imbalance which occurs with polycystic ovary syndrome is not fully understood, but genetics may be a factor. If you have the syndrome, your sisters and daughters have a 50% chance of developing PCOS. Abnormal insulin production and metabolic problems may contribute to the development of PCOS. If you do not ovulate normally for any length of time, you may develop multiple cysts on your ovaries (polycystic ovaries).
You may have more regular menstrual cycles as you near menopause. The reason for this is not known. However, your history of PCOS may still increase your long-term risk of high blood pressure (hypertension), heart disease, diabetes, or endometrial cancer.
The main risk factor for polycystic ovary syndrome (PCOS) is a family history of PCOS. If you have the syndrome, your sisters and daughters have a 50% chance of developing PCOS.
A family history of diabetes may increase your risk for PCOS because of the strong relationship between diabetes and PCOS. Research is ongoing on this risk factor.
The long-term use of the antiseizure medication valproate has been related to an increased risk of developing PCOS.
Symptoms of PCOS
Women with PCOS experience an array of symptoms which are often found in different combinations from person to person. These symptoms include very irregular or absent periods (100%), large and cystic ovaries (95%), obesity (75%, excessive body hair growth or acne (70%) cholesterol and/or triglyceride abnormalities (70%), family history of hypertension, heart diseases, obesity and irregular periods (100%). Many symptoms of polycystic ovary syndrome start gradually and, at first, may be thought to be related to some other medical problem. You may have only a few symptoms or many symptoms.
Early symptoms of PCOS include:
- Fewer than eight menstrual cycles in a year, more than 35 days between cycles, or no menstrual periods. Failure to ovulate each month occurs in almost 50% of women with PCOS.
- Abnormal vaginal bleeding. This symptom occurs in about 30% of women with PCOS.
- Excess hair growth (hirsutism) on the face, chest, back, stomach, thumbs, or toes. More than 70% of women with PCOS complain of excess hair growth.
- Skin problems, such as acne, oily skin, dandruff, dark skin patches (acanthosis nigricans) on the neck, groin, underarms, or in skin folds, or skin tags (acrochordons) in the armpits or neck area.
- Depression or mood swings. Many women have emotional problems related to the many physical symptoms of PCOS, such as excess hair, obesity, or infertility.
Gradual symptoms of PCOS include:
- Pain in the lower abdomen and pelvis (chronic pelvic pain).
- Weight gain or upper body obesity (more abdominal fat than hip fat). This is also known as android obesity and is related to increased male hormone (testosterone) levels.
- Infertility.
- Symptoms of insulin resistance, which increases the risk of developing diabetes in women with PCOS. You may also develop diabetes at a younger age because of PCOS. About 30% of women with PCOS have impaired glucose functioning, and 7% to 10% have type 2 diabetes. Some symptoms associated with insulin resistance include skin changes, such as skin tags or dark skin patches (acanthosis nigricans) and upper body weight gain.
- High blood pressure (hypertension).
- Male pattern baldness or thinning hair (alopecia).
Most women with PCOS seek medical evaluation for a specific symptom, not knowing that they have PCOS. The most common reasons women seek evaluation include menstrual problems, excessive hair growth (hirsutism), infertility and weight gain or upper body obesity.
Conditions With Symptoms Similar to PCOS
Conditions that cause symptoms similar to PCOS include:
- High prolactin hormone levels.
- Excess adrenal hormones. This excess level may be present from birth (congenital adrenal hyperplasia) or may occur in adulthood, causing irregular menstrual cycles and excess hair growth (hirsutism).
- Cushing's syndrome.
- Tumors of the ovary or adrenal gland that produce male hormones.
- Thyroid problems, such as autoimmune thyroiditis, hypothyroidism, or hyperthyroidism.
- Eating disorders.
- Atherosclerosis.
Health Risks of PCOS
PCOS may increase your risk for developing other conditions or diseases over time, such as:
- Reproductive problems:
- Irregular menstrual bleeding
- Miscarriage
- Preeclampsia
- Infertility
- Endometrial hyperplasia
- Endometrial cancer
- Metabolic problems:
- Insulin resistance
- Gestational diabetes
- Metabolic syndrome
- Type 2 diabetes
- Obesity
- Cardiovascular problems:
- Coronary artery disease or heart attack (MI)
- High blood pressure (hypertension)
- High cholesterol
- Other medical problems:
- Sleep apnea
- Research has not determined whether PCOS is related to any increase in the risk for breast cancer or ovarian cancer.
When To Call a Doctor
Polycystic ovary syndrome (PCOS) is a chronic (long-term) condition; many symptoms may start gradually and may initially be thought to be related to another medical problem.
PCOS has a wide range of symptoms, so it may be difficult to determine when to see your health professional. Your health professional should evaluate any of the following problems.
Early diagnosis may prevent long-term complications, such as diabetes. Watchful waiting is not appropriate when PCOS is suspected. Early diagnosis and treatment may help prevent future complications such as reproductive, metabolic, or cardiovascular problems.
If you are a teenage girl, see your health professional if you have:
- Not started menstruating by age 16 or within 2 years of breast and genital hair development.
- Fewer than eight menstrual cycles a year, and this has lasted for 2 years after you started menstruation.
- Severe acne.
- Excessive hair growth or hair growing in places such as the chest, back, or face (hirsutism).
- Menstrual cycles that are consistently less than 21 days apart or more than 35 days apart.
- Any symptoms of high insulin levels in the blood (hyperinsulinemia).
- Excess weight gain or upper body obesity (more abdominal fat than hip fat). This is also known as android obesity and is related to increased male hormone (testosterone) levels.
If you are between 20 and 40 years old, see your health professional if you have:
- Menstrual cycles that are consistently less than 21 days apart or more than 35 days apart.
- Regular menstrual cycles but you have been trying unsuccessfully to become pregnant for more than 12 months.
- Abnormal vaginal bleeding.
- Pelvic pain for more than 6 months.
- Excessive hair growth or hair growing in places such as the chest, back, or face (hirsutism).
- Any symptoms of high insulin levels in the blood (hyperinsulinemia).
- Ongoing skin problems, such as acne, oily skin, dandruff, dark skin patches (acanthosis nigricans) on the neck, groin, underarms, or in skin folds, or skin tags (acrochordons) in the armpits or neck area.
- Depression or mood swings. Many women may have emotional problems related to the many physical symptoms of PCOS, such as excess hair, obesity, or infertility.
- Excess weight gain or upper body obesity (more abdominal fat than hip fat). This is also known as android obesity and is related to increased male hormone (testosterone) levels.
If you are over 40 years old, call your health professional if you have:
- Abnormal vaginal bleeding.
- Pelvic pain for more than 6 months.
- Any symptoms of diabetes.
- Any symptoms of heart disease, such as high blood pressure (hypertension).
- Depression or mood swings. Many women may have emotional problems related to the many physical symptoms of PCOS, such as excess hair, obesity, or infertility.
Summary
PCOS affects many women and their fertility. Although obesity is common in PCOS, it’s not required for the diagnosis. Frequently, women have only a few of the symptoms. Often, blood tests and ultrasounds are required to help make the diagnosis. This condition, however, is usually easily treated and over 80% of patients with this syndrome will eventually conceive and have a baby. Much of the success of the treatment is dependent on how compliant the patient is with the lifestyle modifications described above. PCOS is a condition that has many long term health implications. (diabetes, heart disease, cholesterol problems). It is important – even if pregnancy is not desired – to be treated as early as possible to improve overall health.