Polycystic Ovarian Syndrome (PCOS)

What is PCOS?

An estimated four to six percent of women of childbearing age have polycystic ovarian syndrome (PCOS). It is the most common endocrinopothy of women.

If a woman has two of the three following characteristics, she may have polycystic ovary syndrome:

  1. Evidence of an ovulation or irregular menstrual cycle.
  2. Evidence of hyperandrognemia either clinically or biochemically means there is evidence of elevated male hormone production. This is measured by a blood test that measures testosterone level. Another indication is hirsutism or hair growth issues, which is abnormal hair growth in hormonal dependent areas, including the upper lip, the chin, the face, the breast and the lower abdomen. It can be very mild to very severe.
  3. When you have a polycystic ovary appearance on a transvaginal pelvic ultrasound, the image looks like tiny cyst-like formations. They are eggs or follicles rimming the ovaries, starting to grow and then stopping at a small follicle size of approximately 2-10 mm. This appearance is very characteristic and can be used for making a diagnosis.
  4. Of note, when making the diagnosis of PCOS other medical conditions that present like PCOS must be eliminated. The following hormone conditions must be ruled out prior to making the diagnosis of PCOS: thyroid disease, ovarian and/or adrenal tumors, adrenal enzyme deficiency and prolactin abnormalities.

This condition can be associated with a variety of different symptoms, including:

  • High levels of male hormones, also called androgens. This can cause excessive facial and body hair or hirsutism
  • An irregular or absent menstrual cycle
  • May or may not have many small cysts in their ovaries as seen on an ultrasound
  • Inability to get pregnant
  • Acne, oily skin
  • Weight gain or obesity, usually carrying extra weight around the waist
  • Difficulty losing weight
  • Type 2 diabetes
  • High cholesterol, high triglyceride levels
  • High blood pressure
  • Patches of thickened and dark brown or black skin on the neck, arms, breasts or thighs (acanthosis nigricans)
  • Sleep apnea — excessive snoring and interrupted breathing while sleeping
  • An important reason to recognize PCOS, is that it can put a person at risk for insulin resistance syndrome type medical issues. You can develop a high risk for Type 2 Diabetes, high cholesterol, high triglyceride levels and high blood pressure. A woman can also be at risk for endometrial cancer or abnormal growth of the lining of the uterus. This is why it is important for people with PCOS to be treated medically and have their irregular cycles addressed.

What causes polycystic ovarian syndrome?

The exact cause of PCOS is not known.   There is an inheritable component to PCOS which means women with the condition frequently have a mother or sister with PCOS.  There is a fifty percent chance of getting PCOS if your mother has the condition.  Many women with PCOS have a weight problem, so researchers are looking at the relationship between PCOS and the body’s ability to make insulin.  Insulin is a hormone that regulates the change of sugar, starches and other food into energy for the body’s use or for storage.  Women with PCOS make too much insulin causes the ovaries to react and make too many male hormones.  Insulin also disrupts how your ovaires ature and release eggs, creating irregular cycles. The disruption in normal functioning of the ovary in PCOS can lead to acne, excessive hair growth, weight gain and ovulation problems.

What tests are used to diagnose PCOS?

Various tests will be done to diagnose PCOS.  Your doctor will take a medical history, perform a physical exam and check your hormone levels. This may include looking at the thyroid, pituitary and adrenal hormone levels.  You may have your glucose metabolism and diabetes risks levels tested which is done with an oral two hour glucose tolerance test and a fasting insulin.

A vaginal ultrasound may be performed to examine the ovaries for cystic appearance and to evaluate the lining of the uterus (or endometrium).

Why do women with PCOS have trouble with their menstrual cycle?

Each month, a collection of multiple eggs start to mature in a woman’s ovaries but usually only one becomes mature or dominant.  In women with PCOS, the ovary doesn’t receive the correct signals from the pituitary to produce the hormones it needs for any of the eggs to fully mature.  Some researchers think this is  because of high insulin levels which interrupts the normal signals to grow eggs.  Follicles containing eggs start to grow but do not receive the correct signals.  The follicles stop growing or arrest and become atretic remaining as small cystic areas seen on ultrasound.  Since no egg matures or is released, ovulation does not occur and the hormone progesterone is not made.  Without progesterone, a woman’s menstrual cycle is irregular or absent.  The small arrested or atretic follicles produce male hormones with contribute to the symptoms of PCOS.

How is PCOS treated?

There is no cure for PCOS, so it needs to be managed to prevent problems. Treatments are based on each individual case. Following are descriptions of treatments used for PCOS. The treatment of PCOS is based on the patient’s goals.

  • Lifestyle: This is the most important factor for long term health. Exercise is key. Women with PCOS need to exercises more than the average routine or regular areobic exercise. The Institute of Medicine recommends one hour of areobic exercise each day. It does not have to be done at one time. It can be broken into two thirty-minute routines each day, but exercise is key. In addition, diet is important to lifestyle changes.
  • A Healthy Weight: Women who maintain a healthy weight can help manage PCOS. Since obesity is common, a healthy diet and physical activity help maintain a healthy weight.