Hyperandrogenic Chronic Anovulation - Polycystic Ovarian Syndrome

Overview, Causes, & Risk Factors

Polycystic ovarian syndrome (PCOS) is a disorder that results in abnormal hormone levels in a woman. In a normal ovary, a single egg develops and is released during ovulation each month. A polycystic ovary will have many eggs that are never released.

What is going on in the body?

Polycystic ovarian syndrome often begins with puberty and worsens with time. The cause of PCOS has not yet been completely identified. The symptoms of PCOS are related to an excess of the hormone androgen. This hormone can cause male features such as facial hair and male-pattern baldness in women. Polycystic ovaries may be normal in size, or they may be enlarged, with smooth, thick coverings.

What are the causes and risks of the disease?

The exact cause of PCOS is not clear. Some of the possible causes include:

certain medicines, such as those used for seizure disorders or mood disorders

an enzyme abnormality that causes an excess of the hormone androgen

genetic disorders that cause an increase in the production of the hormone testosterone

inherited metabolic disorders that interfere with the body's normal use of insulin

The risk of PCOS increases in women who also have one of these conditions:

breast cancer

high blood pressure

obesity

uterine cancer

Symptoms & Signs

What are the signs and symptoms of the disease?

The symptoms of polycystic ovarian syndrome include:

acne

amenorrhea, or the lack of menstruation

excess body hair

infertility

obesity

scanty or irregular menstruation

The woman may have several ovarian cysts, or fluid-filled sacs. Small ovarian cysts usually don't produce symptoms. Large cysts or multiple cysts may cause:

abdominal pain

abnormal uterine bleeding

low back pain

pelvic pain

Ovarian cysts may sometimes rupture, although this is rare. They may also start to twist. This can cause sudden abdominal pain, bloating, and stiffness.

Diagnosis & Tests

How is the disease diagnosed?

Diagnosis of PCOS begins with a medical history and physical exam. A pelvic exam may reveal enlarged ovaries. Ovarian cysts may be detected using ultrasound.

Laparoscopy, or the placement of a scope through a small incision in the abdomen, can be used to look directly at the ovaries. A biopsy of the ovary may be performed. This involves taking a small sample of ovarian tissue to be checked in a laboratory. Blood and urine tests may be used to check hormone levels.

Prevention & Expectations

What can be done to prevent the disease?

There is no known way to prevent polycystic ovarian syndrome. A woman may be able to lower her risk factors with good weight management. It's also important to seek effective treatment for breast cancer or high blood pressure.

What are the long-term effects of the disease?

The long-term effects of polycystic ovarian syndrome depend on the woman's condition and her response to treatment, but they may include:

endometrial hyperplasia, or a buildup of cells that line the uterus, which increases her risk for cancer of the uterus

heart disease later in life

infertility

insulin resistance, which can contribute to obesity and diabetes

What are the risks to others?

Polycystic ovarian syndrome is not contagious and poses no risk to others.

Treatment & Monitoring

What are the treatments for the disease?

There are many ways to treat polycystic ovarian syndrome, depending on a woman's symptoms. Treatment can include:

bleaching, electrolysis, waxing, and other cosmetic treatment of unwanted hair

diet and exercise for weight loss

infertility treatments

oral contraceptives and progesterone to regulate menstrual periods and reduce male hormone levels

spironolactone, a mild diuretic that blocks the effects of male hormones

surgery, such as ovarian wedge resection or ovarian drilling

Newer treatments focus on lowering insulin levels in the blood. This may help reduce the production of male hormones. It may also lessen the symptoms of PCOS. Metformin is one medicine that has been used for this.

What are the side effects of the treatments?

Surgery may cause bleeding, infection, and allergic reaction to anesthesia. Medicine side effects will vary, but they include allergic reactions.

What happens after treatment for the disease?

The symptoms of polycystic ovarian syndrome can often be managed over time with proper treatment.

How is the disease monitored?

A woman's healthcare provider will monitor her condition with regular pelvic exams and other tests. Any new or worsening symptoms should be reported to the healthcare provider.