Polycystic ovary syndrome

  • Definition
    • Polycystic ovary syndrome (PCOS) is a condition in which a woman has an imbalance of female sex hormones. This may lead to changes in the menstrual cycle, cysts in the ovaries, trouble getting pregnant, and other health problems.

  • Alternative Names
    • Polycystic ovaries; Polycystic ovary disease; Stein-Leventhal syndrome; Polyfollicular ovarian disease; PCOS

  • Causes
    • PCOS is linked to changes in hormone levels that make it harder for the ovaries to release fully-grown (mature) eggs. The reasons for these changes are unclear. The hormones affected are:

      • Estrogen and progesterone, the female hormones that help a woman's ovaries release eggs
      • Androgen, a male hormone that is found in small amounts in women

      Normally, one or more eggs are released during a woman's cycle. This is known as ovulation. In most cases, this release of eggs occurs about 2 weeks after the start of a menstrual period.

      In PCOS, mature eggs are not released. Instead, they stay in the ovaries with a small amount of fluid around them. There can be many of these. However, not all women with the condition will have ovaries with this appearance.

      These problems with the release of eggs can contribute to infertility. The other symptoms of this disorder are due to the hormone imbalances.

      Most of the time, PCOS is diagnosed in women in their 20s or 30s. However, it may also affect teenage girls. The symptoms often begin when a girl's periods start. Women with this disorder often have a mother or sister who has similar symptoms.

  • Symptoms
    • Symptoms of PCOS include changes in the menstrual cycle, such as:

      • Not getting a period after you have had one or more normal ones during puberty (secondary amenorrhea)
      • Irregular periods that may come and go, and be very light to very heavy

      Other symptoms of PCOS include:

      • Extra body hair that grows on the chest, belly, face, and around the nipples
      • Acne on the face, chest, or back
      • Skin changes, such as dark or thick skin markings and creases around the armpits, groin, neck, and breasts

      The development of male characteristics is not typical of PCOS and may indicate another problem. The following changes may indicate another problem apart from PCOS:

      • Thinning hair on the head at the temples, called male pattern baldness
      • Enlargement of the clitoris
      • Deepening of the voice
      • Decrease in breast size
  • Exams and Tests
    • Your doctor or nurse will perform a physical exam. This will include a pelvic exam. The exam may show:

      • Swollen ovaries
      • Swollen clitoris (very rare)

      The following health conditions are common in women with PCOS:

      • Diabetes
      • High blood pressure
      • High cholesterol
      • Weight gain and obesity

      Your doctor or nurse will check your weight and body mass index (BMI) and measure your belly size.

      Blood tests can be done to check hormone levels. These tests may include:

      Other blood tests that may be done include:

      Your doctor may also order the following imaging test or surgeries to look at your ovaries:

  • Treatment
    • Weight gain and obesity are common in women with PCOS. Losing weight, even a small amount of weight, can help treat the hormone changes and health conditions such as diabetes, high blood pressure, or high cholesterol.

      Your doctor may recommend birth control pills to make your periods more regular. These medicines may also help reduce abnormal hair growth and acne after you take them for several months.

      A diabetes medicine called Glucophage (metformin) may also be recommended to:

      • Make your periods regular
      • Prevent type 2 diabetes
      • Help you lose weight

      Other medicines that may be prescribed to help make your periods regular and help you get pregnant are:

      • LH-releasing hormone (LHRH) analogs
      • Clomiphene citrate, which helps your ovaries grow and release eggs

      These medicines work better if your body mass index (BMI) is 30 or less (below the obese range).

      Your doctor or nurse may also suggest other treatments for abnormal hair growth. Some are:

      • Spironolactone or flutamide pills
      • Eflornithine cream

      Permanent hair removal options include electrolysis and laser hair removal. However, many treatments may be needed, and treatments are expensive.

      A pelvic laparoscopy may be done to remove or alter an ovary to treat infertility. The effects are temporary.

  • Outlook (Prognosis)
    • With treatment, women with PCOS are very often able to get pregnant. There is an increased risk of miscarriage, high blood pressure, and gestational diabetes during pregnancy.

  • Possible Complications
    • Women with PCOS are more likely to develop:

      • Endometrial cancer
      • Infertility
      • Breast cancer (slightly increased risk)
  • When to Contact a Medical Professional
    • Call your health care provider if you have symptoms of this disorder.

  • References
    • Bulun SE. The physiology and pathology of the female reporductive axis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 17.

      Rebar RW, Catherino WH. Reproductive endocrinology and infertility. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 236.

      Rosenfield RL, Barnes RB, Ehrmann DA. Hyperandrogenism, hirsuitism, and polycystic ovary syndrome. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 133.