Polycystic Ovary Syndrome (PCOS) is a genetic disorder characterized by excess androgen hormones. Michael Leventhal, MD, and Irving Stein, MD, in a series of seven women who presented with hirsuitism (excess body and facial hair), amenorrhea (discontinuation of menstrual periods), infertility and large, cystic ovaries, first diagnosed it in 1935. PCOS affects between 5 to 6 percent of women who are of reproductive age. Women with a family history of PCOS are more likely to be diagnosed themselves, although the syndrome is thought to be influenced by environmental factors as well as genetics. Women with PCOS are more likely to develop insulin resistance, diabetes, hypertension and obesity.
Symptoms
Since PCOS is caused by an overabundance of male sex hormones, the symptoms associated with this disorder are related to male secondary sex characteristics, such as excess body hair, thinning scalp hair and acne. PCOS also disrupts menstruation and leads to infertility. Often, women who present to the doctor with symptoms of PCOS exhibit signs of depression and low self-esteem, particularly when there has been no diagnosis or treatment of their condition. Upon patient presentation, a doctor must rule out that symptoms are not caused by a disorder with similar symptoms, such as Cushing syndrome, congenital adrenal hyperplasia or androgen secreting tumors.
Diagnosis
Women must meet one of two criteria to be diagnosed with PCOS. They must have physical or biochemical signs of androgen excess and visible polycystic ovaries upon ultrasound examination but still have regular menstrual periods, or they must have infrequent or absent menstrual periods with visible polycystic ovaries upon ultrasound examination, but no visible or biochemical signs of androgen excess. To diagnose this disorder properly, a doctor typically will order the certain tests--laboratory tests to measure reproductive hormone levels, such as FSH, LH, prolactin, testosterone and estrogen, and an ultrasound examination to determine the size and morphology of the ovaries. In women with PCOS, the hormones LH and testosterone will usually be elevated, and ultrasound will typically reveal ovaries that are 1.5 to 3 times larger than normal, with more than eight cystic follicles per ovary.
Treatment
There is no known cure for PCOS. Treatment is aimed at restoring hormonal balance and increasing fertility. Oral contraceptives are helpful in stabilizing hormone levels and improving the appearance of hirsuitism and acne. For more severe cases of hirsuitism, antiandrogens such as spironolactone, flutamide and cyprotene can be given. Affected women are also instructed to use body waxing, shaving or electrolysis to rid themselves of unwanted hair. For women with PCOS who wish to become pregnant, drugs like clomiphene or human menstrual gonadotropin can be given to help induce ovulation.
References
- Polycystic Ovary Syndrome: Multiple Pathways to a Common Phenotype?; Endocrine Practice; Andrea D. Coviello, MD; May/June 2009.
- Polycystic Ovary Syndrome, Depression and Affective Disorders; Endocrine Practice; Suzette C. Bishop, BM, et al.; July/August 2009.
- Polycystic Ovarian Syndrome Association
