Polycystic Ovarian Syndrome (PCOS)

What is Polycystic Ovarian Syndrome (PCOS)

Polycystic ovarian syndrome is a common hormonal disorder among women of reproductive age. In most women with PCOS, many small fluid-filled sacs (cysts) grow on the ovaries, and the cysts are not part of a normal menstrual cycle.

PCOS can cause problems with your menstrual periods and make it difficult to get pregnant. It can also cause an increased risk of miscarriage with pregnancy. If it is not treated, PCOS can lead to serious health problems, such as diabetes and heart disease.

4 Interesting Facts of Polycystic ovary syndrome (PCOS)

  1. Reproductive endocrinopathy characterized by chronic anovulation, hyperandrogenism, and polycystic ovarian morphology; typical onset occurs in adolescent or young adult
  2. There is extensive overlap with 21-hydroxylase deficiency, with common features of hirsutism, acne, and irregular menses (ie, oligomenorrhea, amenorrhea) developing slowly over time
  3. Formal diagnosis of polycystic ovary syndrome must include a combination of 2 of the 3 following findings: clinical or biochemical hyperandrogenemia, ovulatory dysfunction, and/or polycystic ovaries as identified on pelvic imaging
  4. Additionally, diagnostic criteria for polycystic ovary syndrome require exclusion of nonclassical congenital adrenal hyperplasia (in addition to thyroid disease and hyperprolactinemia) 
    • Polycystic ovary syndrome is clinically indistinguishable from congenital adrenal hyperplasia; thus, differentiation relies upon measurements of 17-hydroxyprogesterone, often using corticotropin stimulation 
    • Basal serum 17-hydroxyprogesterone level of 200 to 400 ng/dL is suggestive of congenital adrenal hyperplasia, whereas 17-hydroxyprogesterone level is typically within reference range (less than 200 ng/dL) in polycystic ovary syndrome 
    • Corticotropin-stimulated 17-hydroxyprogesterone level must be less than 1000 ng/dL to diagnose polycystic ovary syndrome 

What are the causes?

The cause of PCOS is not known, but it may be the result of a combination of certain factors, such as:

  • Irregular menstrual cycle.
  • High levels of certain hormones (androgens).
  • Problems with the hormone that helps to control blood sugar (insulin resistance).
  • Certain genes.

What increases the risk?

This condition is more likely to develop in women who have a family history of PCOS.

What are the symptoms?

Symptoms of PCOS may include:

  • Multiple ovarian cysts.
  • Infrequent periods or no periods.
  • Periods that are too frequent or too heavy.
  • Unpredictable periods.
  • Inability to get pregnant (infertility) because of not ovulating.
  • Increased growth of hair on the face, chest, stomach, back, thumbs, thighs, or toes.
  • Acne or oily skin. Acne may develop during adulthood, and it may not respond to treatment.
  • Pelvic pain.
  • Weight gain or obesity.
  • Patches of thickened and dark brown or black skin on the neck, arms, breasts, or thighs (acanthosis nigricans).
  • Excess hair growth on the face, chest, abdomen, or upper thighs (hirsutism).

How is Polycystic Ovarian Syndrome diagnosed?

Polycystic Ovarian Syndrome is diagnosed based on:

  • Your medical history.
  • A physical exam, including a pelvic exam. Your health care provider may look for areas of increased hair growth on your skin.
  • Tests, such as:
    • Ultrasound. This may be used to examine the ovaries and the lining of the uterus (endometrium) for cysts.
    • Blood tests. These may be used to check levels of sugar (glucose), male hormone (testosterone), and female hormones (estrogen and progesterone) in your blood.

How is Polycystic Ovarian Syndrome treated?

There is no cure for PCOS, but treatment can help to manage symptoms and prevent more health problems from developing. Treatment varies depending on:

  • Your symptoms.
  • Whether you want to have a baby or whether you need birth control (contraception).

Treatment may include nutrition and lifestyle changes along with:

  • Progesterone hormone to start a menstrual period.
  • Birth control pills to help you have regular menstrual periods.
  • Medicines to make you ovulate, if you want to get pregnant.
  • Medicine to reduce excessive hair growth.
  • Surgery, in severe cases. This may involve making small holes in one or both of your ovaries. This decreases the amount of testosterone that your body produces.

Follow these instructions at home:

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Follow a healthy meal plan. This can help you reduce the effects of PCOS.
    • Eat a healthy diet that includes lean proteins, complex carbohydrates, fresh fruits and vegetables, low-fat dairy products, and healthy fats. Make sure to eat enough fiber.
  • If you are overweight, lose weight as told by your health care provider.
    • Losing 10% of your body weight may improve symptoms.
    • Your health care provider can determine how much weight loss is best for you and can help you lose weight safely.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • Your symptoms do not get better with medicine.
  • You develop new symptoms.
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