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Polycystic ovary syndrome

Definition

Polycystic ovary syndrome is a condition in which there is an imbalance of a woman's female sex hormones. This hormone imbalance may cause changes in the menstrual cycle, skin changes, small cysts in the ovaries, trouble getting pregnant, and other problems.

Alternative Names

Polycystic ovaries; Polycystic ovary disease; Stein-Leventhal syndrome; Polyfollicular ovarian disease

Causes, incidence, and risk factors

Female sex hormones include estrogen and progesterone, as well as hormones called androgens. Androgens, often called "male hormones," are also present in women, but in different amounts.

Hormones help regulate the normal development of eggs in the ovaries during each menstrual cycle. Polycystic ovary syndrome is related to an imbalance in these female sex hormones. Too much androgen hormone is made, along with changes in other hormone levels.

It is not completely understood why or how the changes in the hormone levels occur.

Follicles are sacs within the ovaries that contain eggs. Normally, one or more eggs are released during each menstrual cycle. This is called ovulation. In polycystic ovary syndrome, the eggs in these follicles do not mature and are not released from the ovaries. Instead, they can form very small cysts in the ovary.

These changes can contribute to infertility. The other symptoms of this disorder are due to the hormone imbalances.

Women are usually diagnosed when in their 20s or 30s, but polycystic ovary syndrome 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 symptoms similar to those of polycystic ovary syndrome.

Symptoms

Changes in the menstrual cycle:

  • Absent periods, usually with a history of having one or more normal menstrual periods during puberty (secondary amenorrhea)
  • Irregular menstrual periods, which may be more or less frequent, and may range from very light to very heavy

Development of male sex characteristics (virilization):

  • Decreased breast size
  • Deepening of the voice
  • Enlargement of the clitoris
  • Increased body hair on the chest, abdomen, and face, as well as around the nipples (called hirsutism)
  • Thinning of the hair on the head, called male-pattern baldness

Other skin changes:

  • Acne that gets worse
  • Dark or thick skin markings and creases around the armpits, groin, neck, and breasts due to insulin sensitivity

Signs and tests

During a pelvic examination, the health care provider may note an enlarged clitoris (very rare finding) and enlarged ovaries.

Diabetes, high blood pressure, and high cholesterol are common findings, as are weight gain and obesity.

Weight, body mass index (BMI), and abdominal circumference are helpful in determining risk factors.

Levels of different hormones that may be tested include:

Other blood tests that may be done include:

Other tests may include:

Treatment

Losing weight (which can be difficult) has been shown to help with diabetes, high blood pressure, and high cholesterol. Even a weight loss of 5% of total body weight has been shown to help with the imbalance of hormones and also with infertility.

Medications used to treat the abnormal hormones and menstrual cycles of polycystic ovary syndrome include:

  • Birth control pills or progesterone pills, to help make menstrual cycles more regular
  • Metformin, a medication that increases the body's sensitivity to insulin, can improve the symptoms of PCOS and sometimes will cause the menstrual cycles to normalize. For some women, it can also help with weight loss.
  • LH-releasing hormone (LHRH) analogs

Treatment with clomiphene citrate causes the egg to mature and be released. Sometimes women need this or other fertility drugs to get pregnant.

Medications or other treatments for abnormal hair growth include:

  • Birth control pills. It may take several months to begin noticing a difference.
  • Anti-androgen medications, such as spironolactone and flutamide may be tried if birth control pills do not work.
  • Eflornithine cream may slow the growth of unwanted facial hair in women.
  • Hair removal using laser and nonlaser light sources damages individual hair follicles so they do not grow back. This can be expensive and multiple treatments are needed. Laser removal can be combined with other medicines and hormones.

Glucophage (Metformin), a medication that makes cells more sensitive to insulin, may help make ovulation and menstrual cycles more regular, prevent type 2 diabetes, and add to weight loss when a diet is followed.

Pelvic laparoscopy to remove a section of the ovary or drill holes in the ovaries is sometimes done to treat the absence of ovulation (anovulation) and infertility. The effects are temporary.

Expectations (prognosis)

Women who have this condition can get pregnant with the right surgical or medical treatments. Pregnancies are usually normal.

Complications

  • Increased risk of endometrial cancer
  • Infertility (early treatment of polycystic ovary disease can help prevent infertility or increase the chance of having a healthy pregnancy)
  • Obesity-related (BMI over 30 and waist circumferance greater than 35) conditions, such as high blood pressure, heart problems, and diabetes
  • Possible increased risk of breast cancer

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of this disorder.

References

Bulun SE, Adashi EY. The physiology and pathology of the female reporductive axis. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 16.

Radosh L. Drug treatments for polycystic ovary syndrome. Am Fam Physician. 2009;79:671-676.

Lobo RA. Hyperandrogenism: Physiology, etiology, differential diagnosis, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 40.

ACOG Practice Bulletin Number 108, October 2009. Accessed March 31, 2010.


Review Date: 3/31/2010
Reviewed By: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond,Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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