Polycystic ovary syndrome (PCOS) is the most common endocrine disturbance in women of reproductive age; it affects an estimated five percent to 10 percent of females. PCOS, which is also sometimes still called Stein-Leventhal Syndrome after the doctors who first characterized it in the 1930s, is a cause of infertility. It is also now recognized as being associated with long-term risks of diabetes and possibly also cardiovascular disease.

As the term polycystic ovary syndrome suggests, the syndrome often is accompanied by enlarged ovaries containing multiple small "cysts", which are actually tiny follicles in the range of 1/4 to 1/2 of an inch in diameter. During a normal ovulatory menstrual cycle, a small number of follicles begin to grow. One becomes the biggest, outgrowing the rest. This dominant folliclethen ruptures and releases the egg. In women with PCOS, high levels of hormones called androgens halt the normal hormonal process and the egg's development. These follicles -- whose appearance (via an ultrasound) is sometimes likened to a string of pearls -- form the "cysts" observed in PCOS.

Note that the name is a bit misleading -- most woman with PCOS do not have cysts (usually larger than 2 inches in diameter), and many women who have cysts don't have PCOS.

While the biochemical imbalances that cause symptoms are becoming better understood, the trigger for PCOS is unknown. Researchers suspect a genetic predisposition plays a role. One recent study at Mt. Sinai Hospital in New York found a possible connection between a gene that helps the body use insulin and PCOS. Other studies have found that excess insulin production, which can result from insulin resistance, stimulates testosterone production. Insulin resistance is also a precursor to Type II diabetes. Other studies have noted excess insulin production in the presence of insulin resistance.

The most visible symptoms of PCOS stem from excessive levels of androgens, such as testosterone, which in women are produced in the ovaries and adrenal glands and can be further metabolized in other tissues such as fat cells. Testosterone can be converted to a more powerful androgen, dihydrotestosterone (DHT) in areas that affect the skin and hair. Androgens often are called "male hormones," even though they are found in both men and women. They are usually present at much higher concentrations in men and are an important factor in male traits and reproductive activity. Androgens include testosterone, DHT and androstenedione. Other hormones can be converted into testosterone or DHT, including dehydroepiandrosterone (DHEA), DHEA sulfate and estradiol.

Excessive levels of these hormones (hyperandrogenism) in women can lead to some of the most common symptoms of PCOS, including:

* excess body or facial hair

* oily skin and acne

* oligo ovulation

* weight gain

* balding

But such symptoms alone are not enough to support a diagnosis of PCOS. They may only indicate hyperandrogenism, which can result from several conditions and can be treated with anti-androgen medications.

The diagnosis of PCOS hinges on irregular and/or infrequent ovulation, as indicated by irregular menstrual periods. If periods are absent, it is important to induce them from time to time, whether through daily birth control or less frequent courses of the hormone progesterone, because menstruation prompts the shedding of the uterine lining, preventing a build up of the lining and this induced bleeding lowers endometrial cancer risk.

PCOS often is a cause of infertility due to failure to ovulate. The usual course of treatment here is a drug called clomiphene citrate. If that doesn't work, the usual next step is injectable gonadotropins. Many health care professionals are increasingly prescribing insulin-sensitizing drugs designed to treat diabetes to induce ovulation with or without clomiphene citrate. Small studies indicate such drugs alone or in combination with ovulatory medication may be effective for both infertility and other symptoms of PCOS.

PCOS is strongly linked to obesity and insulin resistance (a precursor to Type II diabetes). About one half of women with PCOS who are obese have insulin resistance or Type II diabetes (1;2). For women with PCOS who are obese, a treatment plan will usually incorporate a diet and exercise program.

Obesity in women with PCOS tends to be centered on the abdomen, a fat distribution pattern linked to increased risk of diabetes, heart disease and high blood pressure. As these abnormalities suggest, due most likely to the underlying endocrinological dysfunction, women with PCOS may be more apt to gain weight and have more trouble losing weight.

There is no cure for PCOS. Health care professionals usually address the symptoms that are most bothersome to a particular woman. Because of the complexity of the hormonal interactions, you may need to see an endocrinologist or a reproductive endocrinologist (especially if you are infertile and trying to conceive).

For many, the syndrome begins at puberty, with irregular or absent periods, but for others PCOS symptoms may first become noticeable in their early 20s. Onset of PCOS becomes less likely as a woman ages. The metabolic endocrine abnormalities of PCOS are possible even for women whose ovaries have been removed because androgens can be produced elsewhere in the body.

Record Number: A114750899

SOURCE:
NWHRC Health Center - Polycystic Ovarian Syndrome.  March 22, 2004 pNA.

Full Text: COPYRIGHT 2004 National Women's Health Resource Center