Polycystic ovary syndrome

📅 November 1, 2024 ✍️ By Lisa Hernandez ⏱️ 6 Mins Read 🗂️ Blog 🕒 Last updated: November 5, 2024

Definition

Polycystic ovary syndromemale hormones

Menstrual irregularities
Infertility
Skin problems, such as acne and increased hair growth
Increased number of small cysts in the ovaries
Insulin resistance, with an increased risk of developing diabetes

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 many women with PCOS, mature eggs are not released. Instead, they stay in the ovaries with a small amount of fluid (cyst) around them. The affected ovary may be slightly enlarged. There can be many of these. However, not all women with the condition will have ovaries with this appearance.

Women with PCOS have cycles where ovulation does not occur every month which may contribute to infertility The other symptoms of this disorder are due to the high levels of male hormones.

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 health care providera physical exam

Enlarged ovaries with many small cysts noted on ultrasound
Enlarged clitoris (very rare)

The following health conditions are common in women with PCOS:

Insulin resistance and diabetes
High blood pressure
High cholesterol
Weight gain and obesity

Your provider 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:

Estrogen level
FSH level
LH level
Male hormone (testosterone) level
Progesterone level

Other blood tests that may be done include:

Fasting glucose (blood sugar) and other tests for glucose intolerance and insulin resistance
Lipid level
Pregnancy test (serum hCG)
Prolactin level
Thyroid function tests

Your provider may also perform or order an ultrasound of your pelvis to look at your ovaries.

Treatment

Weight gainweight

Hormone changes
Conditions such as diabetes, high blood pressure, or high cholesterol

Your provider may prescribe birth control pills to make your periods more regular. These pills may also help reduce abnormal hair growth and acne if you take them for several months. Long acting methods of contraception hormones, such as the Mirena IUD, may help to stop irregular periods and the abnormal growth of the uterine lining.

A diabetes medicine called Glucophage (metformin) may also be prescribed 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 or letrozole, which may allow your ovaries to release eggs and improve your chance of pregnancy

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

Your provider may also suggest other treatments for abnormal hair growth. Some are:

Spironolactone or flutamide pills
Eflornithine cream

Effective methods of hair removal include electrolysis and laser hair removal. However, many treatments may be needed. Treatments are expensive and the results are often not permanent.

A pelvic laparoscopy may be done to remove or alter an ovary to treat infertility. This improves the chances of releasing an egg. The effects are temporary.

Outlook (Prognosis)

With treatment, women with PCOS are very often able to get pregnant. During pregnancy, there is an increased risk of:

Miscarriage
High blood pressure
Gestational diabetes

Possible Complications

WomenPCOS

Endometrial cancer
Infertility
Diabetes
Obesity-related complications

When to Contact a Medical Professional

Contact your provider if you have symptoms of this disorder.

Gallery

Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

References

Bulun SE. Physiology and pathology of the female reproductive axis. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 17.

Catherino WH. Reproductive endocrinology and infertility. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 223.

Lobo RA. Polycystic ovary syndrome. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 39.

Rosenfield RL, Barnes RB, Ehrmann DA. Hyperandrogenism, hirsutism, 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.

Last reviewed January 10, 2022 by John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team..