Definition

Polycystic ovary syndrome (PCOS) is a chronic endocrine disorder in women. With PCOS, the ovaries make the follicles, but the eggs do not mature or leave the ovary. The immature follicles can turn into fluid-filled sacs called cysts.

Causes

The cause is not exactly known. Genes may play a role. The problem appears related to insulin resistance that creates high levels of insulin. These high insulin levels cause too much androgen from the ovaries. This prevents ovulation and leads to enlarged, polycystic ovaries. Excess androgen is also associated with:

• Hirsutism—undesired or excess hair growth on face and body
• Acne

Risk Factors

Factors that may increase your chance of PCOS:

• Family members with PCOS
• Irregular menstrual cycles
• Obesity
• Sedentary lifestyle

Symptoms

Some women may not have symptoms. In others, they may appear between the ages of 15-30 years. In women who have symptoms, PCOS may cause:

• Infertility
• Amenorrhea—irregular menstrual periods or no menstrual period
• Obesity
• Dark patches of skin on neck, groin, and arm pit
• Hair loss

Women with PCOS are also at increased risk for:

• Type 2 diabetes
• High cholesterol
• High blood pressure
• Metabolic syndrome—A condition is marked by elevated blood pressure, cholesterol, blood glucose, and body weight. Excess weight centered around the midsection is of particular concern.
• Heart disease
• Endometrial hyperplasia—A precancerous condition marked by overgrowth and thickening of uterine lining.
• Endometrial cancer

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. An ultrasound may be done to look for multiple cysts on the ovaries.

Urine and blood tests may be done to look for potential causes or check for pregnancy.

Treatment

Treatment differs according to whether you want to conceive or not. The goal of treatment is to target the underlying insulin resistance that accompanies PCOS diagnosis.

Other treatment steps may include:

• Managing symptoms
• Weight loss if overweight
• Healthy eating
• Exercise
• Medications to improve insulin resistance, glucose intolerance, and prediabetes management
• Oral contraceptive
• Inducing ovulation (if you want to get pregnant) with:
  • Metformin or clomiphene citrate
  • Advanced reproductive technologies
• Preventing complications
• Anti-androgenic medications for blocking future hirsutism

Prevention

There are no current guidelines to prevent PCOS.

Polycystic Ovarian Syndrome Association http://www.pcosupport.org

Women’s Health Matters http://www.womenshealthmatters.ca

Baillargeon JP. Use of insulin sensitizers in polycystic ovarian syndrome. Curr Opin Invetig Drugs. 2005:6(10):1012-1022.

Glintborg D, Altinok ML, Mumm H, et al. Body composition is improved during 12 months’ treatment with metformin alone or combined with oral contraceptives compared with treatment with oral contraceptives in polycystic ovary syndrome. J Clin Endocrinol Metab. 2014;99(7):2584-2591.

Li XJ, Yu YX, Liu CQ, et al. Metformin vs thiazolidinediones for treatment of clinical, hormonal and metabolic characteristics of polycystic ovary syndrome: A meta-analysis. Clin Endocrinol (Oxf). 2011;74(3):332-339.

Polycystic ovary syndrome. American Academy of Family Physicians Family Doctor website. Available at:
http://familydoctor.org/familydoctor/en/diseases-conditions/polycystic-ovary-syndrome.html
Updated August 2010. Accessed July 26, 2013.

Polycystic ovary syndrome. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated June 17, 2013. Accessed July 26, 2013.

Polycystic ovary syndrome (PCOS). Endocrine Society Hormone Health Network website. Available at:
http://www.hormone.org/diseases-and-conditions/womens-health/polycystic-ovary-syndrome
Updated May 2013. Accessed July 26, 2013.

Stadmauer L, Oehninger S. Management of infertility in women with polycystic ovary syndrome: A practical guide. Treat Endocrinology. 2005;4(5):279-292.