Polycystic Ovary Syndrome

What is polycystic ovary syndrome?

The two ovaries are part of the female reproductive system. The ovaries produce eggs and the female hormones, estrogen and progesterone. Ovarian cysts are fluid-filled sacs that form on the ovaries when the follicles (sacs) on the ovary that contain an egg mature but do not release the egg into the fallopian tube.

Polycystic ovary syndrome (PCOS) is a hormone disorder which prevents the release of an egg from the ovary. Many small benign cysts form under the thick, white covering of the ovary. It can cause your menstrual cycle to be irregular, or you may have no periods at all. In PCOS, the ovaries can also produce a large amount of male hormones that can cause obesity, acne, hair growth on the face and chest, and baldness. PCOS can make it hard for you to become pregnant. It can cause other problems as well.

PCOS increases your risk of uterine cancer, diabetes, and heart disease. If you have PCOS, it is important for you to regularly be checked by your healthcare provider for these other problems and to get treatment to help prevent these problems.

PCOS is most common in women less than 30 years old. It has also been called Stein-Leventhal syndrome.

How does it occur?

The cause of PCOS is not known. Researchers are looking for genes or substances in the environment that might cause it to happen, but nothing has been found yet. Also, because many women with PCOS have diabetes, studies are examining the relationship between PCOS and the level of insulin in the body. High levels of insulin appear to cause the body to make more of the male hormone testosterone, which worsens the symptoms of PCOS. A problem called insulin resistance (inability to normally use insulin in the body) can cause the high levels of insulin. Too much insulin in the body increases the risk for other problems, such as obesity, diabetes, high blood pressure, and heart disease.

Some medicines may cause or worsen the symptoms of PCOS. Be sure to tell your healthcare provider about all the medicines you are taking, including prescription and nonprescription drugs, supplements, and herbal remedies.

What are the symptoms?

The symptoms may include:

• irregular menstrual periods, particularly long cycles, or no periods at all
• very light or very heavy bleeding during your period
• trouble getting pregnant
• more hair on your face, chest, and lower abdomen
• balding in some women
• obesity
• acne or other changes in the skin

Many young women with polycystic ovaries start having menstrual periods at a normal age. But then, after a few years of regular menstruation, the periods may become quite irregular and then infrequent.

How is it diagnosed?

Your healthcare provider will ask about your medical history and may do these tests and exams:

• a physical exam, including a pelvic exam
• blood tests
• an ultrasound scan of the ovaries

Your provider may measure insulin and blood sugar levels to check for diabetes or insulin resistance.

How is it treated?

There is no cure for PCOS, but treatment is important to prevent further problems. The treatment depends on how severe your symptoms are and whether you are trying to get pregnant.

If you are not trying to get pregnant, you may be treated with hormones, usually birth control pills. If you take monthly cycles of birth control pills, then you should have regular menstrual cycles. If you take continuous birth control pills, then you should not have a menstrual cycle. Continuous birth control pills may cause more spotting, also called break through bleeding. Either birth control pill treatment can help reduce your risk for uterine cancer. The birth control pills also lessen production of male hormones, so unwanted hair growth and acne should improve. Your provider may prescribe other treatments to help with excessive hair growth and acne.

If you are trying to get pregnant, your provider may first recommend a weight control program for losing weight. A next step may be taking fertility drugs, which may be combined with another medicine to help increase your chances of getting pregnant.

Eating a healthy diet and maintaining a healthy weight can help lessen the symptoms of PCOS. Regular exercise helps weight loss and also aids the body in reducing blood glucose levels and using insulin more efficiently.

Your provider may prescribe diabetes medicine, such as metformin, to help keep the insulin in the blood at normal levels. Metformin can decrease testosterone levels, restore normal menstrual cycles, and improve fertility.

In rare cases, you may have surgery to remove a wedge of ovarian tissue. This sometimes results in regular menstrual cycles for at least a while. As a last resort, if the symptoms are severe enough, you may have to have both ovaries removed and begin taking hormone replacement therapy.

How long will the effects last?

With treatment your symptoms may improve, but there is no cure for PCOS. The problem may continue until your ovaries stop producing hormones at menopause.

In rare cases PCOS does not recur after you have a baby.

How can I take care of myself?

• Work with your healthcare provider and follow his or her prescribed treatment.
• Keep all your follow-up appointments. Your healthcare provider will want to see you regularly. Make sure you have a pelvic exam every year. Pelvic exams can help your healthcare provider detect problems such as uterine cancer early so that the problem can be treated promptly Your provider may do a sonogram to look for changes in your ovaries or in the wall of the uterus from irregular bleeding. You may need blood tests to check your hormones or to see how well the treatment is working.
• Make sure you have a pelvic exam every year. Pelvic exams can help your healthcare provider detect uterine cancer early so the cancer can be treated promptly.
• Tell your healthcare provider if you have any symptoms or changes other than those that you have been advised to expect.