Polycystic ovary syndrome is a condition in which a woman has an imbalance of female sex hormones. This may lead to changes in the menstrual cycle, cysts in the ovaries, trouble getting pregnant and other health problems.
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 PCOS, mature eggs are not released. Instead, they stay in the ovaries with a small amount of fluid around them. There can be many of these. However, not all women with the condition will have ovaries with this appearance.
These problems with the release of eggs can contribute to infertility. The other symptoms of this disorder are due to the hormone imbalances.
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 doctor or nurse will perform a physical exam. This will include a pelvic exam. The exam may show:
Swollen ovaries
Swollen clitoris (very rare)
The following health conditions are common in women with PCOS:
Diabetes
High blood pressure
High cholesterol
Weight gain and obesity
Your doctor or nurse 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
17-ketosteroids
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 doctor may also order the following imaging test or surgeries to look at your ovaries:
Vaginal ultrasound
Pelvic laparoscopy
Treatment
Weight gain and obesity are common in women with PCOS. Losing weight, even a small amount of weight, can help treat the hormone changes and health conditions such as diabetes, high blood pressure, or high cholesterol.
Your doctor may recommend birth control pills to make your periods more regular. These medicines may also help reduce abnormal hair growth and acne after you take them for several months.
A diabetes medicine called Glucophage (metformin) may also be recommended 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, which helps your ovaries grow and release eggs
These medicines work better if your body mass index (BMI) is 30 or less (below the obese range).
Your doctor or nurse may also suggest other treatments for abnormal hair growth. Some are:
Spironolactone or flutamide pills
Eflornithine cream
Permanent hair removal options include electrolysis and laser hair removal. However, many treatments may be needed, and treatments are expensive.
A pelvic laparoscopy may be done to remove or alter an ovary to treat infertility. The effects are temporary.