Polycystic Ovary Syndrome
(PCOS; Stein Leventhal Syndrome; Polyfollicular Ovarian Appearance; Hyperandrogenic Anovulation; Polycystic Ovarian Disease; PCO; PCOD)
Polycystic ovary syndrome (PCOS) is a chronic endocrine disorder in women. With PCOS, the ovaries make follicles, but the follicles do not mature and release a mature egg each month as they should. The immature follicles can turn into fluid-filled sacs called cysts.
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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 to be made by the ovaries. More androgen than normal can increase the presence of some masculine features. It also prevents ovulation and leads to enlarged, polycystic ovaries. Other features may include:
Risk Factors ^
Factors that may increase your chance of PCOS:
- Family members with PCOS
- Irregular menstrual cycles
- Sedentary lifestyle
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:
- Amenorrhea—irregular menstrual periods or no menstrual period
- Dark, thickened patches of skin on the neck, groin, and armpit areas
- Hair loss from the scalp
Women with PCOS are also at increased risk for:
- Type 2 diabetes
- High cholesterol
- High blood pressure
- Metabolic syndrome—A condition 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 the uterine lining because of infrequent periods.
- Endometrial cancer
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 differs according to whether you want to conceive or not. The goal of treatment is to target the underlying insulin resistance that accompanies PCOS.
Other treatment steps may include:
- Managing symptoms
- Weight loss if overweight
- Healthy eating
- Medications to improve insulin resistance, glucose intolerance, and prediabetes management
- Oral contraceptive
Inducing ovulation (if you want to get pregnant)
- Metformin or clomiphene citrate
- Advanced reproductive technologies
- Preventing complications
- Anti-androgenic medications for blocking hirsutism
Birth control pills regulate periods. Also, by causing the uterine lining to shed regularly, they reduce the risk of overgrowth or cancer. They also control abnormal hair growth and acne by suppressing androgen. Fertility drugs may be given to stimulate ovulation when a woman with PCOS is ready to become pregnant.
There are no current guidelines to prevent PCOS.
Polycystic Ovarian Syndrome Association
The American Congress of Obstetricians and Gynecologists
The Society of Obstetricians and Gynaecologists of Canada (SOGC)
Women's Health Matters
ACOG Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 108: Polycystic ovary syndrome. Obstet Gynecol. 2009;114(4):936-949. Reaffirmed 2015.
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 April 2014. Accessed June 6, 2016.
Polycystic ovary syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 14, 2016. Accessed June 6, 2016.
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 June 6, 2016.
Stadmauer L, Oehninger S. Management of infertility in women with polycystic ovary syndrome: A practical guide. Treat Endocrinology. 2005;4(5):279-292.
Last reviewed June 2016 by James Cornell, MD Last Updated: 6/6/2016