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Polycystic Ovary Syndrome: Diagnosis, Causes, Pathology, Treatment

Polycystic ovary syndrome, or PCOS, is a common HORMONAL disorder affecting about 10% of all women of reproductive age. PCOS is diagnosed when AT LEAST 2 of the following symptoms are present:

• irregular periods due to MISSED ovulation.
• excess male hormone (androgen) as evidenced by lab tests or physical signs, such as excess facial and body hair, severe acne, and baldness.
• presence of numerous small fluid-filled cysts in the ovaries which can be seen as dark circles on an ultrasound image. This is the symptom that originally gave the condition its name but is NOT always present in PCOS patients.

PCOS is highly heritable, but the inheritance pattern is complex, with multiple genetic factors implicated in the susceptibility to the disease. While the exact cause of PCOS is unknown, disturbances in a number of hormones are thought to be responsible. PCOS patients usually have EXCESS luteinizing hormone, LH, together with a relatively LOW level of follicle-stimulating hormone, FSH, and increased levels of insulin.

An ovary contains hundreds of thousands of IMMATURE eggs, each of these is enclosed in a structure called a follicle. Each month, a number of these follicles develop, compete with each other; and one of them survives and gives rise to a MATURE egg that is released during ovulation. Follicle development is mediated by FSH, a pituitary hormone. In PCOS patients, FSH deficiency results in ARREST of follicular maturation: the follicles stop halfway through their development and become cysts. IMPAIRED follicular development means NO mature egg produced or released, hence the ABSENCE of ovulation.

Insulin is a hormone produced by the pancreas and is necessary for consumption of blood glucose by the body’s cells. INcreased insulin level in PCOS patients is a result of the body compensatory response to insulin RESISTANCE associated with PCOS. Excess insulin, together with high levels of luteinizing hormone, induce and maintain OVERproduction of androgen by the ovaries.

Common complications of PCOS include: infertility, miscarriage or premature birth, type 2 diabetes, obesity, cardiovascular diseases, mood disorders, and endometrial cancer.

While the choice of treatment may depend on the patient’s individual concerns, treating insulin resistance is generally recommended for all women with PCOS. Life style changes such as exercise, dieting and weight loss, and medications such as metformin, can LOWER both insulin and androgen levels, thus reducing the risks of type 2 diabetes, and improving ovulation. Patients who want to get pregnant may also be prescribed anti-estrogen medications such as clomiphene.  On the other hand, when fertility is not the goal of treatment, hormonal birth control, a combination of estrogen and progestin, is usually prescribed to regulate the menstrual cycle and reduce risks of endometrial cancer. This treatment may also help improve acne and reduce extra body hair.