Polycystic ovary syndrome (PCOS), previously known as Stein-Leventhal syndrome, is a disorder in which numerous benign cysts form on the ovaries under a thick, white covering. It is most common in women under 30 years old and many ovarian cysts disappear without treatment.
The ovaries are the female reproductive organs that contain and release eggs. They also produce the female hormones estrogen and progesterone. Ovarian cysts are fluid-filled sacs that result from ovulation cycles; the most common are just enlargements of the normal egg follicles.
Between 5 and 30% of women have some characteristic of PCOS. This is one of the most common hormonal abnormalities in women of reproductive age and is a leading cause of infertility. Often in PCOS patients, periods start at the usual age of 12-13, while some start menstruating earlier. Interestingly, there appear to be variations of PCOS clinical manifestations among races. For example, obesity and hirsutism are not prominent among Japanese people, whereas they are much more common among Caucasians.
Polycystic ovary disease is due to an abnormal production of two of the hormones produced by the pituitary gland in the brain. These two hormones are LH (luteinizing hormone) and FSH (follicle-stimulating hormone). Imbalance of these hormones prevents the ovaries from releasing an egg each month. It also results in an increased production of the male hormone testosterone by the ovaries.
Because it is a syndrome, PCOS includes a set of symptoms. Women with PCOS can suffer from any combinations of the usual symptoms. Some women experience only one of these symptoms, while other women experience all of them. The severity of PCOS symptoms can vary widely from woman to woman.
The method of treatment depends upon the severity of the symptoms and whether you are trying to get pregnant. If you are not trying to conceive, you can be treated with hormones, including the birth control pill. Hormones and birth control pills will give regular menstrual cycles and may reduce abnormal hair growth. They also reduce the risk of developing endometrial hyperplasia, a condition that can become uterine cancer. If you are trying to become pregnant, your health care provider may prescribe fertility drugs, but it can be a long and complicated treatment.
In rare cases a wedge of ovarian tissue may be surgically removed or destroyed. This usually results in regular menstrual cycles for a while. For excess body and facial hair, your health care provider may recommend electrolysis.
It is desirable to have a period at least at intervals, though not necessarily monthly. Hormonal treatment, including the use of natural progesterone, can achieve this where required. The natural approach to PCOS should involve using all of the appropriate therapies at the same time and may require several months before improvement is seen.
The conventional treatment of PCOS is directed primarily at the problems of hirsutism, menstrual irregularity and infertility. Treatment modalities for hirsutism include ovarian and adrenal suppression, anti-androgen therapy and local hair removal measures. Oral contraceptives are simple and relatively safe method of ovarian suppression, in addition the estrogen component increases the sex hormone binding globulin (SHBG) with a resultant decrease in free testosterone. When DHEA-S levels are elevated, the addition of dexamethasone may be helpful. Spironolactone is the preferred anti-androgenic compound. It competitively inhibits intracellular dihydrotestosterone receptors within the hair follicles. Both cimetidine and cyproheptadine (a serotonin and histamine antagonist) have weak anti-androgenic effects.
Women with the PCOS have a five to seven times higher risk of myocardial infarction and ischemic heart disease than other women. Surprisingly, the increased risk was found to be independent of obesity, supporting the argument that insulin resistance alone is important in determining cardiovascular risk. [Fertil Steril 2000;73(1): pp.150-6, J Clin Endocrinol Metab 1999;84(6): pp.1897-99]
It has been a tradition to divide patients with hirsutism into those with no elevation of serum androgen levels and no other clinical features ('idiopathic hirsutism') and those with an identifiable endocrine imbalance (most commonly PCOS or rarely other causes). However, in recent years it has become apparent that most patients with 'idiopathic hirsutism' have some radiological or biochemical evidence of PCOS on more detailed investigation.
Some research suggests that girls who begin to develop pubic hair early (usually before the age of eight, a condition known as premature pubarche) have been found to have many of the signs and symptoms of PCOS. When girls with premature pubarche have been followed throughout the rest of puberty they have been found to develop excess testosterone production and irregular periods consistent with PCOS. Thus premature pubarche may be an early form of PCOS.
A majority of patients with PCOS have insulin resistance and/or are obese. There is a lot of evidence that high levels of insulin contribute to increased androgen production, which worsens the symptoms of PCOS.
Researchers found that 75% of women studied with PCOS were hyperinsulinemic. [Fertil Steril 2000;73(1): pp.150-6, J Clin Endocrinol Metab 1999;84(6): pp.1897-9]
Impaired fertility is a prominent feature of PCOS. This is believed to result from elevated insulin levels that stimulate excess androgen production by the ovaries. The androgens cause premature follicular wasting which causes inconsistent or absent ovulation, which in turn is associated with infertility.
Among women with resistant acne (acne not responding to conventional treatments), PCOS is very common.
A high sugar diet causes obesity with further insulin resistance and aggravation of PCOS. According to Jerilyn Prior, M.D., the increased insulin from sugar consumption stimulates androgen receptors on the outside of the ovary, causing a failure of ovulation and the typical PCOS symptoms of hirsutism and acne.
Weight reduction can not only reverse testosterone and luteinizing hormone abnormalities and infertility seen with PCOS, but also improve glucose, insulin and lipid profiles. Obesity is an important feature with regard to hirsutism because it is associated with decreased sex hormone binding globulin (SHBG). This results in increased levels of unbound testosterone and contributes to the acne and hair growth seen in PCOS.
Many women with PCOS have had success using progesterone cream to help produce regular periods.
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