Polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS, also called polycystic ovarian disease (PCOD), Stein-Leventhal Syndrome, sclerocystic ovaries, or syndrome of hyperandrogenic chronic anovulation), is an endocrine disorder[?] that affects women causing dysfunction in many body systems.

The syndrome acquired its name because a common symptom is ovarian cysts. These form where eggs were only partially matured and never released from the ovary. These generally take on a 'string of pearls' appearance.

Not all women with PCOS have ovarian cysts, and not all women with ovarian cysts have PCOS however, so although a pelvic ultrasound is a major diagnostic tool it is not the only one. The diagnosis is actually quite tricky and a number of other conditions have been incuded under the PCOS heading, including endocrine syndrome X, idiopathic hirsutism[?] and non-traditional PCOS. There are several blood tests that should be done to diagnose PCOS.

• Fasting comprehensive biochemical and lipid panel
• 2-hour GTT with insulin levels (also called IGTT)
• LH:FSH ratio
• Total testosterone
• DHEAS
• SHBG
• Androstenedione[?]
• Prolactin
• TSH

Common symptoms of PCOS include -

• multiple small cysts on the ovaries
• Enlarged ovaries
• Chronic pelvic pain
• oligomenorrhea[?], amenorrhea or metrorrhagia[?]- irregular, absent, scanty or unusually heavy menstrual periods
• insulin resistance and hypoglycaemia progressing to type II diabetes if untreated
• high blood pressure
• Dyslipidemia (lipid abnormalities)elevated cholesterol levels
• chronic anovulation causing infertility
• elevated testosterone levels causing hirsuitism, and occasionally masculinisation[?].
• central obesity - 'apple-shaped' obesity centered around the lower half of the torso
• Endometrial hyperplasia[?] and endometrial cancer are possible, due to the lack of menses resulting in an accumulation of uterine lining.
• LH (luteinizing hormone) is often greater than FSH (Folicular Stimulating Hormone[?]) (LH/FSH > 3 in most PCOS cases)
• Alopecia (male pattern baldness)
• Acne/Oily Skin/Seborrhea
• Acanthosis nigricans (dark patches of skin, tan to dark brown/black)
• Acrochordons (skin tags) tiny flaps of skin.

Beyond the symptoms listed above, PCOS is associated with increased risk for endometrial hyperplasia, endometrial cancer, insulin resistance, type11 diabetes, high blood pressure, high cholesterol, and heart disease. PCOS also causes women to have a risk of miscarriage approximately five times higher than other women. It also makes pregnancy difficult to achieve because of the irregular cycles and lack of ovulation. However some women with PCOS have no difficulty in conceiving, and others are able to have normal pregnancies with the aid of medication and diet.

Medical treatment of PCOS used to be mostly directed at the symptoms (ovarian and adrenal suppression, and anti-androgen therapy) and restoring ovulation. Oral contraceptives are used for ovarian suppression. Spironolactone[?] for anti-androgenic activity. Ovulation is induced with clomiphene citrate with human chorionic gonadotropin or dexamethasone. In patients who do not respond to other therapies the polycystic ovaries can be treated with laparoscopy electrocauterization or laser cauterization. Ovarian wedge resection, and more recently ovarian drilling is sometimes performed.

However, recent research suggests that the insulin resistance and over-release of insulin may be the at the root of PCOS, thus many women find insulin-sensitising medications such as glucophage[?], actos[?], and avandia[?] helpful to them. Low-carbohydrate diets and sustained regular exercise are also beneficial.

The condition was first described in 1905 by Stein and Leventhal, hence its original name of Stein-Leventhal Syndrome.

FURTHER INFORMATION

• http://www.soulcysters.com/
• a comprehensive PCOS FAQ - http://www.inciid.org/faq/pcos