Polycystic Ovarian Syndrome (PCOS, PCOD) Symptoms, Causes & Treatment

9/11/2018 Polycystic Ovarian Syndrome (PCOS, PCOD) Symptoms, Causes & Treatment
Polycystic Ovarian Syndrome

(PCOS)
Medical Author:
Melissa Conrad Stöppler, MD, Chief Medical Editor
Medical Editor: Mary Nettleman, MD, MS, MACP
What Is Polycystic Ovarian Syndrome (PCOS, PCOD)?
Polycystic ovarian syndrome (PCOS, polycystic ovary syndrome) is a relatively common hormonal
disorder that causes a number of di erent symptoms in women of reproductive age. Common to all
women with PCOS is an irregularity in the menstrual cycle and the presence of excess male hormones
(androgens). The condition was named because of the nding of enlarged ovaries containing multiple
small cysts (polycystic ovaries). Although most women with PCOS have polycystic ovaries, some a ected
women do not. PCOS has also been referred to as Stein-Leventhal syndrome and polycystic ovarian
disease (PCOD).
https://www.emedicinehealth.com/polycystic_ovarian_syndrome_pcos/article_em.htm#what_is_polycystic_ovarian_syndrome_pcos_pcod 1/7
Picture of Polycystic Ovarian Syndrome (PCOS)
What Causes Polycystic Ovary Syndrome (PCOS)?
The exact cause of polycystic ovarian syndrome is not clear, although a number of abnormalities have
been documented in women with PCOS. There is some evidence for an inherited (genetic) cause for
PCOS, although no speci c genetic mutation has been identi ed as the cause. It has been shown that the
ovaries of women with PCOS may produce excessive amounts of male hormones, or androgens, which
lead to disruptions in the menstrual cycle and impaired fertility.
PCOS is also associated with insulin resistance, or an impaired ability to utilize insulin, and this
abnormality is also likely related to the cause of PCOS.
The presence of small cysts in the ovaries is not speci c for PCOS, since women who do not have PCOS
may have ovarian cysts. Therefore the presence of cysts is not likely to be the cause of the symptoms of
PCOS.
What Are the Symptoms of PCOS?
PCOS leads to disruptions in the menstrual cycle that typically begin around the onset of puberty.
Menstrual cycles may be normal at rst and then become irregular, or the onset of menses may be
delayed. The menstrual irregularities of PCOS are accompanied by a lack of ovulation, so a ected
women may experience infertility. The desire for pregnancy is a factor that prompts many women with
PCOS to rst seek medical attention.
An increase in the production of androgens (male hormones) by the ovaries in PCOS may lead to excess
hair growth in areas suggesting a male pattern, known as hirsutism. Thick, pigmented hair growth occurs
on the upper lip, chin, around the nipples, and on the lower abdomen. Excess androgens can also lead to
acne and male pattern balding.
Because of the absence or reduction in ovulation, women with PCOS have reduced levels of the
hormone progesterone (normally produced after ovulation in the second half of the menstrual cycle).
This can result in growth stimulation of the endometrium (lining tissues of the uterus), leading to
dysfunctional uterine bleeding and breakthrough bleeding. Increased stimulation of the endometrium in
the absence of progesterone production is a risk factor for the development of endometrial hyperplasia
and uterine cancer.
Insulin resistance, weight gain, and obesity are also common in PCOS. Observers have suggested that
about one-half of women with PCOS are obese. Insulin resistance, accompanied by elevated blood
levels of insulin, occurs in most women with PCOS, independent of the presence of obesity.
Women with PCOS have also been reported to have an increased risk of developing type 2 diabetes, and
many studies have shown abnormal blood lipid levels and elevated levels of C-reactive protein (CRP), a
predictor of coronary artery disease. The combination of type 2 diabetes, elevated cholesterol and LDL
levels, and elevated CRP levels suggest an increased risk of coronary heart disease on women with
PCOS, although this risk has not yet been scienti cally established.
When to Seek Medical Care for PCOS
It is appropriate to seek the advice of your health care practitioner if you have irregular or absent
menstrual periods, abnormal or excessive hair growth, di culty in getting pregnant, or any of the other
troubling symptoms of PCOS.
Exams and Tests for PCOS
While the diagnosis of PCOS may be suggested by the characteristic symptoms, a number of laboratory
tests can help establish the diagnosis and rule out other conditions that may be responsible for your
symptoms.
Blood tests may be performed to evaluate levels of male hormones, such as DHEA and testosterone, as
well as gonadotropins (hormones made in the brain that control production of hormones in the ovaries).
Levels of hormones produced by the thyroid and adrenal glands may also be evaluated in order to
exclude other causes of the symptoms.
Although the nding of cysts (small, uid- lled sacs) in the ovaries is not conclusive for PCOS, many
a ected women will have polycystic ovaries. It is important to note that the presence of cysts in the
ovaries is a common nding in women without PCOS as well. Imaging studies such as ultrasound can be
safely used to demonstrate the presence of cysts in the ovaries. Ultrasound uses sound waves to
generate an image of the ovaries; the procedure involves no radiation exposure or injected dyes and
carries no risks for the patient. In some cases, particularly when other conditions such as ovarian or
adrenal gland tumors are suspected, CT and MRI scans may be ordered.
What Are the PCOS Treatments?
There are a number of treatments that have been shown to be e ective in the treatment of PCOS.
Treatment is dependent upon the stage of the woman's life and may be directed toward establishing
regular menstrual cycles, controlling abnormal uterine bleeding, controlling excess hair growth,
management of associated conditions such as insulin resistance, or promoting the chances of pregnancy
when desired.
A number of medical conditions may be associated with PCOS, and treatment may be required that is
directed at these co-existent conditions. Associated conditions that may require speci c medical
treatments include:
type 2 diabetes,
insulin resistance,
elevated blood pressure (hypertension),
heart disease,
obesity, and
elevated blood cholesterol and LDL ("bad" cholesterol) levels.
What Are the Home Remedies for PCOS?
As with any chronic condition, maintenance of a healthy lifestyle can help maximize quality of life and
minimize symptoms. Proper nutrition and regular exercise can help manage the weight gain and
elevated blood pressure that may accompany PCOS. Weight loss has also been shown in many studies
to reduce some of the e ects of excess testosterone in women with PCOS.
Medical Treatment for PCOS
Medications are the mainstay of treatment for both the menstrual and hormonal symptoms of PCOS as
well as associated medical conditions.
What Are the Medications for PCOS?
Oral contraceptive pills (OCPs, birth control pills) are used in some women with PCOS to establish a
regular menstrual cycle and to reduce the risk of endometrial hyperplasia and cancer by establishing
regular menstrual periods. Another treatment option to reduce the risk of endometrial hyperplasia and
cancer is intermittent progestin therapy, for example, medroxyprogesterone acetate (Provera) given for 7
to 10 days every one to two months.
Spironolactone (Aldactone) is a diuretic (water pill) that can successfully reverse e ects of excess
androgen production such as acne and unwanted hair growth. Another medication that can block the
e ect of androgens on hair growth is nasteride (Propecia), a medicine that is taken by men to treat hair
loss. Since both of these medications can a ect the development of a male fetus, they should not be
used if pregnancy is desired. E ornithine (Vaniqa) is a medication that has been approved for reducing
the growth of facial hair.
A medication called clomiphene (Clomid) can be used to induce ovulation (cause egg production) in
women who desire to become pregnant. If this treatment is not successful, women with PCOS and
infertility may require other, more aggressive, treatments for infertility such as injection of gonadotropin
hormones and assisted reproductive technologies.
Metformin (Glucophage) is a medication used to treat type 2 diabetes. This drug a ects the action of
insulin and is sometimes used to treat women with PCOS.
What Is the Surgery Option for PCOS?
Laparoscopic surgery to perform wedge resection of the ovaries was formerly carried out as a measure
to induce ovulation and treat infertility in women with PCOS. This is rarely performed today because of
the e ectiveness of Clomid and other methods to treat infertility as well as the fact that adhesions (scar
tissue) may remain after ovarian wedge resection. A laparoscopic procedure known as ovarian drilling of
the ovaries, in which portions of the ovary are destroyed, has also been used to reduce androgen levels
and treat PCOS in some women.
Follow-up for PCOS
It is important for women with PCOS to routinely follow-up with their health care practitioner according to
his or her recommendations, both for the management of the hormonal e ects of PCOS as well as the
treatment of associated conditions.
How to Prvent PCOS
Since the cause of PCOS is poorly understood, it is not possible to prevent PCOS. However, maintenance
of a healthy weight and lifestyle are important in preventing and controlling many of the conditions that
may be associated with PCOS.
What Is the Prognosis for PCOS?
Hormonal therapies to induce a regular menstrual cycle and to help prevent the risk of endometrial
cancer are usually successful, as are medications that reduce androgen actions.
The prognosis is variable among women with PCOS who undergo fertility treatments.
In women who are overweight or obese, ovulation can sometimes be achieved by moderate weight loss
alone. Others may need medications or assisted reproductive technologies to try to conceive. Although
the outlook for infertility treatments varies according to the woman's age and other medical conditions,
studies show in general that about 80% of women with PCOS ovulate in response to oral clomiphene
citrate (Clomid), and approximately 50% get pregnant. Assisted reproductive technologies can be
successful for some women who do not conceive.
Reviewed on 11/20/2017 Sources:
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9/11/2018 Polycystic Ovarian Syndrome (PCOS, PCOD) Symptoms, Causes & Treatment