This action might not be possible to undo. Are you sure you want to continue?
Polycystic Ovary Syndrome.
Classification and external resources
A polycystic ovary (aka PCO) shown on an ultrasound image. PCO no longer defines PCOS but is a common symptom. As many as 30% or more of women with PCOS do not have PCO as a sign. ICD-10 E28.2 ICD-9 256.4 OMIM 184700 eMedicine med/2173 ped/2155 radio/565 MeSH D011085 Polycystic ovary syndrome (PCOS) is one of the most common female endocrine disorders. PCOS is a complex, heterogeneous disorder of uncertain aetiology, but there is strong evidence that it can to a large degree be classified as a genetic disease. PCOS produces symptoms in approximately 5% to 10% of women of reproductive age (12–45 years old). It is thought to be one of the leading causes of female subfertility and the most frequent endocrine problem in women of reproductive age. The principal features are anovulation, resulting in irregular menstruation, amenorrhea, ovulation-related infertility, and polycystic ovaries; excessive amounts or effects of androgenic (masculinizing) hormones, resulting in acne and hirsutism; and insulin resistance, often associated with obesity, Type 2 diabetes, and high cholesterol levels. The symptoms and severity of the syndrome vary greatly among affected women.
and enlarged polycystic ovaries. it is now used.3 Differential diagnosis 5 Cause 6 Pathogenesis 7 Management o 7.1 Diet o 7. looking like many small cysts or a string of pearls. and SteinLeventhal syndrome.Contents [hide] • • • • • • • • • • • • • 1 Names 2 Definition 3 Signs and symptoms 4 Diagnosis o 4.2 Common assessments for associated conditions or risks o 4.2 Medications o 7.4 Hirsutism and acne o 7.6 Alternative approaches 8 Prognosis 9 Epidemiology 10 History 11 See also 12 References 13 External links Names Other names for this syndrome include polycystic ovary disease. called a polycystic ovary.5 Menstrual irregularity and endometrial hyperplasia o 7. A polycystic ovary has an abnormally large number of developing eggs visible near its surface. hirsutism. if at all. Definition Two definitions are commonly used: . functional ovarian hyperandrogenism. The eponymous last option is the original name.3 Infertility o 7. ovarian hyperthecosis.1 Standard diagnostic assessments o 4. only for the subset of patients with all the symptoms of amenorrhea with infertility. sclerocystic ovary syndrome. Most common names for this disease derive from a typical finding on medical images.
other entities are excluded that would cause excess androgen activity Signs and symptoms Common symptoms of PCOS include: • • • Menstrual disorders: PCOS mostly produces oligomenorrhea (few menstrual periods) or amenorrhea (no menstrual periods). oligoovulation 2. excess androgen activity 2. . Androgen Excess PCOS Society In 2006 the Androgen Excess PCOS Society suggested a tightening of the diagnostic criteria to all of: 1. including many more patients. signs of androgen excess (clinical or biochemical) 3. Critics say that findings obtained from the study of patients with androgen excess cannot necessarily be extrapolated to patients without androgen excess. The Rotterdam definition is wider. High levels of masculinizing hormones: The most common signs are acne and hirsutism (male pattern of hair growth). most notably patients without androgen excess. Infertility: This generally results directly from chronic anovulation (lack of ovulation).NIH In 1990 a consensus workshop sponsored by the NIH/NICHD suggested that a patient has PCOS if she has all of the following: 1. but other types of menstrual disorders may also occur. other entities are excluded that would cause polycystic ovaries Rotterdam In 2003 a consensus workshop sponsored by ESHRE/ASRM in Rotterdam indicated PCOS to be present if any 2 out of 3 criteria are met 1. but it may produce hypermenorrhea (very frequent menstrual periods) or other symptoms. oligoovulation/anovulation and/or polycystic ovaries 3. polycystic ovaries (by gynecologic ultrasound) Other entities are excluded that would cause these. Approximately three-quarters of patients with PCOS (by the diagnostic criteria of NIH/NICHD 1990) have evidence of hyperandrogenemia. oligoovulation and/or anovulation 2. excess androgen activity 3.
including androstenedione and testosterone may be elevated. In PCOS. . 1.7%–88. In a normal menstrual cycle. giving the appearance of a 'string of pearls'. and the absence of breast development. The diagnosis is straightforward using the Rotterdam criteria. A clinical prediction rule found that these four questions can diagnose PCOS with a sensitivity of 77. Laparoscopic examination may reveal a thickened.• Metabolic syndrome: This appears as a tendency towards central obesity and other symptoms associated with insulin resistance. Diagnosis Not all women with PCOS have polycystic ovaries (PCO). one egg is released from a dominant follicle . but is a poor parameter for this and is no better than testosterone alone as a marker for PCOS. that is. specifically for menstrual pattern. 12 or more small follicles should be seen in an ovary on ultrasound examination. smooth. hirsutism.essentially a cyst that bursts to release the egg. The follicles may be oriented in the periphery.e. These are believed to be the result of disturbed ovarian function with failed ovulation. Standard diagnostic assessments • History-taking.7%). insulin resistance and homocysteine levels are higher in women with PCOS. even when the syndrome is associated with a wide range of symptoms.  • • • Gynecologic ultrasonography. reflected by the infrequent or absent menstruation that is typical of the condition. as it would not be routine to examine the ovaries in this way to confirm a diagnosis of PCOS. several follicles develop to a size of 5–7 mm.1% (95% confidence interval [CI] 62. it is not the only one. obesity. but not further. which shrinks and disappears after approximately 12–14 days. The numerous follicles contribute to the increased size of the ovaries. (This would usually be an incidental finding if laparoscopy were performed for some other reason. The Free androgen index of the ratio of testosterone to sex hormone-binding globulin (SHBG) is high and is meant to be a predictor of free testosterone.. specifically looking for small ovarian follicles. pearl-white outer surface of the ovary.0%) and a specificity of 93. According to the Rotterdam criteria.) Serum (blood) levels of androgens (male hormones). i. No single follicle reaches the preovulatory size (16 mm or more). possibly because FAI is correlated with the degree of obesity.8% (95% CI 82.8%–98. Serum insulin. After ovulation the follicle remnant is transformed into a progesterone-producing corpus luteum. Dehydroepiandrosterone sulfate levels above 700-800mcg/dL are highly suggestive of adrenal dysfunction because DHEA-S is made exclusively by the adrenal glands. although a pelvic ultrasound is a major diagnostic tool. The free testosterone level is thought to be the best measure. nor do all women with ovarian cysts have PCOS.5 to 3 times larger than normal. there is a so called "follicular arrest". with ~60% of PCOS patients demonstrating supranormal levels.
5). hyperprolactinemia. Elevated blood sugar and insulin values do not predict who responds to an insulin-lowering medication. Fasting insulin level or GTT with insulin levels (also called IGTT). Frank diabetes can be seen in 65–68% of women with this condition. androgen secreting neoplasms. calculated from the fasting values in glucose and insulin concentrations. as tested on Day 3 of the menstrual cycle. Common assessments for associated conditions or risks • • • • Fasting biochemical screen and lipid profile 2-hour oral glucose tolerance test (GTT) in patients with risk factors (obesity.5% in the general population) actually had impaired glucose tolerance. oral glucose tests revealed that up to 38% of asymptomatic women with PCOS (versus 8. 50-80% of PCOS patients may have insulin resistance at some level. and exercise. 7. Many women with normal levels may benefit from combination therapy. although it is more common in the latter (and in those matching the stricter NIH criteria for diagnosis). particularly among obese or overweight women. Cause .• Some other blood tests are suggestive but not diagnostic. lowglycemic diet.5% of those with frank diabetes according to ADA guidelines. Cushing's syndrome. PCOS has been reported in other insulin-resistant situations such as acromegaly. family history. There are often low levels of sex hormone binding globulin. While fasting glucose levels may remain within normal limits. history of gestational diabetes) may indicate impaired glucose tolerance (insulin resistance) in 15-33% of women with PCOS. The ratio of LH (Luteinizing hormone) to FSH (Follicle stimulating hormone) is greater than 1:1 (sometimes more than 3:1). The pattern is not very specific and was present in less than 50% in one study. A hypoglycemic response in which the two-hour insulin level is higher and the blood sugar lower than fasting is consistent with insulin resistance. Elevated insulin levels have been helpful to predict response to medication and may indicate women who will need higher dosages of metformin or the use of a second medication to significantly lower insulin levels. Differential diagnosis Other causes of irregular or absent menstruation and hirsutism. such as hypothyroidism. Insulin resistance can be observed in both normal weight and overweight patients. should be investigated. Glucose tolerance testing (GTT) instead of fasting glucose can increase diagnosis of increased glucose tolerance and frank diabetes among patients with PCOS according to a prospective controlled trial. allows a direct and moderately accurate measure of insulin sensitivity (glucose-level x insulinlevel/22. congenital adrenal hyperplasia (21-hydroxylase deficiency). A mathematical derivation known as the HOMAI. and other pituitary or adrenal disorders.
 The syndrome acquired its most widely used name due to the common sign on ultrasound examination of multiple (poly) ovarian cysts. but the development has stopped ("arrested") at an early antral stage due to the disturbed ovarian function. and if a daughter receives the variant(s). These "cysts" are actually immature follicles. The allele appears to manifest itself at least partially via heightened androgen levels secreted by ovarian follicle theca cells from women with the allele. greater concordance in monozygotic compared with dizygotic twins and heritability of endocrine and metabolic features of PCOS. Such evidence includes the familial clustering of cases. The follicles have developed from primordial follicles. The follicles may be oriented along the ovarian periphery.  The genetic variant(s) can be inherited from either the father or the mother. all these steps contribute to the development . decreased follicular maturation. and decreased SHBG binding. by either one or a combination of the following (almost certainly combined with genetic susceptibility): • • the release of excessive luteinizing hormone (LH) by the anterior pituitary gland through high levels of insulin in the blood (hyperinsulinaemia) in women whose ovaries are sensitive to this stimulus Alternatively or as well. LH over FSH dominance. this means that each child has a 50% chance of inheriting the predisposing genetic variant(s) from a parent. then the daughter will have the disease to some extent. There is strong evidence that it is a genetic disease. not cysts ("polyfollicular ovary syndrome" would have been a more accurate name). particularly testosterone. Hyperinsulinemia increases GnRH pulse frequency. appearing as a 'string of pearls' on ultrasound examination. The exact gene affected has not yet been identified. The clinical severity of PCOS symptoms appears to be largely determined by factors such as obesity. who will show signs of PCOS. Pathogenesis Polycystic ovaries develop when the ovaries are stimulated to produce excessive amounts of male hormones (androgens). reduced levels of sex-hormone binding globulin can result in increased free androgens. A majority of patients with PCOS have insulin resistance and/or are obese. Their elevated insulin levels contribute to or cause the abnormalities seen in the hypothalamic-pituitaryovarian axis that lead to PCOS. heterogeneous disorder of uncertain aetiology. and can be passed along to both sons (who may be asymptomatic carriers or may have symptoms such as early baldness and/or excessive hair) and daughters. increased ovarian androgen production.PCOS is a complex. The genetic component appears to be inherited in an autosomal dominant fashion with high genetic penetrance but variable expressivity in females.
Broadly. Diet . but recent data concludes this mechanism to be unlikely. an enzyme that converts androstenedione to estrone and testosterone to estradiol. in turn increasing the level of free IGF-I which stimulates ovarian androgen production. Insulin resistance is a common finding among patients of normal weight as well as overweight patients. because they address what is believed to be the underlying cause. The research suggests that women who have heterozygous-normal/low FMR1 have polycystic-like symptoms of excessive follicle-activity and hyperactive ovarian function. Management Medical treatment of PCOS is tailored to the patient's goals. In many cases PCOS is characterised by a complex positive feedback loop of insulin resistance and hyperandrogenism. there is considerable debate as to the optimal treatment. General interventions that help to reduce weight or insulin resistance can be beneficial for all these aims. It has previously been suggested that the excessive androgen production in PCOS could be caused by a decreased serum level of IGFBP-1. PCOS may be associated with chronic inflammation. One of the major reasons for this is the lack of large scale clinical trials comparing different treatments. these may be considered under four categories: • • • • Lowering of insulin levels Restoration of fertility Treatment of hirsutism or acne Restoration of regular menstruation. In most cases it can not be determined which (if any) of those two should be regarded causative. The excess of adipose tissue in obese patients creates the paradox of having both excess androgens (which are responsible for hirsutism and virilization) and estrogens (which inhibits FSH via negative feedback). PCOS has also been associated with a specific FMR1 sub-genotype. Experimental treatment with either antiandrogens or insulin sensitizing agents improves both hyperandrogenism and insulin resistance. with several investigators correlating inflammatory mediators with anovulation and other PCOS symptoms. and prevention of endometrial hyperplasia and endometrial cancer In each of these areas. Adipose tissue possesses aromatase. Smaller trials tend to be less reliable and hence may produce conflicting results.of PCOS.
Low-carbohydrate diets and sustained regular exercise may help. Other factors include changed levels of gonadotropins. For those who after weight loss still are anovulatory or for anovulatory lean women. have been an obvious approach and initial studies seemed to show effectiveness. so treatment of any such deficiency is indicated. then the ovulation-inducing medications clomiphene citrate and FSH are the principal treatments used to promote ovulation. but many women find it very difficult to achieve and sustain significant weight loss. diet and lifestyle modification. For those who do. Some experts recommend a low GI diet in which a significant part of total carbohydrates are obtained from fruit. such as tubal blockages due to a history of sexually transmitted diseases. women with PCOS who are ovulating may be infertile due to other causes. Like women without PCOS. the anti-diabetes medication metformin was recommended treatment for anovulation. Infertility Main article: Infertility in polycystic ovary syndrome Not all women with PCOS have difficulty becoming pregnant. anovulation or infrequent ovulation is a common cause. For patients who do not respond to clomiphene. For overweight. the polycystic ovaries can be treated with a laparoscopic procedure called "ovarian drilling" (puncture of 4-10 small follicles with .Where PCOS is associated with overweight or obesity. However subsequent reviews in 2008 and 2009 have noted that randomised control trials have in general not shown the promise suggested by the early observational studies. hyperandrogenemia and hyperinsulinemia. Although metformin is not licensed for use in PCOS. and the newer thiazolidinedione (glitazones). Vitamin D deficiency may play some role in the development of the metabolic syndrome. but it appears less effective than clomiphene. are associated with resumption of natural ovulation. Medications Reducing insulin resistance by improving insulin sensitivity through medications such as metformin. successful weight loss is the most effective method of restoring normal ovulation/menstruation. Previously. there are options available including assisted reproductive technology procedures such as controlled ovarian hyperstimulation with follicle-stimulating hormone (FSH) injections followed by in vitro fertilisation (IVF). Though surgery is not commonly performed. especially to reduce the intake of simple carbohydrates. weight loss and diet adjustments. the United Kingdom's National Institute for Health and Clinical Excellence recommended in 2004 that women with PCOS and a body mass index above 25 be given metformin when other therapy has failed to produce results. anovulatory women with PCOS. vegetables and whole grain sources.
and . which often results in either resumption of spontaneous ovulations or ovulations after adjuvant treatment with clomiphene or FSH. When appropriate (e. and is often used if there are other features such as insulin resistance. the reduction in hair growth may not be enough to eliminate the social embarrassment of hirsutism. in the UK the available brands are Dianette/Diane. diabetes or obesity that should also benefit from metformin.) There are. Individuals vary in their response to different therapies.  (Ovarian wedge resection is no longer used as much due to complications such as adhesions and the presence of frequently-effective medications. For removal of facial hairs. a standard contraceptive pill is frequently effective in reducing hirsutism. Cyproterone acetate is a progestogen with antiandrogen effects that block the action of male hormones that are believed to contribute to acne and the growth of unwanted facial and body hair.g. Metformin can reduce hirsutism. concerns about the long-term effects of ovarian drilling on ovarian function. The purpose of regulating menstruation is essentially for the woman's convenience. and acts directly on the hair follicles to inhibit hair growth. electrolysis or laser treatments are . or the inconvenience of plucking or shaving. It is usually worth trying other drug treatments if one does not work. perhaps by reducing insulin resistance. progestogens such as norgestrel and levonorgestrel should be avoided due to their androgenic effects.electrocautery. then menstruation can usually be regulated with a contraceptive pill.  5-alpha reductase inhibitors (such as finasteride and dutasteride) may also be  used. though the effects are caused by substituted hormones that can easily cause more problems if the pill is taken for a long period of time. or biopsy needles). Although these agents have shown significant efficacy in clinical trials (for oral contraceptives. in women of child-bearing age who require contraception). laser. they work by blocking the conversion of testosterone to dihydrotestosterone (the latter of which is responsible for most hair growth alterations and androgenic acne).at least for some . A common choice of contraceptive pill is one that contains cyproterone acetate. On the other hand. in 60-100% of individuals). Eflornithine (Vaniqa) is a drug which is applied to the skin in cream form. Spironolactone is probably the mostcommonly used drug in the US.faster and more efficient alternatives than the above mentioned medical therapies. Hirsutism and acne For more details on this topic. see Hirsutism. however. It is usually applied to the face. Other drugs with anti-androgen effects include flutamide and spironolactone. Menstrual irregularity and endometrial hyperplasia If fertility is not the primary aim. which can give some improvement in hirsutism. but drug treatments do not work well for all individuals. Medications that reduce acne by indirect hormonal effects also include ergot dopamine agonists such as bromocriptine.
particularly if obese. PCOS patients show decreased removal of atherosclerosis-inducing remnants.D-chiro-inositol and myo-inositol have shown considerable promise in improving PCOS. Some women prefer a uterine progestogen device such as the intrauterine system (Mirena) or the progestin implant (Implanon). They are generally very well tolerated and have been evaluated by several small-scale trials. Prognosis Women with PCOS are at risk for the following: • • • • • • • • Endometrial hyperplasia and endometrial cancer (cancer of the uterine lining) are possible. High blood pressure.perhaps her sense of well-being. then the endometrium (womb lining) is being shed sufficiently often to prevent an increased risk of endometrial abnormalities or cancer.most experts consider that if a menstrual bleed occurs at least every three months. An alternative is oral progestogen taken at intervals (e. A review published in 2010 concluded that women with PCOS had an elevated prevalence of insulin resistance and type II diabetes. due to overaccumulation of uterine lining. DCI is regulated as a dietary supplement in the United States. there is no medical requirement for regular periods. If menstruation occurs less often or not at all. some form of progestogen replacement is recommended. Cardiovascular disease. hyperinsulinemia.g. Inositol has no documented side-effects and is a naturally occurring human metabolite known to be involved in insulin metabolism. Alternative approaches At least two inositol isomers .disorders of lipid metabolism — cholesterol and triglycerides. which provides simultaneous contraception and endometrial protection for years. If a regular menstrual cycle is not desired. even when controlling for body mass index (BMI). prone to gestational diabetes. Insulin resistance/Type II diabetes. particularly if obese and/or during pregnancy Depression/Depression with Anxiety Dyslipidemia . then therapy for an irregular cycle is not necessarily required . Myo-inositol is naturally present in many foods although not readily digestible from most of them. It is not clear if this risk is directly due to the syndrome or from the associated obesity. seemingly independent of insulin resistance/Type II diabetes. and also lack of progesterone resulting in prolonged stimulation of uterine cells by estrogen. so long as they occur sufficiently often (see below). every three months) to induce a predictable menstrual bleeding. Strokes Weight gain . with a meta-analysis estimating a 2-fold risk of arterial disease for women with PCOS relative to women without PCOS. and hyperandrogenism. PCOS also makes a woman. independent of BMI.
and this can interfere with egg development and release. . which signals their ovaries to release extra male hormones. and also androgens.• • • • • Miscarriage Sleep apnea. In girls with PCOS. again particularly if obesity is present Acanthosis nigricans (patches of darkened skin under the arms. such as type 2 diabetes and heart disease. Research has suggested that PCOS may be related to increased insulin production in the body. in the groin area. doctors can't say for sure what causes it. develop. it's common for them to have irregular or missed periods. Instead of an egg being released during ovulation. Both girls and guys produce sex hormones. Women with PCOS may produce too much insulin. on the back of the neck) Autoimmune thyroiditis Early diagnosis and treatment may reduce the risk of some of these. Because girls with PCOS are not ovulating or releasing an egg each month. which are little sacs filled with liquid. Although no one really knows what causes PCOS. the ovaries produce the hormones estrogen and progesterone. the cysts build up in the ovaries and may become enlarged. like during a normal menstrual cycle. particularly if obesity is present Non-alcoholic fatty liver disease. cysts. the ovaries produce higher than normal amounts of androgens. when the egg is released. Sometimes instead of the eggs maturing. What Is Polycystic Ovary Syndrome? Polycystic (pronounced: pol-ee-sis-tik) ovary syndrome is a common health problem that can affect teenage girls and women. These hormones regulate a girl's menstrual cycle and ovulationovulation. Although PCOS (which used to be called Stein-Leventhal syndrome) was first recognized in the 1930s. Even though androgens are sometimes referred to as "male hormones. In girls. but in different amounts. it seems to be related to an imbalance in a girl's hormones." every female produces them.
and cancer. The gynecologist or endocrinologist will ask you about any concerns and symptoms you have. or diabetes mellitus (high levels of sugar in your blood) Girls who show certain signs of puberty early — such as girls who develop underarm or pubic hair before the age of 8 — may be at greater risk of having PCOS later on. or difficulty maintaining a normal weight. Girls with PCOS are more likely to have infertility. thickened skin around the neck. abnormal bleeding from the uterus. acne. where a girl grows extra hair on her face. it can put a girl at risk for lots of problems. However. so if someone in your family has it. abdomen. diabetes. because it can take up to 2 years after her first period for a girl's menstrual cycle to become regular. The good news is that. Your doctor may refer you to a gynecologistgynecologist or an endocrinologistendocrinologist for a diagnosis. it can be treated. any medications you're taking. nipple area. any allergies . not just her ovaries. If PCOS is not treated properly.PCOS seems to run in families. your family's health. though) thinning hair on the head (doctors call this alopecia) acne and clogged pores darkened. What Are the Signs and Symptoms? A key sign of PCOS is irregular or missed periods because the effects of the condition on the ovaries can make a girl stop ovulating. chest. it can be hard to recognize missed periods as a sign of PCOS in teen girls. high cholesterol. especially when the extra weight is concentrated around the waist a condition called hirsutism (pronounced: her-suh-tiz-um). obesity. obesity. high blood pressure. excessive hair growth. heart disease. you're on the right track. or breasts (this is called acanthosis nigricans) high blood pressure. your past health. So doctors also look for these other signs that might indicate PCOS: • • • • • • • very heavy periods or irregular periods weight gain. How Is Polycystic Ovary Syndrome Diagnosed? If you've taken your concerns about your body to your doctor. Imbalanced hormone levels can cause changes in a girl's entire body. or back (a little of this is normal for most girls. armpits. because getting treatment for PCOS reduces a girl's chances of having serious side effects. you might be more likely to develop it. although there's no cure for PCOS. The most important step is diagnosing the condition. too.
and checking especially for physical signs such as acne. such as thyroid or other ovarian or gland problems. Because cysts are not always visible. Blood tests allow doctors to measure androgen. many girls with PCOS can get pregnant. How Is It Treated? Although there's no cure for PCOS. This is important whether or not you have PCOS. another symptom girls with PCOS sometimes experience.you may have. Getting treated for PCOS is also a good idea if you want to have a baby someday — PCOS often causes infertility if it's not treated. Your doctor also might order an ultrasound to look at your ovaries and to determine if you have cysts or other abnormalities of the ovaries. But when PCOS is treated properly. this test is not always used. In addition to your medical history. The results of these tests can help doctors to determine the type of treatment a girl will receive. and darkened skin. Exercise is a great way to help combat the weight gain that often accompanies PCOS as well as a way to reduce bloating. Sometimes weight loss alone can restore hormone levels to normal. Also. A doctor may also perform blood tests to diagnose PCOS or other conditions. Weight loss can be very effective in lessening many of the health conditions associated with PCOS. A doctor might first have a girl try birth control pills or another hormone pill called progesterone to help control hormone . insulin. which includes checking your weight. and other hormone levels. If you are sexually active. such as high blood pressure and diabetes. causing many of the symptoms to disappear or become less severe. many women with the condition have healthy babies. your doctor will do a physical examination. The doctor may perform a gynecologic examination to rule out other possible causes of your symptoms. there are several ways that the condition can be treated and managed. Sometimes doctors prescribe medications to treat PCOS. you need to use condoms every time you have sex in order to avoid getting pregnant or getting a sexually transmitted disease (STD). Early diagnosis and treatment for PCOS are important because the condition can put girls at risk for long-term problems. and other issues. hair growth. a doctor will recommend that she lose weight. This is called the medical history. Your doctor or a registered dietitian can look at your food intake and your exercise and activity to tailor a weight-loss program for you. but this is not always necessary for diagnosis. He or she will also ask you lots of questions specifically about your period and its regularity. If a girl is overweight or obese.
your doctor may refer you to a dermatologist for further acne treatment. Birth control pills may help control acne and excessive hair growth in some girls. support. . Although the medications used to treat PCOS will slow down or stop excessive hair growth for many girls. metformin. Be sure to follow the instructions carefully so you don't develop a rash or allergic reaction. Depilatory creams can gently remove facial hair on the upper lip or chin. Some girls with PCOS may become depressed. Talking with other teens and women with PCOS is a great way to share information about treatment and get support. A girl can also visit a dermatologist (a doctor who specializes in skin problems) or qualified hair removal specialist for electrolysis and laser surgery treatments. A dermatologist may also be able to recommend medications to help reduce skin darkening or discoloration. Another medication. it may improve if part of your treatment includes birth control pills or antiandrogens. If you can't find a local group. If you have severe acne as a symptom of PCOS. but they are more expensive. Tweezing and waxing are other things you can do (at home or at a salon) to manage hair growth. If it doesn't. it can help control ovulation and androgen levels. or just a listening ear.levels in her body and regulate her menstrual cycle. In some girls with PCOS. Your doctor may be able to recommend a local support group. These procedures offer longer term removal of unwanted hair. Other medications used to treat PCOS include antiandrogens. This can make a girl's menstrual cycles more regular. can lower insulin levels. there are things you can do to reduce the physical symptoms — and take care of the emotional side of living with PCOS. and to prevent hair growth. Some girls and women treated with metformin have also experienced weight loss and lowering of high blood pressure. Coping With Polycystic Ovary Syndrome Having PCOS can be hard on a girl's self-esteem because some of the symptoms. which counter the effects of excess androgens on a girl's body. If you join. but they don't work for everyone. can be noticeable. the Polycystic Ovarian Syndrome Association offers a "Big Cyster" program for teen girls as well as online message boards. Antiandrogens can help clear up skin and hair growth problems in girls with PCOS. you'll be hooked up with other women or teen girls with PCOS to whom you can turn for advice. different types of products are available to help a girl get rid of hair where she doesn't want it. Fortunately. which is used to treat diabetes. such as skin and hair problems and weight gain. in which case it may help to talk to a therapist or other mental health professional.
which sends messages to the pituitary gland. (NB. Clomifene is also available without a brand name. This stops oestrogen from acting on these receptors. and as you already know. Clomifene works by blocking the oestrogen receptors in the hypothalamus. ie as the generic medicine. In 50 per cent of cases there will also be weight gain and unwanted body hair.) Clomifene works by causing an increase in the levels of hormones in the female body which control the development and release of an egg. which sits at the base of the brain. a hormone known as LH-RH. infertility is a possible problem. there is a high level of circulating oestrogen in the bloodstream and a relative increase in the male-type hormone. . It does this by acting on receptors in a part of the brain called the hypothalamus. Tests to assess the severity of your PCOS and to see whether you are ovulating and therefore fertile include a simple blood test. The increase in these hormones increases the chances of egg development and ovulation. an ultrasound scan of your ovaries and possibly a laparoscopy procedure where a narrow telescope is inserted just below the belly button to look directly at the ovaries from the inside. It is caused by an imbalance of hormones released by the pituitary gland. Treatments would include the medication clomiphene to stimulate ovulation. This results in the release of more FSH and LH from the pituitary gland. as part of the normal menstrual cycle. How does it work? Clomid tablets contain the active ingredient clomifene citrate (previously spelt clomiphene in the UK). Oestrogen normally causes the brain to stop releasing FSH and LH following ovulation. Ovulation fails to occur. and therefore stops the message being sent to the pituitary gland. the oral contraceptive pill and surgical removal of a small wedge of ovarian tissue to restore ovarian function. FSH stimulates the ovaries and LH causes the release of an egg from the ovaries (ovulation). It would be very helpful if you could be referred to a gynaecology clinic sooner rather than later to see if any measures can be taken now to maximise your chance of having children in the future. testosterone. These hormones are released from the pituitary gland in the brain and are known as follicle stimulating hormone (FSH) and luteinising hormone (LH).Polycystic ovary syndrome is characterised by irregular periods starting within two years of puberty usually leading to very scanty or even absent periods.
Clomifene is used to stimulate ovulation in women whose infertility is due to problems with ovulation. and pregnancies outside the womb (ectopic pregnancy). Women should be evaluated for the presence of ovarian cysts before each course of treatment. triplets etc.Your doctor should discuss this with you before you start treatment. particularly under conditions of variable lighting. as prolonged use may increase the risk of ovarian cancer. discomfort or swelling after taking this medicine. eg twins. This may make it hazardous to drive or operate machinery. This medicine may cause blurred vision or other visual symptoms during or shortly after taking the medicine. pelvic pain or abdominal pain. This medicine should not be used for more than 6 cycles of therapy. Inform your doctor if you experience weight gain. Use with caution in • • • • Polycystic ovary syndrome Fibroids of the uterus Endometriosis History of seizures Not to be used in • • • Pregnancy Liver disease History of decreased liver function . Your treatment will need to be stopped and you should have an eye examination. If you get visual symptoms you should tell your doctor. Clomid What is it used for? • Infertility in women caused by failure of ovulation Warning! • • • • • • Women should have a pregnancy test to make sure they are not pregnant before each course of clomifene therapy. Fertility treatment with this medicine carries an increased risk of multiple pregnancies.
stop using this medicine and inform your doctor or pharmacist immediately. Side effects Medicines and their possible side effects can affect individual people in different ways. before using any medicine. Seek medical advice from your doctor. Pregnancy and Breastfeeding Certain medicines should not be used during pregnancy or breastfeeding. However. it does not mean that all people using this medicine will experience that or any side effect. • • This medicine should not be used in pregnancy. The following are some of the side effects that are known to be associated with this medicine. Please inform your doctor or pharmacist if you have previously experienced such an allergy. Always inform your doctor if you are pregnant or planning a pregnancy. Seek medical advice from your doctor. eg endometrial cancer Abnormal bleeding from the uterus of unknown cause Ovarian cysts This medicine should not be used if you are allergic to one or any of its ingredients. If you feel you have experienced an allergic reaction. It is not known whether this medicine passes into breast milk.• • • Certain types of cancer that are dependent on hormones for growth. Women should have a pregnancy test to make sure they are not pregnant before each course of clomifene therapy. It may suppress the production of milk. Because a side effect is stated here. other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. • • • • • • • • • • • • • Enlargement of the ovaries Pain in the lower abdomen in the middle of the menstrual cycle (mittelschmerz) Over stimulation of the ovaries causing production of many eggs Hot flushes Abdominal discomfort (swelling or bloating) Nausea and vomiting Breast discomfort Visual disturbances Headache Spotting of blood between menstrual periods Heavy or painful menstrual periods Endometriosis Dizziness .
. Other medicines containing the same active ingredient Clomifene tablets are also available without a brand name. For more information about any other possible risks associated with this medicine. How can this medicine affect other medicines? There are no significant interactions reported with this medicine. please read the information provided with the medicine or consult your doctor or pharmacist. ie as the generic medicine.• • • • • • • • Nervous tension Insomnia Fatigue Skin reactions such as rash and itch Loss of contact with reality (psychosis) Stroke (cerebrovascular accident) Depression Seizures (convulsions) The side effects listed above may not include all of the side effects reported by the drug's manufacturer.
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue reading from where you left off, or restart the preview.