What is PCOS?

Polycystic ovary syndrome (PCOS) was known for many years as Stein-Leventhal Syndrome, when it was thought to be a disease caused by enlarged ovaries with multiple cysts that produced medical problems such as absence of periods, hirsutism (excess hair growth), and obesity.

We now know that PCOS is a much more complex syndrome than that.

PCOS is now considered a hormonal disorder with several abnormalities, most prominently an overproduction of male hormones (androgens) and an absence of ovulation (although some women with PCOS do ovulate).

In PCOS, the ovarian follicles (the sacs that contain the eggs before they're released from the ovary) fail to release their eggs and they form tiny cysts instead, which is why the ovaries in nearly all women with PCOS contain multiple cysts. The consequences of these hormonal abnormalities include abnormal periods, infertility (PCOS is the leading cause of infertility due to absence of ovulation), obesity, hirsutism (which also leads to a great deal of increased stress and emotional disturbance in many women), a raised risk of uterine cancer, and increased risk of miscarriage, and other complications of pregnancy.

Another complication is a much higher risk of type 2 diabetes. It is now well known that PCOS is associated with resistance to insulin, which is the main predisposing factor for type 2 diabetes and its complications (strokes, heart attacks, kidney failure, etc.)

Women with PCOS are more at risk for heart attacks for 2 reasons: they tend to have unfavourable cholesterol levels, and they are also at much higher risk of type 2 diabetes, especially before menopause, which itself is a risk factor for heart attack and heart disease.

Women diagnosed with PCOS should always be tested for cholesterol and glucose levels, and they should have those levels monitored regularly throughout their lives.

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How is PCOS recognized?

PCOS is said to affect up to 10% of women of childbearing years.

PCOS starts with the first menstrual period (menarche), and its most common manifestations are menstrual irregularities caused by an absence of ovulation. The menstrual pattern can vary tremendously and can include complete absence of periods, irregular periods, and light periods interspersed with heavy periods.

Other common problems that often lead a woman to seek medical attention are hirsutism, acne, obesity, and infertility.

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How is PCOS diagnosed?

Unfortunately, there is no consistent test for PCOS.

Women with PCOS tend to have abnormal levels of male hormones, particularly testosterone, as well as DHEA-S, a male hormone produced from the adrenal glands.

Over 50% of women with PCOS have a higher level of luteinizing hormone (LH) and a lower level of follicle stimulating hormone (FSH), but those changes are not present in the other 50%.

As well, ultrasound of the ovaries is not always helpful since some women with PCOS do not have multiple cysts, and conversely, some women with multiple cysts on their ovaries, especially those taking birth control pills, do not have PCOS.

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How is PCOS treated?

It is very important for women with PCOS to lower their risk of heart disease and diabetes by following a healthy diet, trying to keep their weight down, doing regular exercise, and not smoking. An added benefit from a healthy lifestyle is that it helps lower the rate of infertility.

Hirsutism can often be treated with medications that have an antiandrogen (anti-male hormone) effect (e.g., spironolactone). The prescription skin cream eflornithine can be used to slow the growth of unwanted facial hair in women.

Traditional therapy for PCOS has consisted of androgen suppression with the birth control pill, and synthetic progesterone-like medications (these also reduce the risk of uterine cancer), while infertility has been treated with fertility medications.

More recently, it's been recognized that treating insulin resistance with the medication metformin not only helps lower the risk of type 2 diabetes but, when combined with commonly used fertility medications, also increases the chances of ovulation and pregnancy in women with PCOS.

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Art Hister, MD 
in association with the MediResource Clinical Team