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What is it?Polycystic ovarian syndrome (PCOS), which is also called Stein-Leventhal syndrome, is a common condition, affecting 5 to 10% of women of childbearing age. The disorder is probably the most common hormonal abnormality in women of reproductive age and is certainly a leading cause of infertility. Although the underlying cause is not well understood, PCOS is generally characterized by an excess production of androgens (male hormones - usually testosterone), anovulation (the egg is not released by the ovary) and amenorrhea, and by a varying degree of insulin resistance.
Androgens are normally created in small amounts by a woman's ovaries and adrenal glands. Even a slight overproduction can lead to symptoms such as hirsutism and acne. In extreme cases, they can lead to virilization.
Hormone imbalances also affect the menstrual cycle in PCOS, causing infertility problems. Most women with this condition do not have regular monthly periods. Often they have chronic anovulation and amenorrhea, but they may also experience irregular periods and uterine bleeding. With PCOS, both ovaries tend to be enlarged as much as 3 times their normal size. In 90% of women with PCOS, an ultrasound of the ovaries will reveal cysts — small immature egg-bearing follicles, fluid-filled follicles — that can be seen on the surface of the ovary. These ovarian cysts are often lined up to form the appearance of a "pearl necklace." When the egg is not released and a woman is not menstruating, sufficient progesterone is not produced. This leads to a hormonal imbalance in which estrogen goes "unopposed." This can lead to an overgrowth of the lining of the uterus (endometrial hyperplasia) and increases a woman's risk of developing endometrial cancer. Women with PCOS who do ovulate and become pregnant tend to have an increased risk of miscarriage.
Although the cause of PCOS is not well understood, some think that insulin resistance may be a key factor. Insulin is vital for the transportation and storage of glucose at the cellular level; it helps regulate blood glucose levels and has a role in carbohydrate and lipid metabolism. When there is resistance to insulin's use at the cellular level, the body tries to compensate by making more. This leads to hyperinsulinemia, elevated levels of insulin in the blood. Some believe that hyperinsulinemia may be at least one cause for an increased production of androgens by the ovaries.
Most women with PCOS have varying degrees of insulin resistance, obesity, and lipid dysfunction. Insulin resistance tends to be more pronounced in those who are obese and do not ovulate. These conditions put those with PCOS at a higher risk of developing type 2 diabetes and cardiovascular disease.
Signs and symptoms
PCOS is said to be heterogeneous; that is, patients may experience a wide variety of different symptoms to a greater or lesser degree, and vary over time. Also, a uniform and precise definition of the syndrome is lacking. Women often go to their doctor because they are having menstrual irregularities, experiencing infertility, and/or are having symptoms associated with androgen excess.
They may experience:
Abnormal uterine bleeding
Acanthosis nigricans
Acne
Amenorrhea
Decreased breast size
Deeper voice (rare)
Enlarged ovaries
Hirsutism involving male hair growth patterns such as hair on the face, sideburn area, chin, upper lip, lower abdominal midline, chest, areola, lower back, buttock, and inner thigh
Weight gain/obesity, centripedal – fat distribution in center of the body
Skin tags in the armpits, neck, waist, & groin area
Thinning hair, with male pattern baldness
Tests
PCOS is to some extent a diagnosis of exclusion. There is not a specific test that can be used to diagnose PCOS and there is not widespread agreement on what the diagnostic criteria should be. Your doctor will do tests to rule out other causes of anovulation and infertility. He will usually order a variety of hormone tests to help determine whether hormone overproduction may be due to PCOS, an adrenal or ovarian tumor, or an overgrowth in adrenal tissue (adrenal hyperplasia). Ultrasounds are often used to look for cysts in the ovaries and to see if the internal structures appear normal.
Your doctor will be looking for a combination of laboratory results and clinical findings that suggest PCOS. If you are diagnosed with PCOS, your doctor may order tests such as lipid profiles and glucose levels to monitor your risk of developing future complications such as diabetes and cardiovascular disease
Laboratory Tests
FSH (Follicle Stimulating Hormone), will be normal or low with PCOS
LH (Lutenizing Hormone), will be elevated
LH/FSH ratio. This ratio is normally about 1:1 in premenopausal women, but with PCOS a ratio of greater than 2:1 or 3:1 may be considered diagnostic
Prolactin will be normal or low
Testosterone, total and/or free, usually elevated
DHEAS (may be done to rule out a virilizing adrenal tumor in women with rapidly advancing hirsutism), frequently mildly elevated with PCOS
17-ketosteroids (urine metabolites of androgens, used to evaluate adrenal function) elevated or decreased?
Estrogens, may be normal or elevated
Sex hormone binding globulin, may be reduced
Androstenedione, may be elevated
hCG (Human chorionic gonadotropin), used to check for pregnancy, negative
Lipid profile (low HDL, high LDL, and cholesterol, elevated triglycerides)
Glucose, fasting and/or a glucose tolerance test, may be elevated
Insulin, often elevated
TSH (Thyroid stimulating hormone) some who have PCOS are also hypothyroid
Non-Laboratory Tests
Ultrasound, transvaginal and/or pelvic/abdominal are used to evaluate enlarged ovaries. With PCOS, the ovaries may be 1.5 to 3 times larger than normal and characteristically have more than 8 follicles per ovary, with each follicle less than 10 mm in diameter. Often the cysts are lined up on the surface the ovaries, forming the appearance of a "pearl necklace." These ultrasound findings are not diagnostic. They are present in more than 90% of women with PCOS, but they are also found in up to 25% of women without PCOS.
Laparoscopy may be used to evaluate ovaries, evaluate the endometrial lining of the uterus, and sometimes used as part of surgical treatment.
Treatments
There is no cure for PCOS. Although there have been cases involving the spontaneous resumption of menses, most women will have progressive symptoms until after menopause. Treatment of PCOS is aimed at reducing its symptoms and helping to prevent future complications. The goals are to promote ovulation, prevent endometrial hyperplasia, counterbalance the effects of androgen, and reduce insulin resistance. Treatment options depend on the type and severity of the individual patient's symptoms and on the patient's desire to become pregnant.
Low-dose oral contraceptives are often used to stabilize hormones and oppose estrogenic stimulation of the endometrium. Within several months, they can usually regulate menstrual periods, eliminate or minimize uterine bleeding, and reduce androgen levels (improving hirsutism and clearing up acne).
Antiandrogens, such as spironolactone (Aldactone), flutamide (Eulexin) and cyproterone (Cyprostat) are sometimes combined with oral contraceptives to help address more severe hirsutism and acne. Waxing, shaving, depilatory and electrolysis may be used to remove unwanted hair, and antibiotics or retinoic acids may be used to treat acne.
Metformin (Glucophage) is being used to reduce insulin resistance. It has also shown promising initial results in women with PCOS hirsutism and in helping to regulate menstrual cycles, but its effects on infertility and other symptoms are not yet known.
Weight loss and exercise are recommended to help decrease insulin resistance and to minimize lipid abnormalities. Weight reduction can also decrease testosterone, insulin, and LH levels.
Although sometimes performed, surgery is a rare PCOS treatment option. One surgical option, a "wedge resection", involves removing the part of the ovary that contains the cystic follicles to try to restore ovulation. Another option, ovarian drilling, involves using needle with an electric current to make holes in the ovary. Both of these procedures may temporarily increase fertility but may also lead to scarring and adhesions
If a woman with PCOS wants to become pregnant, she is usually given clomiphene citrate (Clomid), a drug that helps induce ovulation. She may also be given human menstrual gonadotropin (Pergonal), although this drug increases the risk of multiple pregnancies.
ALL of this information came from www.labtestsonline.com
