Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS)

What is it?

Polycystic ovarian syndrome is known by a variety of names. It is also called polycystic ovaries, polycystic ovarian disease, sclerocystic ovarian disease, ovarian syndrome and Stein-Leventhal Syndrome.

The ovaries tend to be enlarged with multiple cysts on the surface. The cysts are due to an accumulation of many immature ova, which have not fully developed due to an abnormality in the levels of circulating hormones.

The ovaries are enlarged with multiple cysts on the surface

What causes it?

The cause of this syndrome is not fully understood. It tends to run in families but a precise genetic marker has yet to be discovered. The condition develops after the onset of puberty.

The current thinking on this condition is that the ova fail to mature properly due to abnormalities in the level of oestrogen, which is produced in the ovaries, and the levels of other hormones produced in the hypothalamus and pituitary gland. Normal ovarian function is dependent on a subtle equilibrium between these various hormones.

What are the symptoms?

Menstrual irregularity occurs and this can range from a highly unpredictable pattern to absent or scanty periods.

Many people with polycystic ovaries are overweight. In some cases this may be associated with abnormal insulin levels which can result in diabetes.

Abnormalities of hair growth are common and can range from hirsutism, an excessive growth of hair to virilisation, which means a male pattern of hair growth. This hair growth and weight gain can contribute to loss of self-esteem.

Infertility can arise as a result of the failure to produce mature ova that are capable of being fertilised.

Acne is quite common due to the abnormal levels of hormones in the blood.

Breast size is reduced, also as a result of hormone changes.

How is it diagnosed?

It is not easy to diagnose this condition because there are no specific symptoms that are exclusive to it. One patient might present with a fertility problem whereas another might present because of obesity.

If the doctor suspects the condition, it is likely that he or she will perform an internal examination, which could reveal the presence of enlarged ovaries.

Blood hormone analysis reveals a high level of oestrogen, increased levels of testosterone and low levels of follicle stimulating hormone (produced in the pituitary gland).

Ultrasound examination of the pelvis usually reveals that the affected ovaries are usually at least twice the size of normal ovaries.

Laparoscopy allows the doctor to directly inspect the ovaries revealing the typical appearance of enlarged ovaries with multiple cysts on the surface. A biopsy can be taken during laparoscopy, which enables the laboratory to corroborate the findings on inspection.

What is the treatment?

Various hormone preparations are used to treat the condition including the contraceptive pill, clomiphene and human menopausal gonadotrophin, a powerful fertility drug.

The contraceptive pill helps to normalise the levels of hormone in the body but is obviously contraindicated in those who are anxious to become pregnant. Clomiphene stimulates the pituitary gland to produce follicle-stimulating hormone, which in turn triggers the development and release of the ova or eggs from the ovary. Human menopausal gonadotrophin may be necessary in some cases to overcome the problem of infertility.

Surgery is sometimes performed to remove enlarged cysts from the ovaries. The procedure is known as a wedge resection and literally involves removing a wedge shaped portion from the ovary.

Maintaining general good health and avoiding obesity are very important because of the changes in insulin levels that occur in most cases.

Once the condition is properly diagnosed and the appropriate treatment given, it is possible for an affected woman to become pregnant. Such pregnancies usually proceed normally and do not require any special treatment.

Reviewed: July 28, 2006