Polycystic ovary syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a condition most often characterized by irregular menstrual periods, excess hair growth (hirsutism) and obesity, but it can affect women in different ways. Irregular or heavy periods may signal the condition in adolescence, or PCOS may become apparent later when a woman has difficulty becoming pregnant.
The signs and symptoms of PCOS stem from a disruption in the reproductive cycle, which normally culminates each month with the release of an egg from an ovary (ovulation). The name of the condition comes from the appearance of the ovaries in some women with the disorder - large and studded with numerous cysts (polycystic). These cysts are follicles, fluid-filled sacs that contain immature eggs.
Although the condition has been noted since antiquity, it was first described in medical literature in the 1930s when Irving Stein and Michael Leventhal wrote about a group of women without menstrual periods (amenorrhea) who had large ovaries with multiple cysts. Doctors sometimes call the condition Stein-Leventhal syndrome, polycystic ovaries or polycystic ovary disease.
Early diagnosis and treatment of PCOS can help reduce the risk of long-term complications, which include diabetes and heart disease.
Signs and symptoms
Women with PCOS may have any of several signs of varying severity. A committee at the National Institutes of Health has set three criteria for diagnosing the disorder:
The presence of ovarian cysts, which a doctor may detect by ultrasound, may or may not indicate PCOS. A woman may have ovaries with multiple cysts but still not have PCOS. And, a woman with PCOS may have ovaries that appear normal.
Many women with PCOS are obese. The distribution of fat seems to affect the severity of symptoms. One study found that women who have central obesity — fat in the midsection or trunk of the body — have higher androgen, sugar and lipid levels than do women who have accumulated fat in their limbs.
Other possible conditions associated with PCOS are:
The intricate process of a woman's reproductive cycle is regulated by fluctuating levels of hormones produced in your brain, including luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and by your ovaries.
The ovaries secrete the female hormones estrogen and progesterone and also the so-called male hormones. The male hormones include testosterone, androstenedione and dehydroepiandrosterone (DHEA) and are called androgens.
In PCOS, a woman's body produces an excess of male hormones. The ovaries release eggs less frequently than normal (oligo-ovulation), or they don't release eggs at all (anovulation). In the absence of ovulation, the menstrual cycle is irregular or absent.
Doctors don't know the cause of PCOS, but research suggests a link to excess insulin, the hormone produced in the pancreas that allows cells to use sugars (glucose), your body's primary energy supply. By several mechanisms, excess insulin is thought to boost androgen production by your ovaries.
Studies indicate that women whose sisters have PCOS are more likely to develop the condition. Other research shows links between PCOS and a family history of excess androgen, insulin resistance, hirsutism and menstrual disorders.
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