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Polycystic ovary syndrome (PCOS)

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DIABETES AND ENDOCRINE SYSTEM

Endocrine System

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:

  • Irregular or no menstruation. This is the most common finding in PCOS. Irregular menstruation means having menstrual cycles that occur at intervals longer than 35 days or fewer than eight times a year. The condition may begin in adolescence with the onset of menstruation.

  • Excess androgen. Elevated levels of male hormones may result in physical signs such as long, coarse hair on your face, chest, lower abdomen, back, upper arms or upper legs, acne and male-pattern baldness (alopecia). However, not all women who have PCOS have physical signs of androgen excess. Blood tests are available to detect high androgen levels.

  • Ruling out of other conditions that cause excess androgen and abnormal menstruation. Other potential causes may include hypothyroidism, a condition in which your body produces too little thyroid hormone. This can lead to amenorrhea. Another possible cause is hyperprolactinemia, in which your pituitary gland produces too much prolactin, a hormone that stimulates the production of breast milk and suppresses ovulation. Another source of excess androgen might be tumors of the ovary or adrenal gland, a small gland near the kidney responsible for secreting cortisol as well as androgens.

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:

  • Infertility

  • Acanthosis nigricans — darkened, velvety skin on the nape of your neck, armpits, inner thighs, vulva or under your breasts

  • Chronic pelvic pain

Causes

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.

Risk factors

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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