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    Polycystic ovary syndrome

    Polycystic ovaries; Polycystic ovary disease; Stein-Leventhal syndrome; Polyfollicular ovarian disease

    Polycystic ovary syndrome is a condition in which a woman hasan imbalance of a female sex hormones. This may lead to menstrual cycle changes,cysts in the ovaries, trouble getting pregnant, and other health changes.

    Causes

    PCOS is linked to changes in the level ofcertain hormones:

    • Estrogen and progesterone, the female hormonesthat help a woman's ovaries release eggs
    • Androgen, a male hormone found in small amounts in women

    It is not completely understood why or how the changes in the hormone levels occur. The changes make it harder for a woman's ovaries to release fully grown (mature) eggs. Normally, one or more eggs are released duringa woman's period.This is called ovulation. In PCOS, mature eggs are not released from the ovaries. Instead, they can form very small cysts in the ovary.

    These changes can contribute to infertility. The other symptoms of this disorder are due to the hormone imbalances.

    Most of the time, PCOS isdiagnosed in women in their 20s or 30s. However, itmay also affect teenage girls. The symptoms often begin when a girl's periods start. Women with this disorder often have a mother or sister who has symptoms similar to those of polycystic ovary syndrome.

    Symptoms

    Symptoms of PCOS include changes in your period (menstrual cycle). Some changes are:

    • No period after you have had one or more normal onesduring puberty (secondary amenorrhea)
    • Irregular periods, that may come and go and may be very light tovery heavy

    PCOS can cause you to develop male-like characteristics. This is called virilization. Symptoms include:

    • Body hair growing on the chest, belly, face, and around the nipples
    • Decreased breast size
    • Enlargement of the clitoris
    • Thinning of the hair on the head, called male-pattern baldness
    • Voice gets deeper

    You may also have skin changes:

    • Acne that gets worse
    • Dark or thick skin markings and creases around the armpits, groin, neck, and breasts

    Exams and Tests

    Your doctor or nurse will perform a physical exam. This will include a pelvic exam. This may reveal:

    • Swollen ovaries
    • Swollen clitoris (very rare)

    The following health conditions are common in women with PCOS:

    • Diabetes
    • High blood pressure
    • High cholesterol
    • Weight gain and obesity

    Your doctor or nurse will check your weight andbody mass index (BMI) and measure your belly size.

    Blood tests can be done to check hormone levels. These tests may include:

    • Estrogen level
    • FSH level
    • LH level
    • Male hormone (testosterone) level
    • 17-ketosteroids

    Other blood tests that may be done include:

    • Fasting glucose (blood sugar) and other tests for glucose intolerance and insulin resistance
    • Lipid level
    • Pregnancy test (serum HCG)
    • Prolactin level
    • Thyroid function tests

    Your doctor may also order the following imaging test or surgeries to look at your ovaries:

    • Vaginal ultrasound
    • Pelvic laparoscopy

    Treatment

    Weight gain and obesity is common in women with PCOS. Losing weight can help treat the hormone changes and health conditions such asdiabetes, high blood pressure, or high cholesterol.

    Losing just 5% of your body weight can help your hormone imbalance and may make it easier to get pregnant. For a 160-pound woman, that's just8 pounds!

    Your doctor may recommend birth control pills to make your periods more regular. Such medicines may also help reduce abnormal hair growth after you take them for a few months.

    A diabetes medicine called glucophage (metformin)may also be recommended to:

    • Make your periods regular
    • Prevent type 2 diabetes
    • Help you lose weight when you follow a healthy diet

    Other medicines that may be prescribed to help make your periods regular and help you get pregnant are:

    • LH-releasing hormone (LHRH) analogs
    • Clomiphene citrate, which helps your ovaries grow and release eggs

    Your doctor or nurse may also suggest other treatments forabnormal hair growth. Some are:

    • Spironolactone or flutamide pills
    • Eflornithine cream

    Permanent hair removal options include:

    • Electrolysis
    • Laser hair removal- works best on very dark hair that covers large areas

    Treatments can be expensive and multiple treatments may be needed.

    Apelvic laparoscopy may be done to remove or alter an ovary to treat infertility. The effects are temporary.

    Outlook (Prognosis)

    With treatment, women with PCOS are usually able to get pregnant. There is an increased risk of high blood pressure and gestational diabetes during pregnancy.

    Possible Complications

    Women with PCOS are more likely to develop:

    • Endometrial cancer
    • Infertility
    • Breast cancer (slightly increasedrisk)

    When to Contact a Medical Professional

    Call for an appointment with your health care provider if you have symptoms of this disorder.

    References

    Bulun SE, Adashi EY. The physiology and pathology of the female reporductive axis. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 17.

    Radosh L. Drug treatments for polycystic ovary syndrome. Am Fam Physician. 2009;79:671-676.

    Lobo RA. Hyperandrogenism: Physiology, etiology, differential diagnosis, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 40.

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    • Endocrine glands

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    • Pelvic laparoscopy

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    • Female reproductive anat...

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    • Stein-Leventhal syndrome

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    • Uterus

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    • Follicle development

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      • Endocrine glands

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      • Pelvic laparoscopy

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      • Female reproductive anat...

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      • Stein-Leventhal syndrome

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      • Uterus

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      • Follicle development

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      A Closer Look

        Self Care

          Tests for Polycystic ovary syndrome

            Review Date: 2/26/2012

            Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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