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| |    Polycystic Ovarian Syndrome (PCOS) by Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. Polycystic ovarian syndrome, or PCOS, is a condition that involves a complex hormonal imbalance and includes irregular ovulations or no ovulation. Another medical term for PCOS is chronic anovulation. In PCOS, the hormone estrogen is present without the balancing effects of the hormone progesterone, which the ovary normally produces after releasing an egg. This hormonal imbalance increases the production of testosterone and other hormones, resulting in a wide variety of side effects. Classic full-blown PCOS typically is seen in women who are overweight and have acne, excessive facial and body hair, and for whom menstruation may be absent or heavy and irregular. However, more subtle versions of PCOS occur as well. A subgroup of women with this condition show resistance to the hormone insulin, which regulates the levels of sugar in the body. Some women with PCOS in fact have diabetes. In the long run, women with untreated chronic anovulation face a number of medical risks, including excessive menstrual bleeding (to the point of hemorrhage), infertility, diabetes, hypertension, cardiovascular disease, and uterine cancer. PCOS and body weight One cause of PCOS is excess body fat. Because fat cells have the ability to make estrogen, a large amount of fat can lead to an overproduction of estrogen. If the body produces too much estrogen, it prevents the normal rise in the hormone FSH, which is necessary to start the process of egg maturation at the beginning of the menstrual cycle. Oftentimes, a modest weight loss of between 15 and 25 pounds is enough to decrease the overall amount of estrogen in the body so that the other necessary hormones can start cycling normally again. When successful, the loss of extra pounds is one of the healthiest ways for overweight women to treat their PCOS. It's important to note that while PCOS most often occurs in those who are overweight, this syndrome can take place in women of normal weight as well. Menstruation Because women and girls with PCOS either don't release eggs at all, or do so infrequently, they usually witness irregularities of the menstrual cycle. Some women with chronic anovulation don't bleed at all; others bleed irregularly. Occasionally a woman with PCOS will appear to have regular periods. In women who don't have PCOS and who ovulate regularly, menstruation comes two weeks after egg release, and the flow usually is consistent in amount and duration from month to month. In PCOS, menstrual bleeding is the result of structural instability of the uterine lining, where the lining gets so thick that parts start to shed on their own, without any hormonal prompting. This is why bleeding may be irregular, very heavy, and prolonged. Excessive hair growth and acne Chronic anovulation causes the ovary to make excess testosterone. Because of this, many girls and women with PCOS are prone to having an unusual amount of facial or abdominal hair (known as hirsutism) and acne.Birth control pills often can help by decreasing the circulating testosterone that causes these unwanted effects. Effects on the ovaries The name "polycystic ovarian syndrome" is misleading. While some women with PCOS do have numerous small cysts on their ovaries, the ovaries themselves may be perfectly normal in size and shape. And the cysts are not the cause of PCOS, just an effect of the ovaries not releasing eggs regularly. It also is worth noting that cystic ovaries aren't painful, and women who do have these cysts don't usually have any pelvic symptoms. How can I tell if I have PCOS? A woman should be evaluated for polycystic ovarian syndrome if:
Treatment will then depend on whether the patient desires to get pregnant, wants to prevent pregnancy, needs treatment for excess facial hair or other problems related to PCOS, or simply wishes to avoid the long-term risk of uterine cancer.
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