What is polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS) is a hormone disorder that affects the ovaries. The 2 ovaries are part of the female reproductive system. The ovaries produce eggs and the female hormones, estrogen and progesterone. PCOS prevents release of an egg from the ovaries.

When you have PCOS many small benign cysts form under the thick, white covering of the ovary. Ovarian cysts are fluid-filled sacs that form on the ovaries when follicles (sacs) containing an egg mature but do not release the egg into the fallopian tube.

PCOS can cause your menstrual cycle to be irregular, or you may have no periods at all. In PCOS the ovaries can also make a large amount of male hormones. The male hormones can cause you to gain too much weight and to have acne, hair growth on the face and chest, and baldness. PCOS can make it hard for you to become pregnant. It can cause other problems as well.

PCOS is most common in women less than 30 years old. It has also been called Stein-Leventhal syndrome.
What is the cause?

Doctors do not know what causes PCOS. Researchers are looking for genes or substances in the environment that might cause it, but nothing has been found yet. Also, because many women with PCOS have diabetes, studies are examining the relationship between PCOS and the level of insulin in the body. High levels of insulin appear to cause the body to make more of the male hormone testosterone, which worsens the symptoms of PCOS. A problem called insulin resistance (inability to use insulin normally in the body) can cause the high levels of insulin.

Some medicines may cause or worsen the symptoms of PCOS. Be sure to tell your healthcare provider about all of the medicines you are taking, including prescription and nonprescription drugs, supplements, and herbal remedies.
What are the symptoms?

The symptoms may include:
irregular menstrual periods, particularly long cycles, or no periods at all
very light or very heavy bleeding during your period
trouble getting pregnant
more hair on your face, chest, and lower abdomen
balding in some women
acne or other changes in the skin

Many young women with polycystic ovaries start having menstrual periods at a normal age. But then, after a few years of regular menstruation, the periods may become quite irregular and then infrequent.
How is it diagnosed?

Your healthcare provider will ask about your medical history. You may have these tests and exams:
a physical exam, including a pelvic exam
blood tests
an ultrasound scan of the ovaries

Your provider may measure insulin and blood sugar levels in your blood to check for diabetes or insulin resistance.
How is it treated?

There is no cure for PCOS, but treatment is important to prevent further problems. The treatment depends on how severe your symptoms are and whether you are trying to get pregnant.

If you are not trying to get pregnant, you may be treated with hormones, usually birth control pills, to help make your menstrual cycles more regular. The birth control pills also lessen production of male hormones, so you should start having less unwanted hair growth and acne. Your provider may prescribe other treatments to help with excessive hair growth and acne.

If you are trying to get pregnant, your provider may first recommend a weight control program for losing weight. A next step may be taking fertility drugs, which may be combined with another medicine to help increase your chances of getting pregnant.

Your healthcare provider may prescribe diabetes medicine, such as metformin, to help keep your insulin at normal levels. Metformin can decrease testosterone levels, help you have normal menstrual cycles again, and improve your chances of getting pregnant.

In rare cases, you may have surgery to remove a wedge of ovarian tissue. This sometimes results in regular menstrual cycles for at least a while.

As a last resort, if the symptoms are severe enough, you may have to have both ovaries removed and begin taking hormone replacement therapy.
How long will the effects last?

With treatment your symptoms may improve, but there is no cure for PCOS. You may keep having PCOS until you go through menopause and your ovaries stop making hormones. In rare cases some women stop having PCOS after they have a baby.

PCOS increases your risk of uterine cancer, diabetes, and heart disease. If you have PCOS, it is important for you to be checked regularly by your healthcare provider and to get treatment to help prevent these problems. Birth control pill treatments for PCOS can help reduce your risk for uterine cancer.
How can I take care of myself?
Work with your healthcare provider and follow his or her prescribed treatment.
Your healthcare provider will want to see you regularly. Keep all of your follow-up appointments. Make sure you have a pelvic exam every year. Pelvic exams can help your healthcare provider find problems such as uterine cancer early so that the problem can be treated right away. You may have ultrasound scans to look for changes in your ovaries or in the wall of the uterus. You may need blood tests to check your hormones or to see how well the treatment is working.
Eat a healthy diet and try to keep a healthy weight to help lessen the symptoms of PCOS.
Exercise regularly. It can help you lose weight. It also helps the body reduce blood glucose levels and use insulin better.
Tell your healthcare provider if you have any symptoms or changes other than those that you have been told to expect.

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