Polycystic ovary syndrome: Causes, symptoms, and treatments

Polycystic ovary syndrome (or Stein-Leventhal syndrome), widely known as PCOS, is an endocrine system disorder affecting women in their reproductive years. Small fluid-filled sacs often develop on the ovaries.

Symptoms include changes to the menstrual cycle and excess hair growth. If left untreated, it can cause diabetes, heart disease, and infertility.

While there is no known cause of PCOS, it is important that the condition is diagnosed early. Treatment and weight loss will be recommended to decrease the risk of other associated health risks, such as insulin resistance, type 2 diabetes, high cholesterol, heart disease, and high blood pressure.

In this article, we will cover the causes, symptoms, diagnosis, and treatment of PCOS.

Contents of this article:

  1. What is PCOS
  2. Causes
  3. Symptoms
  4. Tests and diagnosis
  5. Treatment
  6. PCOS during pregnancy and menopause
Fast facts on PCOS
Here are some key points about PCOS. More detail and supporting information is in the main article.

  • PCOS is one of the most common hormonal endocrine disorders affecting 8-20 percent of women, many of whom are undiagnosed.
  • PCOS is linked to the development of several other medical conditions, such as insulin resistance, type 2 diabetes, high cholesterol, high blood pressure, and heart disease.
  • More than half of women with PCOS develop type 2 diabetes before they are 40.
  • Around 70 percent of ovulatory fertility issues are related to PCOS.

What is PCOS?

The majority of women with PCOS grow a number of small cysts (fluid-filled sacs) on their ovaries. Although the cysts are not harmful themselves, they can lead to an imbalance in hormone levels.

Women with PCOS may also experience menstrual cycle abnormalities, increased androgen (sex hormone) levels, excess hair growth, acne, and obesity.

In addition to the many health conditions associated with PCOS, which will be discussed in this article, PCOS is the most common cause of infertility in women – because it can prevent ovulation.

Women who can conceive with PCOS have a higher incidence of miscarriage, gestational diabetes, pregnancy-induced high blood pressure, preeclampsia, and premature delivery.

Causes of PCOS

Currently, there is no known cause of PCOS. However, there are associations with excess insulin, low-grade inflammation, and genetics.

Risk factors

PCOS is thought to have a genetic component. People who have a mother or sister with PCOS are more likely to develop PCOS than someone whose relatives do not have the condition. This family link is the main risk factor.

Sugar is the body’s primary source of energy, and it is regulated in the body by insulin, which is secreted by the pancreas. Women who are insulin-resistant are unable to use insulin efficiently; this causes the pancreas to go into overdrive secreting additional insulin to meet the body’s glucose needs.

Excess insulin is thought to affect a woman’s ability to ovulate because of its effect on androgen production. Research has shown that women with PCOS have low-grade inflammation that stimulates polycystic ovaries to produce androgens.

Associated health risks

There are several health risks associated with PCOS; these include:

  • type 2 diabetes
  • infertility
  • high cholesterol
  • elevated lipids
  • sleep apnea
  • liver disease
  • abnormal uterine bleeding
  • high blood pressure
  • obesity possibly leading to issues with low self-esteem and depression
  • metabolic syndrome
  • nonalcoholic fatty liver (steatohepatitis)
  • depression and anxiety

Also, there is an increased risk of endometrial cancer, gestational diabetes, pregnancy-induced high blood pressure, heart attacks, and miscarriage.

Symptoms of PCOS
People with PCOS can have trouble gaining or losing weight.

Symptoms of PCOS may include:

  • Irregular menses.
  • Excess androgen levels.
  • Weight management difficulties including weight gain or difficulty losing weight.
  • Excessive facial and body hair growth known as hirsutism.
  • Sleep apnea.
  • High cholesterol and triglycerides.
  • Acanthosis nigricans – dark patches of skin.
  • Polycystic ovaries.
  • High stress levels.
  • High blood pressure.
  • Skin tags.
  • Infertility.
  • Acne, oily skin, dandruff.
  • Fatigue.
  • Male pattern balding.
  • Insulin resistance.
  • Type 2 diabetes.
  • Pelvic pain.
  • Depression and anxiety.
  • Decreased libido.

Tests and diagnosis of PCOS

There is not one single test to determine the presence of PCOS. However, a doctor can diagnose the condition through medical history, a physical exam that includes a pelvic exam, and blood tests to measure hormone, cholesterol, and glucose levels.

Additionally, an ultrasound may be used to look at the uterus and ovaries.

Treatments for PCOS

While there is no cure for PCOS, treatment is based on the management of a woman’s personal symptoms. The goal of treatment depends on whether the individual wants to become pregnant and aims to reduce the risk of secondary medical conditions, such as heart disease and diabetes.

There are several recommended treatment options for women with PCOS, including:

Birth control pills – to help regulate hormones and menstruation.

Diabetes medications – to manage diabetes if necessary.

Fertility medications – if pregnancy is desired. These include clomiphene (Clomid), a combination of clomiphene and metformin, or injectable gonadotropins, such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) medications. In certain situations, letrozole (Femara) may be recommended.

Fertility treatments – including in vitro fertilization (IVF) or inseminations.

Excessive hair growth may be reduced with the drug spironolactone (Aldactone) or eflornithine (Vaniqa). Finasteride (Propecia) may also be recommended, however, should not be handled by women who may become pregnant.

NOTE: contraception is required with spironolactone due to the risk of birth defects if taken while pregnant. Breast-feeding on this medication is not recommended. Other possible options to manage hair growth is laser hair removal, electrolysis, hormonal treatments, or vitamin and mineral use.

Surgical options include:

  • Ovarian drilling – tiny holes are made in the ovaries, which reduces the amount of androgens being produced.
  • Oophorectomy – removal of one or both ovaries.
  • Hysterectomy – removal of all or part of the uterus.
  • Cyst aspiration – removing fluid from the cyst.
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