Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive-aged women, affecting between 6–8% of all such women. There is a higher incidence in women with a family history of PCOS, a personal for family history of diabetes, as well as in Hispanic women or overweight women.

Cause of PCOS

The cause of PCOS is unknown. It is a complex syndrome with an underlying genetic component. It is thought to arise from abnormal stimulation of the ovaries by the hormones that normally regulate ovarian function (FSH and especially LH). Up to 70% of patients with PCOS also show resistance of peripheral tissues to the actions of insulin (insulin resistance). Additionally, PCOS patients have increased production of male hormones (androgens) from the adrenals and an increased incidence of obesity (60% of patients).

Symptoms of PCOS

The classic symptoms of PCOS are irregular or absent menstrual cycles, acne, excessive facial or body hair (hirsutism), excessive loss of scalp hair, weight gain and difficulty becoming pregnant.

Laboratory Findings in PCOS

Testosterone and LH levels are usually elevated in PCOS. The ratio of LH to FSH may be elevated as well (LH:FSH > 2). Patients may also have an abnormal glucose tolerance test or abnormalities of their lipids (high LDL, high triglycerides, low HDL). Multiple cysts are sometimes (but not always) visible on ultrasound examination of he ovaries (80–100%).

Complications of PCOS

PCOS patients have an increased incidence of infertility, excessive hair growth, acne and irregular menstrual cycles. It is also associated with increased risk of obesity, heart disease, sleep apnea and diabetes. Approximately 35% of PCOS patients develop pre-diabetes by the age of 40; 10% of patients with PCOS develop type 2 diabetes. PCOS worsens as obesity increases.

Treatment of PCOS

Lifestyle changes to reduce weight are useful in overweight women with PCOS. Oral contraceptives are generally considered the first-line drug therapy in women with PCOS that are not trying to conceive. This treatment will help to regulate menstrual irregularities and improve acne and hirsutism. Low-dose contraceptives are less likely to cause weight gain. Medications normally used to lower insulin levels in diabetes have also shown to to improve PCOS. Metformin is most commonly recommended, but some studies show a benefit from thiazoladinedione compounds (Actos, Avandia). The combination of metformin and clomiphene citrate may be helpful in women trying to conceive. We also use spironolactone to control hair growth in some women with PCOS.

Close endocrine monitoring is required for women with PCOS to optimize therapy and monitor patients for potential complications that may arise from this common condition.