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Polycystic ovarian syndrome (PCOS), also known as Stein-Leventhal Syndrome, is a hormonal imbalance that causes women to develop a number of small cysts on their ovaries. Cysts are abnormal growths that aren’t usually harmful in and of themselves, but can cause trouble when it comes to things like maintaining regular menstrual cycles and enabling fertility. In most cases, women with this condition produce too many male hormones and too few female hormones, which causes irregular ovulation. It afflicts approximately five to ten percent of women of childbearing age. It can be treated but not readily cured, though there are a range of things women can do once they’ve been diagnosed to manage their condition and keep it from interfering with their lives.
The female reproductive system is governed in large part byhormones, chemical signals that act as messengers in the body. Hormones control menstruation, which is a monthly shedding of the uterine lining, as well as ovulation, which is when an egg is released from the ovaries. Polycystic ovarian syndrome usually impacts ovulation most profoundly.
Under normal circumstances, ovulation occurs when a follicle containing the egg grows, then releases the mature egg. The ovaries produce estrogen, which is the female sex hormone, as well as small amounts of androgen, a male sex hormone. Polycystic ovarian syndrome causes an imbalance in hormone production such that there is often more androgen than estrogen. This prevents the follicle from growing, which results in a buildup of eggs in the ovaries. Small, benign, estrogen-releasing cysts in the ovaries result in most cases.
This release of estrogen, coupled with the presence of the male hormones, prevents two other hormones, the luteinizing hormone (LH) and the follicle-stimulating hormone (FSH), from being produced at the proper level. Without ovulation, the male hormones remain at a high level, causing a repeat in the cycle.
The most common symptoms include obesity, high blood pressure, high cholesterol, and diabetes, as well as elevated insulin levels and a condition known as “insulin resistance,” both of which are common precursors to diabetes. Patients may have patches of thicker, dark brown or black skin on their upper body, skin tags, and acne. Excessive hair growth is also very common, and sufferers may have hair growing on her chest, lower abdomen and face. PCOS patients may also experience alopecia, or thinning of the hair on the scalp. Most of this has more to do with the presence of excess male hormones than any ovarian growths.
Nonexistant or irregular menstrual cycles are also common. Women also may not ovulate regularly, if at all. Both of these can profoundly impact fertility. Many women with the condition find that they are unable to conceive without hormone therapy or other medical interventions.
Researchers are not entirely sure what causes polycystic ovarian syndrome. There is some evidence of a genetic link and the condition sometimes runs in families, but not always. Some have suggested that there may be a connection between the condition and a woman’s ability to produce insulin. It is common for women who have PCOS to produce excess insulin, which prompts the ovaries to compensate by mass-producing androgens in an effort to balance things out.
This condition is usually first suspected when a woman has irregular menstrual cycles, particularly if she is also overweight. A lot of things can cause menstrual irregularity, though; healthcare providers will usually perform a physical exam and take blood tests to measure levels of hormones in order to get a better picture of what is going on internally. An ultrasound may also be performed to locate any cysts in the ovaries.
Treatment typically starts with the advice to lose weight. Staying at a healthy size is often one of the easiest ways of correcting hormonal imbalances. Drug therapy is often very effective, too. Metformin, an insulin-sensitizing drug, helps women with polycystic ovarian syndrome to ovulate on their own.
Fertility drugs like clomiphene and gonadotropins typically have a 70 to 90% success rate in causing ovulation, and many women are also able to conceive within about a year of starting treatments. Conception isn’t always the end of the battle, though, since as many as one in five of these pregnancies end in miscarriage. If a woman suffering from polycystic ovarian syndrome is not trying to get pregnant, taking birth control pills may help balance the hormones, resulting in less acne and sparser hair growth.
Ovarian drilling is one common surgical treatment for PCOS. The doctor performing it inserts a small needle with an electric current into the ovary. This destroys a small part of the ovary, which hopefully lowers the production of male hormones. Possible side effects include the formation of scar tissue, which can sometimes actually make the condition worse. The procedure isn’t always successful, either, and is usually only recommended when the condition is seriously interfering with a patient’s life and no other treatment option is working.
It's pretty widely accepted now that insulin resistance is one of the causes of PCOS and its symptoms, not the other way around. Treating insulin resistance treats the root cause of the problem rather than just the symptoms. Metformin is commonly prescribed for PCOS and most people respond to it very positively, including with reduction of all symptoms, getting to regular menstrual cycles, and being able to conceive a child.
A co-worker has PCOS and was under the impression she was primarily diabetic, rather than dealing with PCOS. She got on Metformin and her symptoms improved so much, her doctor did more tests and concluded the diabetes was probably a symptom of PCOS.
She still has to watch her blood glucose and take the Metformin, but her other symptoms have really diminished and her doctor is very pleased with her progress. She is also feeling much better now that her hormones have settled and are more regulated. She said her mood swings have evened out and she feels more stable.