Polycystic ovary syndrome

Overview

Polycystic ovary syndrome or PCOS is a common hormonal problem in women of reproductive age. The imbalance levels of androgen hormone which causes irregularities in the menstrual cycle, such as a missed period or prolonged period days. It is a common cause of infertility in women.

PCOS is a “syndrome”, or collection of symptoms, that has an impact on the ovaries and ovulation. “Polycystic” means “many cysts” and is one of its main characteristics. It refers to the many fluid-filled sacs that form in the ovaries due to lack of ovulation. The sacs are called follicles, containing one immature egg each. Not all women with PCOS have small cysts in the ovaries.

PCOS has unknown cause. The treatment focuses on management of symptoms and lowering risk for other health conditions such as type 2 diabetes, high blood pressure, heart problems, and endometrial cancer.

Symptoms

PCOS can affect women and girls of reproductive age. According to a study, up to 70% of women with PCOS are not diagnosed.

The symptoms can vary for every individual. Women may start noticing the symptoms of PCOS around the time of their first period or during pregnancy difficulties. Common symptoms are:

• Menstrual irregularities: Higher levels of androgen prevent ovulation and cause irregular periods. Women with PCOS have longer periods than what is considered normal. Some will have fewer than eight periods a year, with intervals greater than 35 days. Some will not have any period at all. Women with irregular periods may experience difficulties getting pregnant.
• Too much androgen: Excessive level of male hormones (androgen) can cause acne, excess body hair growth and thinning of scalp hair in women. Hirsutism is an excess hair growth pattern that appears in the face and body – including the back, belly, and chest of women.
• Polycystic ovaries: Women with PCOS can have multiple small cysts on the ovaries. The follicles which contain one immature egg can form on the border of the ovary. Immature eggs cannot trigger ovulation.

Some women with PCOS may not have any symptoms. However, women who are overweight are most likely to experience severe symptoms.

Women who experience these symptoms are recommended to consult the gynecologist for proper diagnosis.

Causes

PCOS has unknown cause. Several factors that may contribute are:

• Family History: Women whose mother or sister has PCOS are more likely to develop this condition. One or many genes can contribute to PCOS.
• Insulin resistance: Women with PCOS often have insulin resistance as the body cannot effectively use the insulin, which is a hormone produced by the pancreas that helps the body use sugar for energy. The body needs more insulin when cells cannot effectively use it, therefore the pancreas produces extra insulin, which further causes the ovaries to create more male hormones known as androgen. Excessive levels of androgen negatively impact the ovaries.

Obesity is one of the major contributors to insulin resistance. Women with insulin resistance have higher risk for type 2 diabetes. They may also notice darkening of skin in the lower part of the neck, armpits, groin or under the breasts.

• Inflammation: Research suggests a strong association between PCOS and low-grade inflammation. The levels of C-reactive protein (CRP) and white blood cells seen in blood tests determines the level of inflammation in the body.

Chronic, low-grade inflammation causes polycystic ovaries to create androgens which can result to heart and blood vascular issues. Inflammation can also be increased by being overweight.

• Androgen: Excess androgen production can cause PCOS and cause acne and hirsutism. Abnormal androgen levels hamper ovulation which causes irregular menstrual period.