PCOS 101

• Is also known as Stein-Leventhal Syndrome or Polycystic Ovary Disease (PCOD).
• Affects an estimated 6-10% of all women and most don't even know they have it.
• Is treatable, but not curable, by medications, changes in diet and exercise.
• Is one of the leading causes of infertility in women.
• Has been identified for 75 years and they still aren't sure what causes it.
• PCOS is generally considered a syndrome rather than a disease (though it is sometimes called Polycystic Ovary Disease) because it manifests itself through a group of signs and symptoms that can occur in any combination, rather than having one known cause or presentation.
• There is no cure for PCOS. It is a condition that is managed, rather than cured.
• Affects far more than just reproduction.
• At this time, there is no single definitive test for PCOS. This is because no exact cause of PCOS has been established yet. This is why there is a wide-range of opinion on how to diagnose and treat PCOS.
• Treatment of the symptoms of PCOS can help reduce risks of future health problems.
• PCOS is associated with increased risk for endometrial hyperplasia, endometrial cancer, insulin resistance, type II diabetes, high blood pressure, high cholesterol, and heart disease.
• IT IS NOT just a cosmetic problem.
• Although up to 15 million women in the U.S. alone have PCOS, less than half know they have it!

Can include the following symptoms:

• Irregular or absent menses
• Numerous cysts on the ovaries in many, but not all, cases
• High blood pressure
• Acne
• Elevated insulin levels, Insulin Resistance, or Diabetes
• Infertility
• Excess hair on the face and body
• Thinning of the scalp hair (alopecia)
• Weight Problems or obesity that is centered around your mid section

What a Polycystic Ovary looks like:

The many cysts in a polycystic ovary are follicles that have matured but, due to abnormal hormone levels, were never released. In a normal ovary, a single egg develops and is released each month.

Symptoms Associated with Polycystic Ovary Syndrome

Women with PCOS may have some of the following symptoms:

• Amenorrhea (no menstrual period), infrequent menses, and/or oligomenorrhea (irregular bleeding) — Cycles are often greater than six weeks in length, with eight or fewer periods in a year. Irregular bleeding may include lengthy bleeding episodes, scant or heavy periods, or frequent spotting.
• Oligo or anovulation (infrequent or absent ovulation) — While women with PCOS produce follicles — which are fluid-filled sacs on the ovary that contain an egg — the follicles often do not mature and release as needed for ovulation. It is these immature follicles that create the cysts.
• Hyperandrogenism — Increased serum levels of male hormones. Specifically, testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS).
• Infertility — Infertility is the inability to get pregnant within six to 12 months of unprotected intercourse, depending on age. With PCOS, infertility is usually due to ovulatory dysfunction.
• Cystic ovaries — Classic PCOS ovaries have a "string of pearls" or "pearl necklace" appearance with many cysts (fluid-filled sacs). It is difficult to diagnose PCOS without the presence of some cysts or ovarian enlargement, but sometimes more subtle alterations may not have been recorded, or are not recognized as abnormal, by the ultrasonographer.
• Enlarged ovaries — Polycystic ovaries are usually 1.5 to 3 times larger than normal.
• Chronic pelvic pain — The exact cause of this pain isn't known, but it may be due to enlarged ovaries leading to pelvic crowding. It is considered chronic when it has been noted for greater than six months.
• Obesity or weight gain — Commonly a woman with PCOS will have what is called an apple figure where excess weight is concentrated heavily in the abdomen, similar to the way men often gain weight, with comparatively narrower arms and legs. The hip:waist ratio is smaller than on a pear-shaped woman — meaning there is less difference between hip and waist measurements. It should be noted that most, but not all, women with PCOS are overweight.
• Insulin resistance, hyperinsulinemia, and diabetes — Insulin resistance is a condition where the body's use of insulin is inefficient. It is usually accompanied by compensatory hyperinsulinemia — an over-production of insulin. Both conditions often occur with normal glucose levels, and may be a precursor to diabetes, in which glucose intolerance is further decreased and blood glucose levels may also be elevated.
• Hypertension (high blood pressure) — Blood pressure readings over 140/90.
• Hirsutism (excess hair) — Excess hair growth such as on the face, chest, abdomen, thumbs, or toes.
• Alopecia (male-pattern baldness or thinning hair) — The balding is more common on the top of the head than at the temples.
• Acne/Oily Skin/Seborrhea — Oil production is stimulated by overproduction of androgens. Seborrhea is dandruff — flaking skin on the scalp caused by excess oil.
• Acanthosis nigricans (dark patches of skin, tan to dark brown/black) — Most commonly on the back of the neck, but also but also in skin creases under arms, breasts, and between thighs, occasionally on the hands, elbows and knees. The darkened skin is usually velvety or rough to the touch.
• Acrochordons (skin tags) — Tiny flaps (tags) of skin that usually cause no symptoms unless irritated by rubbing.

What is Polycystic Ovary Syndrome?  Polycystic Ovary Syndrome (PCOS) is the most common hormonal problem in women. It is also a metabolic disorder that affects several body systems and can cause significant long-term health consequences. PCOS is often characterized by enlarged ovaries, with multiple small painless cysts or follicles that form in the ovary. Two other key features of PCOS are production of excess androgens (male sex hormones) and annovulation (the failure to ovulate properly), which makes PCOS the leading cause of infertility.

What are the symptoms of PCOS?  The symptoms of PCOS can be not only physically debilitating, but also emotionally and psychologically wrenching. While no two women may have the same symptoms of POCS, they are likely to include any or all of the following:

·         Infertility

·         Irregular or absent periods

·         Excess hair growth on face and body

·         Male-Pattern hair thinning

·         Acne

·         Obesity

·         Lipid Abnormalities

If a woman has two or more of these symptoms, she should go to a physician, such as a reproductive endocrinologist, for an accurate diagnosis and treatment of symptoms.

Is PCOS life-threatening?  PCOS can be associated with a number of serious medical conditions. If left untreated, PCOS can lead to endometrial cancer and hysterectomy of the ovaries and uterus. PCOS affects the glucose levels of the body causing Insulin Resistance, a serious pre-diabetic condition.  PCOS increases a woman’s risk of heart attack and stroke because it increases cholesterol and blood pressure. PCOS is the leading cause of infertility in women. If causes Endometriosis, cysts, and early Ovarian failure.

How many women are affected by PCOS?  It is estimated that approximately five to ten percent of women may have PCOS, with some researchers suggesting that the number is as high as ten percent.

What Causes PCOS?  The susceptibility to PCOS is often inherited; however the precise cause is unknown.

How is PCOS diagnosed? While many physicians diagnose a woman with PCOS based on the symptoms listed above, confirmation of the diagnosis requires obtaining blood samples for a variety of hormones, including those produced by the ovaries, adrenal glands, pituitary gland and thyroid gland. A full physical examination and screening for cholesterol, triglyceride, glucose and insulin should also be part of a complete evaluation.

Is PCOS a gynecological or an endocrinological disorder?  Since many of the symptoms involve a woman’s reproductive system, PCOS is often mistaken for a gynecological disorder. It is, however, a disorder of the endocrine system, involving hormones and hormone production. Therefore a specialist in the endocrine system, such as a reproductive endocrinologist, should be consulted to confirm diagnosis.

Is there an overall treatment for PCOS?  Unfortunately, at the present time doctors can only treat the individual symptoms of women with PCOS, rather than the entire syndrome.  Once diagnosed, in most patients, it can be managed effectively to help them lead healthier and more satisfying lifestyles.  In the meantime, research continues to determine the cause and look for new and better treatments for PCOS.  

Are there other issues related to PCOS?  There is often a stigma attached to many of the symptoms of PCOS, particularly facial and body hair, infertility and obesity. Some women may even suffer from depression as a result of the symptoms. Women with PCOS need emotional and social support to deal with the effects of this condition on their lives Research has shown that a strong network of friends and family greatly enhances an individual’s ability to cope with the distressing effects of the syndrome.