Polycystic Ovary Syndrome

Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder affecting women of reproductive age. Characterized by a variety of symptoms and biochemical abnormalities, PCOS is primarily noted for its impact on a woman's ovarian function and metabolic health.

Overview

PCOS is one of the most common hormonal disorders among women of reproductive age, with a prevalence estimated to be between 6% to 12% depending on the population studied and the diagnostic criteria used. The disorder is named for the multiple (poly) cysts (small, fluid-filled sacs) that typically accumulate in the ovary. However, not all women diagnosed with PCOS have ovarian cysts.

Symptoms

The symptoms of PCOS can vary significantly from one individual to another but commonly include:

• Irregular menstrual cycles or absence of menstruation (amenorrhea)
• Hirsutism (excessive hair growth on the face and body)
• Acne and oily skin
• Scalp hair thinning or male-pattern baldness
• Obesity or difficulty losing weight
• Infertility or subfertility

Pathophysiology

The pathophysiology of PCOS involves multiple systems within the body, primarily the endocrine system. Key features include:

• Insulin resistance, which can lead to elevated insulin levels and may contribute to increased androgen production
• Hyperandrogenism (excess levels of androgens), which can cause many of the physical symptoms associated with PCOS
• Disruptions in the regulation of gonadotropins, such as Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH), which can affect ovarian function

Diagnosis

Diagnosis of PCOS is generally based on the presence of at least two of the following three criteria (known as the Rotterdam criteria):

1. Irregular ovulation or anovulation
2. Clinical or biochemical signs of hyperandrogenism
3. Polycystic ovaries visible on ultrasound

Management

Management of PCOS typically focuses on addressing the specific symptoms that each patient experiences. Treatment options may include:

• Lifestyle modifications, such as diet and exercise, which can help manage weight and reduce insulin resistance
• Pharmacotherapy for managing hormonal imbalances, such as hormonal contraceptives to regulate menstrual cycles and anti-androgens to reduce hair growth and acne
• Fertility treatments if pregnancy is desired, including medications like clomiphene citrate or In Vitro Fertilization (IVF)

Prognosis

While PCOS is a chronic condition, the prognosis can be good with appropriate management. Long-term complications can include an increased risk for developing type 2 diabetes, cardiovascular disease, and endometrial cancer. Regular monitoring and adjustments in treatment can help mitigate these risks.

Epidemiology

PCOS affects women across all ethnicities and backgrounds, although the prevalence and presentation can vary. It is also associated with other metabolic conditions such as obesity, type 2 diabetes, and metabolic syndrome.

See Also

• Endocrine disorders
• Menstrual cycle
• Insulin resistance syndrome