Polycystic Ovaries – Polycystic Ovarian Syndrome

What is polycystic ovarian syndrome?

A disorder in which many benign cysts (fluid-filled sacs that result from ovulation cycles) form on the ovaries (glands located on either side of the uterus in a woman’s lower abdomen) under a thick, white covering is known as polycystic ovarian syndrome (PCOS). This is a disease that is most common in women under the age of 30 years.

Many times no treatment is needed for ovarian cysts, as the most common cysts are enlargements of normal egg follicles.

What are the causes of polycystic ovarian disease?

A key feature in polycystic ovarian syndrome is insulin resistance. When a person is resistant to insulin, this implies that cells throughout the body do not readily respond to the insulin circulating in the blood. It is because of this reason that the amount of insulin remains high in the blood. Lack of ovulation, infertility, early pregnancy loss and high androgen levels are all because of high levels of insulin.

In polycystic ovarian disease under-developed follicles (sacs within the ovaries that contain eggs) collect in the ovaries. As the eggs in these follicles do not mature they cannot be released from the ovaries, so they accumulate as cysts in the ovaries. The inability to ovulate and the lack of follicle maturation are caused by the low levels of follicle stimulating hormone (FSH) and higher-than-normal levels of androgens (male hormones) that are produced in the ovary.

What are the symptoms and signs of polycystic ovarian syndrome?

Here are some signs and symptoms that a person with polycystic ovaries is likely to experience:

• Irregular, scanty or abnormal menstrual cycles
• Diabetes or insulin resistance
• Weight gain sometimes-even obesity
• Irritation of acne
• Decreased size of the breast
• Virilization i.e. the presence of male sex characteristics in a female. Increase of body hair, a deepening of the voice and enlargement of the clitoris are some of the characteristics.
• Absent periods which is usually after having one or more normal menstrual during puberty.
• Infertility

How is polycystic ovarian syndrome diagnosed?

To diagnose polycystic ovarian syndrome, the doctor records a detailed medical history and will ask for the following tests and examinations.

• Follicle stimulating hormones (FSH)
• LH levels
• Androgen levels
• Estrogen levels
• Vaginal ultrasound and maybe abdominal ultrasound too
• Laparoscopy
• Biopsy of the ovary
• MRI of the abdomen
• Urine 17 ketosteroids

The blood tests may include:

• Levels of prolactin
• Thyroid function tests
• Serum HCG (which is a pregnancy test)

How is polycystic ovarian disease treated?

The treatment for polycystic ovarian syndrome depends on the symptoms and on the fact whether the lady wants to get pregnant.

In the case that the lady does not want to get pregnant then the doctor may prescribe birth control pills. The birth control or hormone pills regularize the menstrual cycle and decrease abnormal hair growth. The risk of developing endometrical hyperplasia, a condition that can turn into uterine cancer is greatly reduced because of this treatment.

Fertility drugs may be prescribed if pregnancy is desired. In some cases, which are actually quite rare, the doctor may surgically remove or destroy a wedge of ovarian tissue. This may either cure the problem or regularize the menstrual cycles for a while. Obese patients may have to enroll for a weight control program and excess body hair that has resulted because of polycystic ovaries may be removed using electrolysis.

What are the possible complications that could result from polycystic ovarian syndrome?

Some of the complications that could result are:

• Problems related to obesity (diabetes and high blood pressure)
• Increased risk of breast cancer
• Increased risk of endometrial cancer
• Sterility