What is Polycystic Ovary Syndrome (PCOS)?
Polycystic Ovary Syndrome (PCOS)
The ovaries are the main reproductive organs in women that produce the eggs or ova. Eggs grow, develop, and mature in the ovaries and then are released during ovulation. Polycystic ovary syndrome (PCOS) is a syndrome in which the ovaries are enlarged and have several fluid-filled sacs or cysts. Ovarian cysts form on the ovaries when the follicles (sacs) on the ovary that contain the egg mature, but do not release the egg into the fallopian tube where it would be fertilized.
Polycystic ovaries are usually 1.5 to 3 times larger than normal ovaries. A woman can have one to many cysts which look like a string of pearls or a pearl necklace. Women with PCOS may experience a number of other symptoms as well. PCOS is a leading cause of infertility and is the most common reproductive syndrome in women of childbearing age. An estimated five to ten percent of women of childbearing age have PCOS (ages 20-40) and at least 30% of women have some symptoms of PCOS.
Causes of PCOS
PCOS develops when the ovaries overproduce androgens (eg, testosterone). Androgen overproduction often results from overproduction of LH (luteinizing hormone), which is produced by the pituitary gland. Research also suggests that when insulin levels in the blood are high enough, the ovary can be stimulated to produce more testosterone. Obesity, which itself can cause insulin levels to rise, may intensify PCOS. Yet, not all women who are overweight develop PCOS.
Symptoms of PCOS
Polycystic ovary syndrome is an endocrine (hormonal) disorder in which symptoms first appear in adolescence, around the start of menstruation. However, some women do not develop symptoms until their early to mid-20's. Although PCOS presents early in life, it persists through and beyond the reproductive years.
No two women experiencing PCOS have exactly the same symptoms. The following symptoms are very often associated with PCOS, but not all are seen in every woman:
- Infrequent menstrual periods, no menstrual periods, and/or irregular bleeding;
- Infrequent or no ovulation;
- Increased serum levels of male hormones, such as testosterone;
- Inability to get pregnant within six to 12 months of unprotected sexual intercourse (infertility);
- Pelvic pain that lasts longer than six months;
- Weight gain or obesity;
- Diabetes, over-production of insulin, and inefficient use of insulin in the body;
- Abnormal lipid levels (such as high or low cholesterol levels, and high triglycerides);
- High blood pressure (over 140/90);
- Excess growth of hair on the face, chest, stomach, thumbs, or toes;
- Male-pattern baldness or thinning hair;
- Acne, oily skin, or dandruff;
- Patches of thickened and dark brown or black skin on the neck, groin, underarms, or skin folds; and
- Skin tags, or tiny excess flaps of skin in the armpits or neck area.
PCOS and pregnancy
PCOS can negatively affect fertility since it can prevent ovulation. Some women with PCOS have menstrual periods, but do not ovulate. A woman with PCOS may be able to take fertility drugs, such as Clomid, or injectable fertility medications to induce ovulation. To help ovulation occur, women also can take insulin-sensitizing medications or steroids (to lower androgen levels). Research also shows that taking low doses of aspirin, which helps prevent blood clotting in the uterine lining and improves blood flow, can improve chances of pregnancy.
There appears to be a higher rate of miscarriage in women with PCOS (possibly by 45%). Elevated levels of insulin and glucose can cause problems with development of the embryo in pregnant women. In women with PCOS, insulin resistance and late ovulation (after day 16 of the menstrual cycle) may reduce egg quality further, which can lead to miscarriage. The best way to prevent miscarriage in women with PCOS is to normalize hormone levels to improve ovulation, and normalize blood sugar, glucose, and androgen levels.
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