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Polycystic Ovary Syndrome
Also known as
Polycystic ovary syndrome (PCOS), also called Stein-Leventhal syndrome, polycystic ovarian disease, or hyperandrogenic chronic anovulation, is an endocrine disorder that occurs in 5%-10% women. It can cause a myriad of symptoms that appear, on the surface, to be unrelated
Description
Polycystic ovary syndrome (PCOS) is a condition in which the ovaries accumulate tiny cysts, actually little follicles, 2 to 5 millimeters in diameter, each containing an egg. Instead of growing and going on to ovulate, the cysts stall and secrete male hormones into the blood. Ovulation is rare without the help of medications. In some women, there will be a long history of irregular periods and, perhaps, an increase in facial and body hair. Approximately 20% of women have mild polycystic ovaries (PCO).
PCOS is a major cause of infertility.
Causes
Unknown
Genetic
Insulin resistance, an abnormal response to oral glucose and/or elevated insulin levels in the blood disorder, may cause abnormal hormone responses in the ovaries.
Symptoms
Irregular or absent periods secondary to a lack of ovulation
Infertility
Weight gain, particularly around the waist (the 'apple' shape as opposed to the 'pear' or 'hourglass' shape which is more typical for women)
Hirsutism (excess body hair) that tends to worsen over time
Insulin resistance, as measured by a person's abnormal response to oral glucose and/or elevated insulin levels in the blood
Syndrome X: Insulin resistance is associated with high blood pressure, high triglyceride levels, and a decrease in HDL (the good cholesterol) and obesity.
Acne, male-pattern baldness
Multiple small cysts on the ovaries
Acanthosis nigricans (darkening of the skin under the arms, breasts and back of neck)
Diagnosis
History
Physical examination, including pelvic examination
Ultrasound
Blood tests to test the level of different hormones: High androgen levels (particularly free testosterone), high levels of luteinizing hormone (LH), or an elevated LH to follicle stimulating hormone ratio are characteristic of PCOS.
Treatment
In mild cases, treatment is not administered until a woman wants to become pregnant.
Medication to induce ovulation when infertility is caused by anovulation:
a. Clomiphene citrate (Clomid or Serophene) is generally taken daily from days 3-7 of a cycle. Ovarian follicle development is usually monitored with a combination of home urinary LH testing and office ultrasound examination. Additional endometrial support may be promoted with the use of progesterone or HCG injections. There is an increased rate of multiple pregnancies with Clomiphene (6-7%), but no increased risk of birth defects. The majority of women who conceive on Clomiphene will do so in the first 4 cycles.
b. Gonadotropins are prescribed if Clomiphene fails to successfully induce ovulation.
Medications are available to reverse hirsutism, regulate menstrual cycles, and control acne.
Watch for development of diabetes mellitus, high blood pressure, high cholesterol and/or high triglyceride levels, and treat aggressively, if present, with diet and medication.
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