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Polycystic ovary syndrome (PCOS)

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Related Terms
  • Functional ovarian hyperandrogenism, hyperandrogenic chronic anovulation, infertility, ovarian hyperthecosis, PCOD, PCOS, polycystic ovarian syndrome, polycystic ovaries, polycystic ovary disease, polyfollicular ovarian disease, sclerocystic ovary syndrome, Stein-Leventhal syndrome.

Background
  • Polycystic ovary syndrome (PCOS), also called polycystic ovarian syndrome, is an endocrine disorder that affects approximately 5-10% of women of childbearing age. It is a leading cause of infertility and occurs among all races and nationalities. It is the most common hormonal disorder among women of reproductive age.
  • Women with PCOS have a hormonal imbalance. Although the exact cause of PCOS is unknown, insulin resistance, diabetes, and obesity are all strongly correlated with the syndrome. PCOS may be inherited. Not all women with PCOS have polycystic ovaries, nor do all women with ovarian cysts have PCOS. Risk factors include a family history, diabetes, or the use of valproic acid.
  • Symptoms of PCOS include weight problems, lack of regular ovulation and/or menstruation, skin changes, small cysts (fluid-filled sacs) in the ovaries, trouble getting pregnant, and excessive amounts or effects of androgenic (masculinizing) hormones. The symptoms and severity of the syndrome tend to start gradually and vary greatly among women. Women are usually diagnosed when in their 20s or 30s, but PCOS may also affect teenage girls. In these girls, the symptoms often begin after the first menstrual cycle. It is common for PCOS symptoms to be mistaken for other medical problems. Symptoms may be especially noticeable after a weight gain.
  • There is no single definitive test to diagnose PCOS. Although there is some disagreement in the medical community, PCOS is generally diagnosed based on medical history, physical exam, ultrasound of the ovaries, and the results of blood tests. Women diagnosed with PCOS are advised to see medical specialists, such as an endocrinologist, for long-term management of the syndrome. A reproductive endocrinologist may be able to assist women with PCOS that are trying to conceive.
  • PCOS cannot be prevented. However, early diagnosis and treatment may help in the prevention of long-term complications, such as endometrial cancer, infertility, diabetes, high blood pressure, and heart disease.
  • There is no cure for PCOS. However, treatments are available to help control symptoms, such as irregular menstrual cycles, acne, and unwanted hair growth. Treatments include lifestyle modifications, medications, and, rarely, surgery. It is possible to have a normal life with proper management of PCOS symptoms. Becoming pregnant may be difficult, however.

Signs and symptoms
  • General: Symptoms of polycystic ovary syndrome (PCOS) include weight problems, lack of regular ovulation and/or menstruation, skin changes, small cysts in the ovaries, trouble getting pregnant, and excessive amounts or effects of androgenic (masculinizing) hormones. The symptoms and severity of the syndrome tend to start gradually and vary greatly among women. Women are usually diagnosed when in their 20s or 30s, but PCOS may also affect teenage girls. In these girls, the symptoms often begin after the first menstrual cycle. It is common for PCOS symptoms to be mistaken for other medical problems. Symptoms may be especially noticeable after a weight gain.
  • Abnormal hair growth patterns: About 70% of women in the United States with PCOS experience abnormal female hair growth patterns. Hirsutism (excess hair) may occur, resulting in excess hair growth on the face, chest, nipple area, back, stomach, thumbs, or toes. Alopecia (male-pattern baldness) may also occur, with baldness or hair thinning at the top of the head.
  • Abnormal lipid levels: Some women with PCOS have elevated LDL cholesterol and triglyceride levels as well as reduced HDL cholesterol levels.
  • Breathing problems: Some PCOS patients may experience obstructive sleep apnea, or trouble breathing while sleeping. This symptom is linked to both obesity and insulin resistance.
  • Depression: Some PCOS symptoms may affect a woman's sense of well-being, sexual satisfaction, and quality of life, which may lead to depression.
  • Hormonal imbalance: Women with PCOS often have increased blood serum levels of androgens, commonly referred to as "male hormones." Examples are testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS).
  • Hypertension (high blood pressure): Blood pressure readings over 140/90mmHg may occur.
  • Infertility: Women with PCOS may have trouble becoming pregnant, due to infrequent or absent ovulation. Follicles are sacs within the ovaries that contain eggs. In PCOS, there are many poorly developed follicles in the ovaries. The eggs in these follicles do not mature and therefore cannot be released from the ovaries during each menstrual cycle. Instead, they may form very small cysts in the ovary.
  • Insulin resistance: About half of women with PCOS have problems with how the body uses insulin, causing insulin resistance. Patients with insulin resistance have high levels of insulin in the blood and elevated blood glucose levels, which may progress to diabetes. Symptoms of too much insulin (hyperinsulinemia) may include upper body weight gain and skin changes.
  • Male sex characteristics: Virilization (development of male sex characteristics), such as increased hair growth on the chest, stomach, back, and face; a deepening of the voice; male-pattern baldness; decreased breast size; and enlargement of the clitoris (very rare), may occur due to higher-than-normal levels of androgens (often called "male hormones").
  • Menstrual period irregularities: Some women with PCOS may have amenorrhea (no menstrual periods), although they usually have had a history of having one or more normal menstrual periods during puberty. Others may have few menstrual periods (less than nine per year). Approximately 30% of women with PCOS have irregular bleeding, including heavy bleeding, light bleeding, or frequent spotting. Some women with PCOS have regular periods but are not ovulating (releasing an egg) each month.
  • Miscarriages: Some women with PCOS have frequent miscarriages. It is not clear why this happens, although it may be caused by high insulin levels or abnormal ovulation.
  • Ovary abnormalities: During an ultrasound procedure, PCOS ovaries have a "string of pearls" or "pearl necklace" appearance, with many cysts. Polycystic ovaries are usually 1.5-3 times larger than normal.
  • Pelvic pain: Some women may experience pelvic pain that is chronic, or lasts longer than six months. The pain may be due to enlarged ovaries putting pressure on other organs.
  • Skin problems: Pimples and an oily face can also bother women with PCOS, due to increased androgen levels. Acne may worsen. It is caused by high androgen levels and is usually found around the face, especially along the jaw line, chest, and back. Seborrhea (dandruff, or flaking skin on the scalp) may be caused by excess oil production. Acrochordons (skin tags, or tiny flaps of skin that usually cause no symptoms unless irritated by rubbing) may occur. Acanthosis nigricans may also occur, which is dark or thick skin markings and creases around the armpits, groin, neck, and breasts due to insulin sensitivity. These areas of skin may be tan to dark brown or black and velvety or rough to the touch.
  • Weight gain: Most, but not all, women with PCOS are overweight. Some women with PCOS gain weight around their abdomen, taking on an apple shape rather than a pear shape. Such weight gain has been linked with hormonal, glucose, and insulin imbalances in the body.

Diagnosis
  • General: There is no single definitive test to diagnose polycystic ovary syndrome (PCOS). Although there is some disagreement in the medical community, PCOS is generally diagnosed based on medical history, physical exam, ultrasound of the ovaries, and the results of blood tests. Women diagnosed with PCOS are advised to see medical specialists, such as an endocrinologist, for long-term management of the syndrome. A reproductive endocrinologist may be able to assist women with PCOS who are trying to conceive.
  • A detailed medical history is the first step in determining if someone has PCOS. A medical practitioner will gather information, such as changes in body weight, skin, hair, and menstrual cycle. Information regarding fertility, as well as a family history of PCOS or other medical conditions, may assist in the diagnosis. Diabetes, high blood pressure, high cholesterol, weight gain, and obesity are often found in PCOS patients.
  • Blood tests: Patients with PCOS may be tested for unusually high levels of androgens, also called "male hormones." Due to fertility problems associated with PCOS, female reproductive hormones may also be tested. Blood samples are usually tested for irregularities in the following hormone levels: testosterone and androstenedione (androgens), human chorionic gonadotropin (hCG, pregnancy test), estrogen, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin, as well as the LH:FSH ratio. Levels of sex hormone-binding globulin (SHBG), a protein that binds to sex hormones, may also be determined. Since patients with PCOS often have abnormal lipid levels, a lipid panel, including testing levels of cholesterol and triglycerides, may aid in the diagnosis. Due to the association between diabetes and PCOS, the following tests may be performed: blood sugar, fasting glucose, insulin levels, and a glucose tolerance test (GTT). To rule out adrenal gland problems, levels of adrenal hormones, such as DHEAS or 17-hydroxyprogesterone, may be measured. Thyroid-stimulating hormone (TSH) levels may be measured to check for an overactive or underactive thyroid. Blood markers of kidney and liver function may also be tested.
  • Pelvic examination: During a pelvic examination, enlarged ovaries and, rarely, an enlarged clitoris may indicate PCOS.
  • Physical exam: Findings that may indicate PCOS during a physical exam include an enlarged thyroid, skin problems, unusual hair growth, high blood pressure, and enlarged or abnormal ovaries. Weight, body mass index (BMI), and waist circumference may indicate a risk for developing PCOS.
  • Ultrasound: Pelvic ultrasound provides a safe, noninvasive way to evaluate the size, shape, and configuration of the ovaries. Ultrasound uses high-frequency sound waves to produce images of the inside of the body. An ultrasound of the ovaries is usually performed transvaginally, where the probe is placed into the vagina. An abdominal ultrasound may also be performed, where the probe is placed on the belly. Some, but not all, women with PCOS show enlarged ovaries or more eggs than normal on the ovaries. Ultrasound technicians look for a "string of pearls" inside the ovary, where the pearls are the cysts. Diagnosis of polycystic ovaries may be made if there are at least 8-10 cysts that are less than 10 millimeters in size on each ovary. The polycystic ovary tends to be enlarged to 1.5-3 times the size of a normal ovary and often has an increase in the stromal tissue in the center of the ovary and around the follicles.
  • Other tests: Other diagnostic tests may include computerized tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI). In a surgical procedure called pelvic laparoscopy, a laparotomy may be used to look more closely at the ovaries. The surgeon may collect samples of abdominal fluid and remove an ovary for examination by a pathologist.

Complications
  • General: Polycystic ovary syndrome (PCOS) is associated with increased risk for endometrial cancer, infertility, diabetes, high blood pressure, and heart disease. It is unclear if there is an increased risk for development of breast cancer.
  • Diabetes: About half of women with PCOS have problems with how the body uses insulin, causing insulin resistance. Patients with insulin resistance have high levels of insulin in the blood and elevated blood glucose levels, which may progress to diabetes. It is recommended that women with PCOS have blood glucose testing for diabetes by age 30. This testing should be done at an earlier age if other risk factors for diabetes are present, such as obesity, lack of exercise, a family history of diabetes, or gestational diabetes during a past pregnancy.
  • Heart disease: PCOS is linked to higher risks of high blood pressure, weight gain, high cholesterol, heart disease, atherosclerosis, heart attack, and stroke. For this reason, levels of cholesterol and triglycerides, blood pressure, and weight should be monitored frequently in PCOS patients.
  • Infertility: Women with PCOS may have trouble becoming pregnant due to infrequent or absent ovulation. Follicles are sacs within the ovaries that contain eggs. In PCOS, there are many poorly developed follicles in the ovaries. The eggs in these follicles do not mature and therefore cannot be released from the ovaries during each menstrual cycle. Instead, they may form very small cysts in the ovary. Early treatment of PCOS may prevent infertility or increase the chance of having a healthy pregnancy.
  • Obesity-related conditions: Obese patients (with a body mass index (BMI) over 30 and a waist circumference greater than 35) with PCOS may be at risk for high blood pressure and heart problems.
  • Uterine (endometrial) cancer: Often women with PCOS will have infrequent menstrual cycles or no menstrual cycles at all. This causes the uterine lining to build up for a long time and puts these patients at risk for endometrial hyperplasia (precancer of the uterine lining). A transvaginal ultrasound and/or endometrial biopsy may be performed regularly to look for signs endometrial cancer.

Treatment
  • General:
  • There is no known cure for polycystic ovary syndrome (PCOS). However, treatments are available to help control symptoms such as irregular menstrual cycles, acne, and unwanted hair growth. Early diagnosis and treatment may also prevent long-term problems, such as infertility, miscarriages, diabetes, uterine cancer, and heart disease.
  • Dietary/lifestyle modifications:
  • Healthy diet: It is recommended to consume a balanced, healthy diet that includes lots of fruits, vegetables, and whole grains. Eating a low-carbohydrate diet and cutting down or eliminating estrogen-rich foods, such as tomatoes, nonorganic red meat, and dairy products, may have some benefit. High carbohydrate consumption leads to weight gain, and the storage of estrogen in fat cells. Enlarged fat cells lead to high estrogen storage. High estrogen promotes ovarian cysts that do not dissolve normally. High carbohydrate consumption affects prostaglandin hormones, which lead to cyst fluid retention or swelling and the pain response.
  • Not smoking: Women who smoke have higher levels of androgens than women who don't smoke, which may worsen PCOS symptoms. Smoking also increases the risk of heart disease.
  • Regular exercise: PCOS patients that exercise regularly feel better about themselves and have an easier time maintaining a healthy body weight and preventing PCOS-related complications, such as heart disease.
  • Weight loss: PCOS is linked to higher risks of obesity and high cholesterol. Obese patients (with a body mass index (BMI) over 30 and a waist circumference greater than 35) with PCOS may be at risk for high blood pressure and heart problems. For women with this condition who are overweight, weight loss can reduce insulin resistance, stimulate ovulation, and improve fertility rates. It may also help with diabetes, high blood pressure, and high cholesterol. Even a weight loss of 5% of total body weight has been shown to help with the imbalance of hormones and also with infertility. A nutritionist may help to develop personalized diet plans.
  • Medications:
  • Birth control: Several types of birth control may be used to ensure regular shedding of the endometrium to make menstrual cycles more regular and prevent cyst formation, as well as reduce the risk of uterine cancer. Combination estrogen and progestin hormones in birth control pills, vaginal rings, or skin patches may be used. The hormones present in these treatments may also improve acne problems, male-type hair growth, and male-pattern hair loss.
  • Birth control treatments do not protect against human immunodeficiency virus (HIV) infection or transmission or other sexually transmitted diseases. Common adverse effects include abdominal pain, breast tenderness, fluid retention, weight gain, and headache. Females on birth control therapy should consult a healthcare professional before becoming pregnant or using tobacco products, potassium-containing products (e.g., potassium iodide, potassium salts, dietary salt substitutes), heparin, anticonvulsants, or antibiotics.
  • Clomiphene citrate: Clomiphene citrate (Clomid®, Serophene®) is an example of a fertility drug that may be used by PCOS patients who are having trouble becoming pregnant. Clomiphene citrate causes the pituitary gland to produce more follicle-stimulating hormone (FSH), which causes the egg to mature and be released.
  • Females taking clomiphene citrate should consult a healthcare professional before becoming pregnant or using DHEA supplements, chasteberry, chaste tree fruit, Vitex agnus-castus, black cohosh, or Cimicifuga racemosa. Patients with hepatic disease, untreated adrenal insufficiency, pituitary problems, ovarian problems, abnormal uterine bleeding, ovarian or endometrial cancer, untreated thyroid disease, diabetes mellitus, hirsutism (or hyperandrogenism), hyperinsulinemia, obesity, or lowered levels of endogenous estrogen should consult a healthcare provider before using clomiphene citrate. Clomiphene should not be administered to patients with ovarian enlargement or a preexisting ovarian cyst that is not due to PCOS. Common adverse effects include flushing, abdominal discomfort, insomnia, blurred vision, feeling nervous, and enlargement of ovaries.
  • Eflornithine: Eflornithine (Vaniqa®) is a prescription skin cream used to prevent facial hair growth. Common adverse effects include acne and stinging or burning of the skin.
  • Flutamide: Flutamide is an antiandrogen that may be used to treat hirsutism, or excessive hair growth. Patients that are pregnant or have liver problems should avoid flutamide. Common adverse effects include rash, hot sweats, diarrhea, and nausea.
  • Metformin: Metformin (Glucophage®) is an antidiabetic agent that is used to lower blood glucose in patients that have insulin resistance. It may help make ovulation and menstrual cycles more regular, prevent type 2 diabetes, and assist in weight loss. Metformin may improve fertility and reduce miscarriages. Other antidiabetic medications that may be used include rosiglitazone maleate (Avandia®) and pioglitazone HCl (Actos®).
  • Metformin may cause or worsen congestive heart failure and is not recommended in patients with heart problems. Lactic acidosis is a rare but serious metabolic complication that can occur due to metformin accumulation during treatment with metformin or pioglitazone. When it occurs, it is fatal in approximately 50% of cases. Common adverse effects include edema, edema of the lower extremities, weight gain, diarrhea, headache, and dizziness. Females taking metformin should consult a healthcare professional before becoming pregnant or using other antidiabetic medications, calcium-channel blockers, antifungals, or thiazide diuretics.
  • Progestins: For women that are not able to use the hormone estrogen, progestin shots or pills may be used to make the endometrial lining build up and shed, similar to a menstrual period. There are three prescription progestins that do not increase androgen levels and are best for PCOS treatment: norgestimate, desogestrel, and drospirenone. Side effects may include headaches, fluid retention, and mood changes.
  • Spironolactone: Spironolactone (Aldactone®) is a potassium-sparing diuretic that lowers androgen levels and is often used with estrogen-progestin birth control pills in PCOS patients. It may be effective in preventing bone loss in young women given a gonadotropin-releasing hormone agonist. It is also effective in the treatment of acne, male-pattern baldness, and excessive hair growth (hirsutism).
  • Spironolactone should not be used in patients with high potassium levels. Pregnant patients, those with renal disease, and the elderly should consult with a healthcare provider before using spironolactone. Spironolactone should not be used at the same time as other potassium-sparing diuretics, potassium supplements, potassium-containing medications, cyclosporine, tacrolimus, trimethoprim, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor antagonists (ARBs). Common adverse effects include rash, gynecomastia, stomach cramps, diarrhea, headache, nausea, vomiting, and lethargy.
  • Surgical treatment:
  • General: Surgical removal of small cysts is sometimes used for women with infertility caused by PCOS who do not start ovulating after all other available treatments have been tried. There is a slight risk that ovarian surgery may cause scar tissue that may cause pain or further fertility problems.
  • Ovarian wedge: Ovarian wedge resection is the surgical removal of part of an ovary that is performed to help regulate menstrual cycles and start normal ovulation. It is rarely used due to the risk of scarring.
  • Laparoscopic ovarian drilling: Laparoscopic ovarian drilling is a surgical treatment that may trigger ovulation in women over the short term. In this procedure, a laser may be used to destroy portions of the ovaries. It is not clear how effective this treatment is in PCOS patients. Younger women with a healthy body weight are the most likely to benefit from laparoscopic ovarian drilling.
  • Other treatments:
  • Topical agents: Over-the-counter creams are available to treat acne.
  • Hair removal: Excessive hair growth slows when androgen levels in the body are normalized during the treatment of PCOS. Additional methods that may be used to remove unwanted hair include laser hair removal, electrolysis (hair removal by an electric current), depilatories (chemical hair removal products applied to the skin), waxing, shaving, tweezing, and bleaching.

Integrative therapies
  • Good scientific evidence:
  • Chromium: Chromium picolinate may help improve glucose tolerance in women with polycystic ovary syndrome (PCOS). However, chromium does not appear to alter hormones. Additional research is needed to confirm these findings.
  • Trivalent chromium appears to be safe, because side effects are rare or uncommon. However, hexavalent chromium may be toxic (poisonous). Avoid if allergic to chromium, chromate, or leather. Use cautiously with diabetes, liver problems, weakened immune systems (such as HIV/AIDS patients or organ transplant recipients), depression, Parkinson's disease, heart disease, and stroke, and in patients who are taking medications for these conditions. Use cautiously if driving or operating machinery. Use cautiously if pregnant or breastfeeding.
  • Unclear or conflicting scientific evidence:
  • Acupuncture: There is preliminary evidence suggesting electroacupuncture may increase ovulation in some women with PCOS. However, the study design was inadequate to recommend for or against electroacupuncture for this indication.
  • Acupuncture is generally considered safe. Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders or anticoagulants (drugs that increase the risk of bleeding), medical conditions of unknown origin, and neurologic disorders. Avoid on areas that have received radiation therapy. Avoid during pregnancy. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, and those with a history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.
  • Arginine: Arginine is a semiessential amino acid, which means that although the body normally makes enough of it, supplementation with additional amounts is sometimes needed. Arginine is found in foods containing protein. In preliminary research, treatment with N-acetyl cysteine (NAC) and L-arginine restored gonadal function in patients with PCOS.
  • Use caution in patients with bleeding disorders or those taking drugs that may increase the risk of bleeding. Use caution in patients with diabetes or hypoglycemia or those taking agents that affect blood sugar. Use caution in patients with impaired kidney function, those at risk for high blood potassium (including those with diabetes), or those using drugs that elevate potassium levels (including potassium-sparing diuretics and potassium supplements). Use caution with phosphodiesterase inhibitors (such as sildenafil [Viagra®]), in postmenopausal patients, in patients with herpes virus, and in individuals at risk for headaches. Use caution in patients with immunological disorders, acrocyanosis, sickle cell anemia, hyperchloremic acidosis, or guanidinoacetate methyltransferase (GAMT) deficiency. Avoid in those with low blood pressure or those using blood-pressure lowering agents, in patients with asthma or breast cancer, in those at risk for or with a history of heart attack, or in those using nitrates or spironolactone. Avoid in pregnant or breastfeeding women. Avoid with known allergy or sensitivity to arginine.
  • Licorice: Spironolactone is a synthetic steroid that is commonly used as a diuretic in women with PCOS. Licorice has been used in combination with spironolactone to reduce side effects related to the diuretic activity of spironolactone,
  • Avoid licorice if with a known allergy to licorice, any component of licorice, or any member of the Fabaceae (Leguminosae) plant family. Avoid licorice in those with congestive heart failure, coronary heart disease, kidney or liver disease, fluid retention, high blood pressure, or hormonal abnormalities, or those taking diuretics. Licorice can cause abnormally low testosterone levels in men or high prolactin or estrogen levels in women, which may make it difficult to become pregnant and may cause menstrual abnormalities.
  • N-acetyl cysteine: N-acetyl cysteine (NAC) is made from the amino acid L-cysteine. It may act as a strong antioxidant. Limited evidence suggests that NAC may increase ovulation and chances of pregnancy and improve insulin levels in women with PCOS. Results are mixed, however.
  • Use with caution in patients with bleeding disorders or those taking drugs that may increase the risk of bleeding, in patients with blood pressure disorders or those taking agents that affect blood pressure, or in patients with diabetes or high or low blood sugar, or those taking agents that affect blood sugar. Use with caution in patients with heart disease, gastrointestinal disorders, breathing disorders, zinc deficiency, or unpleasant mood, or those complaining of dizziness, lightheadedness, or visual complaints. Use with caution in those using antibiotics or nitroglycerin, or those needing charcoal treatment. Avoid in doses greater than 30 grams daily. Avoid in pregnant or breastfeeding women. Avoid with known allergy or sensitivity to NAC or related substances.
  • Traditional Chinese medicine (TCM): TCM herbs have been reported to not reduce symptoms, but to increase pregnancy rates in women with PCOS. More studies are needed to explore the possible contributions of TCM herbs in this condition.
  • Chinese herbs can be potent and may interact with other herbs, foods, or drugs. Patients should consult a qualified healthcare professional before taking. There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metal or not containing the listed ingredients. Herbal products should be purchased from reliable sources.

Prevention
  • General: Polycystic ovary syndrome (PCOS) cannot be prevented. However, early diagnosis and treatment may help in the prevention of long-term complications, such as infertility, obesity, diabetes, and heart disease.
  • Blood pressure monitoring: PCOS is linked to higher risks of high blood pressure. For this reason, blood pressure should be monitored frequently in PCOS patients.
  • Dietary modifications: There is no clinical evidence supporting a dietary modification in the prevention of PCOS. However, eating a low-carbohydrate diet and cutting down or eliminating estrogen-rich foods, such as tomatoes, nonorganic red meat, and dairy products, may have some benefit. High carbohydrate consumption leads to weight gain, and the storage of estrogen in fat cells. Enlarged fat cells lead to high estrogen storage. High estrogen promotes ovarian cysts that do not dissolve normally. High carbohydrate consumption affects prostaglandin hormones, which lead to cyst fluid retention or swelling and the pain response.
  • Glycemic control: About half of women with PCOS have problems with how the body uses insulin, causing insulin resistance. Patients with insulin resistance have high levels of insulin in the blood and elevated blood glucose levels, which may progress to diabetes. It is recommended that women with PCOS have blood glucose testing for diabetes by age 30. This testing should be done at an earlier age if other risk factors for diabetes are present, such as obesity, lack of exercise, a family history of diabetes, or gestational diabetes during a past pregnancy.
  • Uterine (endometrial) cancer testing: Often women with PCOS will have infrequent menstrual cycles or no menstrual cycles at all. This causes the uterine lining to build up for a long time and puts these patients at risk for endometrial hyperplasia (precancer of the uterine lining). A transvaginal ultrasound and/or endometrial biopsy may be performed regularly to look for signs endometrial cancer.
  • Weight loss: PCOS is linked to higher risks of obesity and high cholesterol. For this reason, levels of cholesterol and triglycerides, as well as body weight, should be monitored frequently in PCOS patients. Obese patients (with a body mass index (BMI) over 30 and a waist circumference greater than 35) with PCOS may be at risk for high blood pressure and heart problems. Losing weight may help to reduce the high insulin levels in the blood. For women with this condition who are overweight, weight loss can reduce insulin resistance, stimulate ovulation, and improve fertility rates. Even a weight loss of 5% of total body weight has been shown to help with the imbalance of hormones and also with infertility.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Andy C, Flake D, French L. Clinical inquiries. Do insulin-sensitizing drugs increase ovulation rates for women with PCOS? Journal of Family Practice. 2005; 54 (2): 156, 159-60.
  2. Barnard L, Ferriday D, Guenther N, et al. Quality of life and psychological well being in polycystic ovary syndrome. Human Reproduction. 2007; 22 (8): 2279-2286.
  3. Boomsma CM, Fauser BC, Macklon NS. Pregnancy complications in women with polycystic ovary syndrome. Seminars in Reproductive Medicine. 2008; 26 (1): 72-84.
  4. Brewer M, Pawelczak M, Kessler M, et al. A review of polycystic ovarian syndrome in adolescents. Minerva Pediatr. 2010 Oct;62(5):459-73.
  5. Chen ZJ, Shi Y. Polycystic ovary syndrome. Front Med China. 2010 Sep;4(3):280-4.
  6. Goldenberg N, Glueck C. Medical therapy in women with polycystic ovarian syndrome before and during pregnancy and lactation. Minerva Ginecologica. 2008; 60 (1): 63-75.
  7. Legro RS, Barnhart HX, Schlaff WD. Clomiphene, metformin, or both for infertility in the polycystic ovary syndrome. New England Journal of Medicine. 2007; 356 (6): 551-66.
  8. Marsh K, Brand-Miller J. The optimal diet for women with polycystic ovary syndrome? British Journal of Nutrition. 2005 Aug; 94 (2): 154-65.
  9. Moran LJ, Hutchison SK, Norman RJ, et al. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD007506.
  10. National Institutes of Health.
  11. National Women's Health Information Center.
  12. Natural Standard: The Authority on Integrative Medicine.
  13. Navaratnarajah R, Pillay OC, Hardiman P. Polycystic ovary syndrome and endometrial cancer. Seminars in Reproductive Medicine. 2008; 26 (1): 62-71.
  14. Polycystic Ovarian Syndrome Association (PCOSA).
  15. Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Fertility and Sterility. 2008 Mar; 89 (3): 505-22.

Causes
  • General: Women with polycystic ovary syndrome (PCOS) have a hormonal imbalance. Although the exact cause of PCOS is unknown, insulin resistance, diabetes, and obesity are all strongly correlated with the syndrome. PCOS may be inherited.
  • Genetic predisposition: Mutations in a combination of yet unidentified genes may be responsible for causing PCOS. Research in this area is ongoing.
  • Hormonal irregularities: Polycystic ovaries develop when the ovaries are stimulated to produce excessive amounts of androgens (often referred to as "male hormones"), particularly testosterone. This may occur as a result of the release of excessive luteinizing hormone (LH) by the anterior pituitary gland or through hyperinsulinemia (high levels of insulin in the blood) in susceptible women. High androgen levels in a woman cause male-type hair and acne problems. When the hormones that trigger ovulation are not at the right levels, the ovary does not release an egg every month. In some women, cysts form on the ovaries. The cysts then cause the production of additional androgen.
  • Insulin resistance: About half of women with PCOS have problems with how the body uses insulin, causing blood sugar levels to become elevated. If not treated, elevated insulin levels may contribute to increased androgen production, worsening PCOS symptoms and eventually increasing the risk of certain cancers, diabetes, and heart disease.
  • Poorly developed follicles: Follicles are sacs within the ovaries that contain eggs. In PCOS, there are many poorly developed follicles in the ovaries. The eggs in these follicles do not mature and therefore cannot be released from the ovaries during each menstrual cycle. Instead, they may form very small cysts in the ovary.
  • Valproic acid: Use of the seizure medication valproic acid (Depakene®, Depakote®, Epilim®, Stavzor®) has been associated with an increased risk of developing PCOS. It is unclear whether PCOS symptoms are caused in some women due to the valproic acid treatment or the epileptic condition.

Risk factors
  • Genetics: The main risk factor for polycystic ovary syndrome (PCOS) is a family history of the syndrome. Mutations in a combination of yet unidentified genes may be responsible. Sisters and daughters of patients with PCOS have a 50% chance of also developing PCOS.
  • Diabetes: A family history of diabetes may increase the risk of developing PCOS.
  • Valproic acid: Use of the seizure medication valproic acid (Depakene®, Depakote®, Epilim®, Stavzor®) may be associated with an increased risk of developing PCOS.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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