Polycystic Ovary Syndrome

Polycystic ovary syndrome

Polycystic ovaries; Polycystic ovary disease; Stein-Leventhal syndrome; Polyfollicular ovarian disease

Last reviewed: February 26, 2012.

Polycystic ovary syndrome is a condition in which a woman has an imbalance of a female sex hormones. This may lead to menstrual cycle changes, cysts in the ovaries, trouble getting pregnant, and other health changes.

Causes, incidence, and risk factors

PCOS is linked to changes in the level of certain hormones:

  • Estrogen and progesterone, the female hormones that help a woman’s ovaries release eggs
  • Androgen, a male hormone found in small amounts in women

It is not completely understood why or how the changes in the hormone levels occur. The changes make it harder for a woman’s ovaries to release fully grown (mature) eggs.  Normally, one or more eggs are released during a woman’s period. This is called ovulation. In PCOS, mature eggs are not released from the ovaries. Instead, they can form very small cysts in the ovary.

These changes can contribute to infertility. The other symptoms of this disorder are due to the hormone imbalances.

Most of the time, PCOS is diagnosed in women in their 20s or 30s. However, it may also affect teenage girls. The symptoms often begin when a girl’s periods start. Women with this disorder often have a mother or sister who has symptoms similar to those of polycystic ovary syndrome.

Symptoms

Symptoms of PCOS include changes in your period (menstrual cycle).  Some changes are:

  • No period after you have had one or more normal ones during puberty (secondary amenorrhea)
  • Irregular periods, that may come and go and may be very light to very heavy

PCOS can cause you to develop male-like characteristics. This is called virilization. Symptoms include:

  • Body hair growing on the chest, belly, face, and around the nipples
  • Decreased breast size
  • Enlargement of the clitoris
  • Thinning of the hair on the head, called male-pattern baldness
  • Voice gets deeper

You may also have skin changes:

  • Acne that gets worse
  • Dark or thick skin markings and creases around the armpits, groin, neck, and breasts

Signs and tests

Your doctor or nurse will perform a physical exam. This will include a pelvic exam. This may reveal:

  • Swollen ovaries
  • Swollen clitoris (very rare)

The following health conditions are common in women with PCOS:

  • Diabetes
  • High blood pressure
  • High cholesterol
  • Weight gain and obesity

Your doctor or nurse will check your weight and body mass index (BMI) and measure your belly size.

Blood tests can be done to check hormone levels. These tests may include:

Other blood tests that may be done include:

Your doctor may also order the following imaging test or surgeries to look at your ovaries:

Treatment

Weight gain and obesity is common in women with PCOS. Losing weight can help treat the hormone changes and health conditions such as diabetes, high blood pressure, or high cholesterol.

Losing just 5% of your body weight can help your hormone imbalance and may make it easier to get pregnant. For an 160 pound woman, that’s just 8 pounds!

Your doctor may recommend birth control pills to make your periods more regular. Such medicines may also help reduce abnormal hair growth after you take them for a few months.

A diabetes medicine called glucophage (metformin) may also be recommended to:

  • Make your periods regular
  • Prevent type 2 diabetes
  • Help you loss weight when you follow a healthy diet

Other medicines that may be prescribed to help make your periods regular and help you get pregnant are:

  • LH-releasing hormone (LHRH) analogs
  • Clomiphene citrate, which helps your ovaries grow and release eggs

Your doctor or nurse may also suggest other treatments for abnormal hair growth. Some are:

Permanent hair removal options include:

  • Electrolysis
  • Laser hair removal – works best on very dark hair that covers large areas

Treatments can expensive and multiple treatments may be needed.

pelvic laparoscopy may be done to remove to remove or alter an ovary to treat infertility. The effects are temporary.

Expectations (prognosis)

With treatment, women with PCOS are usually able to get pregnant. There is an increased risk of high blood pressure and gestational diabetes during pregnancy.

Complications

Women with PCOS are more likely to develop:

  • Endometrial cancer
  • Infertility
  • Breast cancer (slightly increased risk)

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of this disorder.

References

  1. Bulun SE, Adashi EY. The physiology and pathology of the female reporductive axis. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 17.
  2. Radosh L. Drug treatments for polycystic ovary syndrome. Am Fam Physician. 2009;79:671-676.
  3. Lobo RA. Hyperandrogenism: Physiology, etiology, differential diagnosis, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 40.
Review Date: 2/26/2012.Reviewed by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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J Clin Endocrinol Metab. 2013 Oct 22. [Epub ahead of print]

Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline.

Source

The Penn State University College of Medicine (R.S.L.), Hershey, Pennsylvania 17033; Children’s Hospital of Pittsburgh (S.A.A), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15224; University of Chicago (D.A.E.), Chicago, Illinois 60637; University of Rochester Medical Center (K.M.H.), Rochester, New York 14627; Mayo Clinic (M.H.M.), Rochester, Minnesota 55905; Orsola-Malpighi Hospital, University Alma Mater Studiorum, (R.P.), 40126 Bologna, Italy; and Massachusetts General Hospital (C.K.W.), Boston, Massachusetts 02114.

Abstract

Objective:The aim was to formulate practice guidelines for the diagnosis and treatment of polycystic ovary syndrome (PCOS).Participants:An Endocrine Society-appointed Task Force of experts, a methodologist, and a medical writer developed the guideline.Evidence:This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence.Consensus Process:One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of The Endocrine Society and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines. Two systematic reviews were conducted to summarize supporting evidence.Conclusions:We suggest using the Rotterdam criteria for diagnosing PCOS (presence of two of the following criteria: androgen excess, ovulatory dysfunction, or polycystic ovaries). Establishing a diagnosis of PCOS is problematic in adolescents and menopausal women. Hyperandrogenism is central to the presentation in adolescents, whereas there is no consistent phenotype in postmenopausal women. Evaluation of women with PCOS should exclude alternate androgen-excess disorders and risk factors for endometrial cancer, mood disorders, obstructive sleep apnea, diabetes, and cardiovascular disease. Hormonal contraceptives are the first-line management for menstrual abnormalities and hirsutism/acne in PCOS. Clomiphene is currently the first-line therapy for infertility; metformin is beneficial for metabolic/glycemic abnormalities and for improving menstrual irregularities, but it has limited or no benefit in treating hirsutism, acne, or infertility. Hormonal contraceptives and metformin are the treatment options in adolescents with PCOS. The role of weight loss in improving PCOS status per se is uncertain, but lifestyle intervention is beneficial in overweight/obese patients for other health benefits. Thiazolidinediones have an unfavorable risk-benefit ratio overall, and statins require further study.

PMID:
24151290
[PubMed – as supplied by publisher]

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Lifestyle Management of PCOS

For women with polycystic ovary syndrome (PCOS), making some healthy lifestyle changes can be very helpful in managing the condition. Lifestyle management is important for all women with PCOS – whether you are overweight or in the healthy weight range. Even when not actively trying to lose weight, adopting a healthy diet will ensure that you are receiving a healthy intake of nutrients, vitamins and minerals and can reduce your long-term risk of disease such as type 2 diabetes and cardiovascular disease. Physical activity also increases energy levels, improves self esteem and reduces anxiety and depression.

Managing your weight includes preventing excess weight gain if you are a healthy weight, losing weight if you are overweight or maintaining weight loss long-term. Weight management can be much better achieved by combining diet with physical activity and behaviour change than by simply dieting alone.

Behavioural changes

For dietary and exercise changes to be sustainable in the long-term, they need to be part of your daily life. Read more…

Dietary approaches

There are a range of dietary approaches that can be tried for weight management in PCOS. Read more…

Lifestyle FAQs

Do women with PCOS have a greater risk of being overweight? What is the best diet for PCOS? What diet and exercise approaches should non-overweight women with PCOS follow? Read more…

Physical activity

There is now evidence that moderate physical activity, in the absence of weight loss still improves PCOS symptoms and fertility as well as risk factors for heart disease and type 2 diabetes including high blood pressure, high glucose levels and insulin resistance. Read more…

Readiness to change

Good psychological wellbeing is critical in successfully changing to a healthy lifestyle. If you are anxious, stressed, depressed, guilty, or have low self esteem, it is difficult to find the motivation to change to a healthier lifestyle. Read more…

Weight Management

Being both under and overweight has adverse effects on fertility and health. It is therefore very important that a healthy lifestyle is maintained, and weight gain prevented. Read more…

Further resources

Fact sheets

pdf PCOS and Emotional Health 105.50 Kb

pdfPCOS and Fertility254.15 KB

pdf PCOS and Physical Health 99.14 Kb

pdf PCOS Management 115.24 Kb

Related articles

PCOS – the big picture – Jean Hailes Magazine Summer 2011-12

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Cochrane Database of Systematic Reviews: Plain Language Summaries.

The effect of a healthy lifestyle for women with polycystic ovary syndrome

First published: July 6, 2011; This version published: 2011; Review content assessed as up-to-date: September 07, 2010.

Plain language summary

Polycystic ovary syndrome (PCOS) is a very common condition affecting 4% to 18% of women. Being overweight worsens all clinical features of PCOS. These clinical features include reproductive manifestations such as reduced frequency of ovulation and irregular menstrual cycles, reduced fertility, polycystic ovaries on ultrasound, and high male hormones such as testosterone which can cause excess facial or body hair growth and acne. PCOS is also associated with metabolic features and diabetes and cardiovascular disease risk factors including high levels of insulin or insulin resistance and abnormal cholesterol levels. PCOS affects quality of life and can worsen anxiety and depression either due to the features of PCOS or due to the diagnosis of a chronic disease. A healthy lifestyle consists of a healthy diet, regular exercise and achieving and maintaining a healthy weight. This review identified six studies with 164 participants that assessed the effects of a healthy lifestyle in women with PCOS. In this review, there were no studies reporting on fertility outcomes such as pregnancy, live birth and miscarriage. While some studies reported on menstrual regularity and ovulation, the findings were reported in a variety of ways and it was not possible to estimate the overall effects of lifestyle on these outcomes. Current evidence suggests that following a healthy lifestyle reduces body weight and abdominal fat, reduces testosterone and improves both hair growth, and improves insulin resistance. There was no evidence that a healthy lifestyle improved cholesterol or glucose levels in women with PCOS.

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Treatment of PCOS.

1.Medications

2.Fiber

3. Low GI program

4.Reduce stress.

5.Essential fatty acids

6.Drink enough water.

7.Antioxidants

8.Herbal remedies.

9.Detoxification.

1. Medications:

-Anti-androgen medications: Aldactone, Tagamet.

-Testosterone metabolism blockers : Propecia (finasteride)

-Medications to lower blood sugar: Metformin is the most successful

-Gonadotrophin-Releasing Hormone Antagonists: Lupron

-Hair growth stimulators: Rogaine solution (Minoxidil)

-Hair metabolism inhibitors: Vaniqa cream (eflornithine)

-Menstrual regulators: Progestins, BCP. Progesterone

-Ovulation Inducers: Clomid, Pergonal, Follistim, Pregnyl (HCG)

2. Fiber:

-Lowers blood sugar, blood pressure and cholesterol.

3. Low glycemic index diet

– Weight loss and Exercise.

– study revealed that after 6 months on the above, women lost 11% central fat, 71% improvement in insulin sensitivity, 33% decrease fasting insulin level, 39 % decrease LH, and 50% of women started ovulating. (Ref Huber-Bucholz : Jrnl Clin Endoc Metab 1999.)

4. Reduce Stress.

– Cortisol stimulates the release of glucose, fats and amino acids for the production of energy in the body.

-During times of stress, cortisol, insulin and cholesterol  levels rise in the body. This exacerbates the symptoms of PCOS.

5. Essential Fatty Acids. (Omega-3,6 and 9 mainly)

-EFA slow down the absorption of carbohydrates into the blood stream.(Kasim Journ Clin Endoc Metab 2004)

6. Drink enough water.

– people who drink 5-8 glasses of water a day have fewer heart attacks. (Ref: Chan,J Amer Jour Epidemiology 2002)

7. Nutritional treatment of Insulin Resistance.

-Chromium Picolinate (400-600 micrograms): Decreases sugar cravings and improves insulin sensitivity.

-Lipoic Acid (200-600 mg): Improves insulin sensitivity and prevents neuropathy.

-CLA (1,000-3,000 mg): Improves insulin sensitivity.

-Zinc (25-50 mg): Helps balance blood sugar levels.

-Taurine (1,000-3,000 mg) : Increases activity of insulin receptor and improves sensitivity to insulin.

-Magnesium (400-800 mg): Improves glucose uptake.

– Biotin (4-8 mg): Increases insulin sensitivity.

-Vitamin D (400 – 2,000 IU) : Helps pancreas release insulin.

-Co-enzyme Q10 (30-300 mg): Provides energy for metabolic pathways.

-Inositol; decreases insulin resistance.

– Lentils, Chickpeas and Broccoli all reduce insulin levels.

Reference all the above: Pamela Smith. “What you must know about Vitamins, Minerals and Herbs, and More” 2008.

8. Herbal therapies.

-Fenugreek: Interferes with absorption and digestion of sugars. (Uemura,T. “Diosgenin present in fenugreek improves glucose metabolism” Mol Nutr food res 2010.)

-Cinnamon: Improves glucose utilization and increases insulin receptor sensitivity.

-Gymnema Sylvestre: Improves insulin sensitivity and interferes with the absorption of sugar.

-Saw Palmetto: Inhibits conversion testosterone to DHT. Reduces Acne and Hirsutism. (200 mg BD)

-Nettle Root: reduces testosterone by binding to SHBG. 300 mg BD. Must be the root.

– Green tea: Increases SHBG, lowering testosterone. Promotes weight loss. (Nagata Nutr Cancer 1998. Trial of women with PCOS showed weight loss of 2.4 % (Journ Soc Gynecol Investig 2006)

-Licorice root: Decrease testosterone level. 3.5 gms of liquorice. (Amanin D Exp Clin Endoc Diabetes 2002. Also Steroids 2005

-spearmint tea: Lowers testosterone level, improves hirsutism. (Grant P.Phytother Res 2010;24:186-88)

– D-chiro-inositol: 1200 mg 4 times daily. Lowers insulin and testosterone levels, increasing chances of ovulating. (Nestler J et al. NEJM 1999)

-Maitake mushroom extract. Study compared patients with PCOS given Mushroom vs clomiphene. After 3 cycles -76% mushroom group ovulated, vs 93% with clomiphene. (Chen J ; Jrnl Altern comple med 2010;16(12);1295-99)

Best reference book for Patients: The PCOS protection Plan by Colette Harris and Theresa Cheung.  Hay House.


Content updated 3 May 2012

  1. It will depend on the individual, but probably best something mechanical, and not hormonal. Such as the condom, IUD or Diaphragm

  2. Dr Holloway, what birth control would you recommend for PCOS sufferers? Preferably nothing that has a long term impact on getting pregnant in future but at the same time doesn’t impact the hormonal imbalance or increase likelihood of weight gain. Thanks.

  3. Which condition are you referring to?

  4. Do you treat this condition?

  5. Will / could natural progesterone be of benefit?

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