Polycystic Ovary Syndrome
Polycystic Ovary Syndrome (PCOS) is an endocrine related disease that affects
approximately 5 to 9 percent of premenopausal women. An ovary is generally
called polycystic when it shows more than 10 cysts in a single plane. It
is the most common androgenic cause associated with hirsutism, which is
a hair development disorder in women.
Diagnostic history and prevalence of PCOS
PCOS was first associated with the condition of oligo-amenorrhea (menstrual
abnormality), obesity, and hirsutism by Stein and Leventhal in 1934. They
described it as sclerocystic ovaries. Then again, Balen and colleagues conducted
a transabdominal ultrasound to detect the a polycystic ovary, only 66% of
such patients had oligo-amenorrhea, 38% were obese and 66% reported hirsutism.
Prevalence of PCOS has been a controversial issue. But to ensure some degree
of uniformity a 1990 National Institutes of Health (NIH) consensus conference
committee outlined a evaluation process based on two main criteria: ‘oligoamenorrhea
and evidence of either clinical or biochemical hyperandrogenism’.
Manifestations of PCOS
Based on the above findings and suggestions the main symptoms of PCOSs can
be as follows:
- Eight or more subcapsular follicular cysts less than 10 mm and increased
ovarian stroma is could be a key indicator of PCOS. However, this can
occur in approximately 50 percent of women who show no endocrinological
Hence, the ovarian morphologic transformation must be separated from the
endocrine related PCOS.
- Chronic anovulation: This results in menstrual irregularity,
oligomenorrhea (menses of 6 weeks to 6 months), amenorrhea, or dysfunctional
Most PCOS cases are chronically amenorrheic, since they record an absence
of the progesterone-regulated follicular stage of ovulation. These cases
are however not estrogen deficient. The ovulation problems can occur as early
as the peripubertal years and aggravate with age-related weight increase.
- Hirsutism: This condition is almost evident and is marked by excess and
unwanted terminal hair production in a male-like pattern in body areas
such as the
upper lip, chin, neck, side burns, periareolar area, sternum, and
the midline of the lower abdomen etc. Hirsutism may occur either prepubertally,
adolescence, or even later.
- Infertility: Stein and Leventhal suggested
infertility in their original definition of PCOS. However, more recent
findings suggest that women with
PCOS have irregular
ovulation at best, and infertility may be too farfetched a conclusion
and very rare. But infertility may be the manifestation of anovulation.
marked by increased waist-hip proportion or the “apple
Acanthosis mgricans is also common in obese PCOS cases.
symptoms such as male like (temporal) alopecia and acne may be a result
of hyperandrogenism, though in PCOS they are generally mild
to moderate. A
rapid onset of hyoerandrogenic symptoms or virilization (including
thicker muscle mass, voice deepening, masculine body formation, clitoromegaly
and speedy hirsutism etc) is rare in PCOS. They could rather indicate
causes of hyperandrogenism.
- Eevated LH/FSH hormones
Causes of PCOS
Despite years of research regarding the cause of PCOS, there has been no
conclusive findings. Disorders in areas of the Central Nervous System, CNS,
pituitary, ovary, adrenal, and extraglandular tissues have all been considered.
There may be vast variations that can be traced to various sources, hence
PCOS is a condition that is marked by vast divergences in physiologic markers.
One can say that different triggers can be attributed to different subgroups
of PCOS cases. Following is a list of some of the major causes that may be
found in many but not all patients:
- Insulin resistance with compensatory hyperinsulinemia. Although acanthosis
nigricans is a key indicator for insulin resistance and hyperandrogenism
it occurs in only around 5 % of such cases. Fasting insulin values is generally
less than 50 J-LU/mL in case of PCOS.
- Primary adrenal androgen excess
has also been related with PCOS like
ovarian disorders. It is seen in patients with 21-hydroxylase deficiency as
- Though there are many variations herein as well, adrenal enzyme deficiency
is a well established cause of some cases of PCOS associated disorders.
causes are also certainly most commonly suggested. Certainly, excess ovarian
androgen production is closely linked to PCOS but at the
it may be produced by stroma, theca, or both. There are many other
variations and indications as well.
- Derivations of gonadotropin secretion
that moderately cause LH production with normal or lessened FSH production
may also cause PCOs-like
- Changes in the Central Nervous System that cause a rise
in GnRH pulse frequency and/or amplitude is often a plausible factor for
PCOS in various
PCOS triggered ailments
PCOS often causes various other health risks like cardiovascular ailments,
diabetes, infertility, endometrial cancer and hyperlipidemia.
Treatment of PCOS
The treatment of this syndrome includes weight management, Oral Contraceptive
Pills (OCPs) and insulin sensitizers. This apart one must also undergo therapy
for the PCOS triggered ailments. Treatment is however continuously evolving.