Polycystic ovary syndrome is a common cause of hirsutism

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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 abnormality. Hence, the ovarian morphologic transformation must be separated from the endocrine related PCOS.
  • Chronic anovulation: This results in menstrual irregularity, mainly oligomenorrhea (menses of 6 weeks to 6 months), amenorrhea, or dysfunctional uterine bleeding. 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, during 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.
  • Obesity marked by increased waist-hip proportion or the “apple body” shape. Acanthosis mgricans is also common in obese PCOS cases.
  • Other 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 secondary 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 well.
  • Though there are many variations herein as well, adrenal enzyme deficiency is a well established cause of some cases of PCOS associated disorders.
  • Ovarian causes are also certainly most commonly suggested. Certainly, excess ovarian androgen production is closely linked to PCOS but at the same time 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 ovarian symdromes.
  • 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 patients.

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.


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