Doctor's Notes on Polycystic Ovarian Syndrome (PCOS)
Polycystic ovarian syndrome (PCOS) is a condition in which the female ovaries contain multiple cysts. Cysts are fluid-filled structures within an organ or tissue. In PCOS, there are a number of hormonal disturbances that lead to characteristic symptoms. Characteristic symptoms associated with PCOS include
Elevated levels of male hormones (known as androgens) are responsible for the symptoms of PCOS.
Polycystic ovarian syndrome (PCOS) Causes
PCOS is the most common cause of infertility in women and occurs in 5-10% of women.
Other associated symptoms and abnormalities can include
- elevated insulin levels, insulin resistance,
- high cholesterol levels,
- oily skin,
- dandruff, and
- high blood pressure.
Sometimes, women may not have any symptoms except for abnormalities in the menstrual cycle. While the exact cause is not understood, many experts believe the development of PCOS is related to the abnormalities in insulin and the blood sugar control system.
Polycystic Ovarian Syndrome (PCOS) Symptoms
PCOS leads to disruptions in the menstrual cycle that typically begin around the onset of puberty. Menstrual cycles may be normal at first and then become irregular, or the onset of menses may be delayed. The menstrual irregularities of PCOS are accompanied by a lack of ovulation, so affected women may experience infertility. The desire for pregnancy is a factor that prompts many women with PCOS to first seek medical attention.
An increase in the production of androgens (male hormones) by the ovaries in PCOS may lead to excess hair growth in areas suggesting a male pattern, known as hirsutism. Thick, pigmented hair growth occurs on the upper lip, chin, around the nipples, and on the lower abdomen. Excess androgens can also lead to acne and male pattern balding.
Because of the absence or reduction in ovulation, women with PCOS have reduced levels of the hormone progesterone (normally produced after ovulation in the second half of the menstrual cycle). This can result in growth stimulation of the endometrium (lining tissues of the uterus), leading to dysfunctional uterine bleeding and breakthrough bleeding. Increased stimulation of the endometrium in the absence of progesterone production is a risk factor for the development of endometrial hyperplasia and uterine cancer.
Insulin resistance, weight gain, and obesity are also common in PCOS. Observers have suggested that about one-half of women with PCOS are obese. Insulin resistance, accompanied by elevated blood levels of insulin, occurs in most women with PCOS, independent of the presence of obesity.
Women with PCOS have also been reported to have an increased risk of developing type 2 diabetes, and many studies have shown abnormal blood lipid levels and elevated levels of C-reactive protein (CRP), a predictor of coronary artery disease. The combination of type 2 diabetes, elevated cholesterol and LDL levels, and elevated CRP levels suggest an increased risk of coronary heart disease on women with PCOS, although this risk has not yet been scientifically established.
Polycystic Ovarian Syndrome (PCOS) Causes
The exact cause of polycystic ovarian syndrome is not clear, although a number of abnormalities have been documented in women with PCOS. There is some evidence for an inherited (genetic) cause for PCOS, although no specific genetic mutation has been identified as the cause. It has been shown that the ovaries of women with PCOS may produce excessive amounts of male hormones, or androgens, which lead to disruptions in the menstrual cycle and impaired fertility.
PCOS is also associated with insulin resistance, or an impaired ability to utilize insulin, and this abnormality is also likely related to the cause of PCOS.
The presence of small cysts in the ovaries is not specific for PCOS, since women who do not have PCOS may have ovarian cysts. Therefore the presence of cysts is not likely to be the cause of the symptoms of PCOS.
Ovarian cysts are fluid-filled sacs that grow inside or on top of one (or both) ovaries. A cyst is a general term used to describe a fluid-filled structure. Ovarian cysts are usually asymptomatic, but pain in the abdomen or pelvis is common.
What Are the Ovaries? What Do the Ovaries Do?
The ovaries are reproductive organs in women that are located in the pelvis. One ovary is on each side of the uterus, and each is about the side of a walnut. The ovaries produce eggs and the female hormones, estrogen and progesterone. The ovaries are the main source of female hormones that control sexual development including breasts, body shape, and body hair. The ovaries also regulate the menstrual cycle and pregnancy.
What Is Ovulation?
Ovulation is controlled by a series of hormone chain reactions originating from the brain’s hypothalamus. Every month, as part of a woman’s menstrual cycle, follicles rupture, releasing an egg from the ovary. A follicle is a small fluid sac that contains the female gametes (eggs) inside the ovary. This process of releasing and egg from the ovary an into the Fallopian tube is known as ‘ovulation’.
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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.