What is PCOS and the Symptoms of Polycystic Ovarian Syndrome?
Polycystic ovarian syndrome (PCOS) is a term
given to a condition that affects a subset
(approximately 10-20%) of women with ovulatory
dysfunction. The condition was initially described
in 1935 by Dr. Stein and Dr. Leventhal as an
anatomical disorder based on appearance of ovaries
at hysterectomy. It was not until the 1960s that
PCOS was recognized as an endocrine disorder and it
was finally recognized to actually be a metabolic
disorder in 2000.
The diagnostic criteria
established by the National Institute of Health in
1990 require the presence of both a chronic failure
to ovulate as well as clinical evidence of excess
male hormone (androgen) production. Symptoms
associated with androgen excess include acne,
deepening of the voice, and excessive hair growth in
a male pattern. In 2003, the diagnostic criteria for
PCOS were revised to include rare or a complete
absence of ovulation combined with either evidence
of male hormone production or a polycystic ovarian
appearance diagnosed by ultrasound.
Polycystic Ovarian Syndrome Increases the Risk of Endometrial Cancer, Type II Diabetes, and Heart Disease
Women who are diagnosed with polycystic ovarian
syndrome are at an increased risk of developing
endometrial cancer as well as components of the
Metabolic Syndrome including Type II diabetes,
elevated cholesterol and triglycerides,
hypertension, and heart disease. In the United
States, there is a much higher incidence of impaired
glucose tolerance and progression to type II
diabetes in women who have polycystic ovarian
syndrome; therefore, all women with this diagnosis,
particularly those who are overweight, should be
screened for abnormal glucose metabolism.
PCOS is
the most common endocrine disorder in women of
reproductive age affecting up to 8% of all women.
The incidence is higher in certain ethnic
populations affecting approximately 5% of Caucasian
women and up to 15% of Hispanic or Latino women.
Most women who have polycystic ovarian syndrome give
a history of irregular cycles often from the time of
their first menses. They often also exhibit excess
androgen activity as well as an increased waist to
hip ratio. The laboratory evaluation of PCOS should
also include tests designed to exclude other
conditions that can cause irregular ovulation such
as thyroid abnormalities and excessive production of
prolactin.
Obesity and the Treatment of Polycystic Ovarian Syndrome
If women are obese, a fasting lipid profile as well
as a glucose tolerance test should be performed. For
women who are diagnosed with polycystic ovarian
syndrome and are overweight, the first line therapy
for management of the condition is weight loss. The
best diet and exercise regimens have not been
standardized, although a low calorie diet with
reduction of carbohydrate intake and increased
physical activity are recommended. For women who are
morbidly obese, there is a strong recommendation to
consider the use of bariatric surgery. The ideal
amount of weight loss is unknown, but clinically
significant improvements in the condition has been
reported with as little as a 5% decrease in overall
body weight.
In most cases, treatment of the obese
PCOS patient should precede ovulation induction.
Concurrent medications used to treat polycystic
ovarian syndrome include insulin-sensitizing agents
such as metformin. The use of metformin should be
restricted to patients with demonstrated glucose
intolerance. Decisions about continuing metformin
during pregnancy should be left to obstetricians who
are providing prenatal care. These decisions should
be based on the careful evaluation of the risks and
benefits – both to the patient as well as to her
fetus. Almost all patients with PCOS will require
treatment with some type of ovulation induction
medication (clomiphene citrate or gonadotropin
therapy) in addition to metformin in order to
achieve ovulation and pregnancy.
