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Polycystic Ovary Syndrome
(Stein-Leventhal Syndrome)
What is polycystic ovary syndrome?
Polycystic ovary syndrome (PCOS) is a disorder in which many benign cysts form on the ovaries under a thick, white covering. It is most common in women under 30 years old.
The ovaries are glands located on either side of the uterus (womb) in a woman's lower abdomen. The ovaries produce the female hormones oestrogen and progesterone. Before menopause, they also produce eggs.
Ovarian cysts are fluid-filled sacs that result from ovulation cycles. Many ovarian cysts go away without treatment. The most common cysts are just enlargements of normal egg follicles.
This disorder has also been called Stein-Leventhal syndrome.
How does it occur?
Polycystic ovary syndrome is caused by an abnormal production of two hormones by the pituitary gland in the brain. These two hormones are LH (luteinising hormone) and FSH (follicle-stimulating hormone). Imbalance of these hormones prevents the ovaries from releasing an egg each month. The ovaries produce more of the male hormone testosterone. They continue to produce oestrogen but not progesterone.
What are the symptoms?
The symptoms may include:
irregular periods: abnormal, irregular, heavy or scanty (oligomenorrhea)
absent periods (amenorrhea)
ovarian cysts
hirsutism (excess facial and/or body hair)
alopecia (male-pattern hair loss)
obesity
acne
skin tags
acanthosis nigricans (brown skin patches, often found on the nape of the neck)
high cholesterol levels
high blood pressure
excess "male" hormones, such as androgens, DHEAS, or testosterone
lower levels of Sex Hormone Binding Globulin (SHBG)
infertility
insulin resistance
Many young women with polycystic ovaries start having menstrual periods at a normal age. After a year or two of regular menstruation, the periods become quite irregular and then infrequent. Obesity and excessive body hair are symptoms in about 50% of the cases.
How is it diagnosed?
Your health care provider will ask about your medical history and do these tests and exams:
a physical exam
blood tests to check hormone levels
an ultrasound scan
How is it treated?
Your treatment depends on how severe your symptoms are and whether you are trying to get pregnant.
If you are not trying to get pregnant, you can be treated with hormones. Your health care provider may prescribe birth control pills. If you take hormones or birth control pills, you will have regular menstrual cycles. You may have less abnormal hair growth. This treatment will also reduce your risk of developing endometrial hyperplasia, a condition that can become uterine cancer.
If you are trying to get pregnant, your health care provider may prescribe fertility drugs. In rare cases the doctor may surgically remove or destroy a wedge of ovarian tissue. This usually results in regular menstrual cycles for a while, or it may cure the problem.
Your health care provider may recommend electrolysis to remove excess body or facial hair. If you are obese, he or she may suggest a weight control program.
How long will the effects last?
Many women with this disorder who want to become pregnant are treated successfully with fertility drugs, but it can be a long, complicated treatment.
How can I take care of myself?
Continue the prescribed treatment for regular menstrual periods.
Keep all your follow-up appointments. Your health care provider will want to see you regularly. He or she will look for changes in your ovaries or in the wall of the uterus from irregular bleeding. You may need blood tests to check your hormones or to see how well the treatment is working.
Make sure you have a pelvic exam every year. Pelvic exams can help your health care provider detect ovarian or uterine cancer early so the cancer can be treated promptly.
Tell your health care provider if you have any symptoms or changes other than those that you have been advised to expect.
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Copyright © Clinical Reference Systems 2002 & Kathleen King
