What are the other Names for this Condition? (Also known as/Synonyms)

• Functional Ovarian Hyperandrogenism
• Multicystic Ovaries
• Sclerocystic Ovarian Degeneration

What is Polycystic Ovarian Syndrome? (Definition/Background Information)

• Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder occurring exclusively in women of reproductive age. It is characterized by the accumulation of numerous fluid-filled cysts in the ovaries
• The risk factors associated with Polycystic Ovarian Syndrome include obesity and family history of the disorder
• In this disorder, there is increased production of male hormones (androgens) that is manifested by the presence of excessive body and facial hair similar to that of men, obesity, menstrual signs and symptoms (prolonged or infrequent menstrual periods), and other metabolic disturbances
• Important diagnostic tests include blood sex hormones test (testosterone and luteinizing hormone (LH) are increased and follicle stimulating hormone (FSH) and progesterone are decreased) and glucose tolerance test to check the level of blood sugar
• Complications of PCOS include development of cysts in the ovaries, infertility, uterine cancer and breast cancer; individuals are also at risk of heart disease. Women with PCOS find it difficult to get pregnant due to irregular menstrual periods
• There is no specific treatment for Polycystic Ovarian Syndrome. The focus is on managing the symptoms and in preventing long-term complications. Lifestyle changes may also be included such as controlling one’s weight, exercise to lower blood glucose levels, and eating high-fiber low-calorie diets
• The prognosis of women with Polycystic Ovarian Syndrome is generally good with appropriate treatment

Who gets Polycystic Ovarian Syndrome? (Age and Sex Distribution)

• Polycystic Ovarian Syndrome (PCOS) affects females in their reproductive ages (between 12-45 years old). Typically, the signs and symptoms occur during the teenage years
• PCOS affects between 5-10% of women of child-bearing age
• The condition is observed worldwide; all races and ethnicities are affected

What are the Risk Factors for Polycystic Ovarian Syndrome? (Predisposing Factors)

The following are the risk factors for Polycystic Ovarian Syndrome (PCOS):

• Obesity
• A family history of PCOS
• The use of the medication valproate, which is used for the treatment of seizure, is associated with an increased risk of PCOS

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Polycystic Ovarian Syndrome? (Etiology)

• The exact cause of Polycystic Ovarian Syndrome (PCOS) is still not well understood. It has a genetic association and runs in families
• In PCOS, sex hormone levels stay out of balance. The ovaries produce greater amounts of the male hormones (androgen), which in turn leads to the clinical manifestations such as acne, facial hair, and menstrual abnormalities with infrequent or prolonged periods
• Besides, the body is unable to make use of excess insulin and as a result, the blood sugar goes up leading to a diabetes-like state
• In this syndrome, the maturation and release of the egg from the ovary with each menstrual cycle is also disturbed, resulting in the development of numerous cysts on the surface of the ovaries (polycystic ovaries). This can lead to infertility

What are the Signs and Symptoms of Polycystic Ovarian Syndrome?

The classic signs and symptoms of Polycystic Ovarian Syndrome include:

• Excessive facial and body hair, similar to hirsutism
• Increased weight or obesity
• Irregular menstrual periods

Other symptoms of PCOS may include:

• Difficulty getting pregnant (infertility)
• Acne or oily skin
• Body becomes less responsive to the hormone insulin (termed insulin resistance)
• Abnormal cholesterol levels
• High blood pressure (hypertension)
• Baldness or thinning of hair
• Patches of darkened skin under the arms, in the groin area, or on the back of the neck (acanthosis nigricans)
• Formation of skin tags

How is Polycystic Ovarian Syndrome Diagnosed?

The diagnosis of Polycystic Ovarian Syndrome may involve a physical exam, diagnostic lab tests and imaging tests.

• Complete evaluation of medical history and a thorough physical exam with special emphasis on pelvic examination
• Blood sex hormones: It may be found that testosterone and luteinizing hormone (LH) may be increased and follicle stimulating hormone (FSH) and progesterone decreased
• Glucose tolerance test to check the level of blood sugar
• Blood insulin levels
• Blood thyroid hormone levels
• Blood lipid levels
• Ultrasound examination of the ovaries: A large number of developing eggs are seen near the surface of the ovary, giving a classical necklace or ‘string of pearls’ appearance

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Polycystic Ovarian Syndrome?

Complications associated with Polycystic Ovarian Syndrome include and increased risk for the following conditions:

• Heart diseases
• Uterine and breast cancer
• Development of diabetes
• Increased blood pressure
• Development of metabolic syndrome
• Sleep apnea
• Depression and anxiety
• Infertility (inability to have children)

During pregnancy, the presence of Polycystic Ovarian Syndrome may lead to gestational diabetes, pre-eclampsia, or even a miscarriage.

How is Polycystic Ovarian Syndrome Treated?

Presently, there is no cure for Polycystic Ovarian Syndrome (PCOS); however, it is a treatable condition. The aim of the treatment is symptomatic management of the disorder with prevention of long-term complications. Moreover, the treatment options available depend on each individual’s specific set of symptoms and whether the individual desires to conceive (in the future) or not.

Weight loss for individuals who are obese or overweight:

• Losing weight is the most effective method of restoring the normal menstruation cycle
• Low-carbohydrate diet, diets rich in fresh fruits, vegetables, and whole grains, along with sustained regular exercise are helpful

Restoration of regular menstrual period: Birth control pills may be used to correct menstrual abnormalities.

Excessive facial and body hair (hirsutism) may be treated by using various hair removal techniques. However, many of these treatment methods may have to be repeated. Some hair removal techniques that may be used include:

• Shaving
• The use of facial cream with chemicals that break down the structure of the hair (depilatories)
• Tweezing and waxing
• The destruction of hair roots using an electrical current (electrolysis)
• The destruction of hair follicles by laser therapy

Lowering insulin levels:

• Insulin sensitizing medication, such as Metformin, may be used
• The medication can also aid in the release of eggs from the ovary (ovulation)

Restoration of fertility:

• Medications, such as Clomiphene and Letrozole, can be used to stimulate the egg release from the ovary
• HCG injections may also be used for this purpose
• In vitro fertilization (IVF) may be an option in some cases, for women who want to get pregnant

Surgical methods:

• With severe PCOS, ovarian drilling may be done, whereby all ovarian cysts are removed, which in turn can help enhance fertility
• Women who do not desire to conceive anymore may undergo a bilateral salpingo-oophorectomy or hysterectomy surgical procedures, in which either the ovaries or uterus is removed. This can help decrease the level of sex hormones; although, hormone replacement therapy may be needed thereafter

Alternative treatment methods: Although the use of alternative treatment in PCOS is increasing nowadays, there is no proof of its benefits yet. The rebalancing of hormones is the focus of the treatment.

• Acupuncture works on the body's energy flow, according to the meridian system
• The use of Chinese herbs may be effective
• Bringing about dietary changes, including reduction in animal products and fats, while increasing foods that nourish the liver such as carrots, dark green vegetables, lemons, and beets, can be beneficial
• Essential fatty acids, including flax oil and evening primrose oil, act as hormonal regulators
• Western herbal medicine uses phytoprogesteronic herbs, such as blue cohosh and false unicorn root, as well as liver herbs such as dandelion, to work towards restoring hormonal balances
• Supplementation with antioxidants, such as zinc and vitamins A, E, and C, may also help

How can Polycystic Ovarian Syndrome (PCOS) be Prevented?

Currently, there are no specific methods or guidelines to prevent Polycystic Ovarian Syndrome (PCOS). It is believed to be a genetic condition.

• Genetic testing of the expecting parents (and related family members) and prenatal diagnosis (molecular testing of the fetus during pregnancy) may help in understanding the risks better during pregnancy
• If there is a family history of the condition, then genetic counseling will help assess risks before planning for a child
• Certain complications of PCOS, such as heart disease, diabetes, and uterine cancer, can be prevented by proper management of the condition
• Weight control through diet modification and exercise can help balance the hormone levels, thereby preventing complications
• Active research is currently being performed to explore the possibilities for treatment and prevention of inherited and acquired genetic disorders

What is the Prognosis of Polycystic Ovarian Syndrome? (Outcomes/Resolutions)

• Without treatment Polycystic Ovarian Syndrome (PCOS) can lead to infertility and an increased risk for heart disease, diabetes, and uterine cancer. With proper diagnosis and treatment, the symptoms can be controlled
• However, infertility can be treated well, and pregnancy achieved in most women. women who plan to get pregnant should try to achieve a healthy weight, regularly take folic acid tablets, and keep blood sugar levels under control
• Blood pressure, cholesterol levels, blood insulin, and blood sugar levels should be routinely checked since these are risk factors for heart disease and diabetes. Through the use of proper medication, almost all complications can be mitigated

Additional and Relevant Useful Information for Polycystic Ovarian Syndrome:

• Hysterectomy is a surgical procedure characterized by the surgical removal of the uterus
• Salpingo-oophorectomy is a surgical procedure characterized by the surgical removal of the fallopian tube and ovary

The following article link will help you understand hysterectomy (abdominal) with salpingo-oophorectomy:

http://www.dovemed.com/common-procedures/procedures-surgical/hysterectomy-abdominal-with-salpingo-oophorectomy/