Polycystic Ovary Syndrome (Stein-Leventhal Syndrome)

What is polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS) is a hormone disorder that causes many small benign cysts to form on the ovaries under a thick, white covering, which prevents the release of an egg. It causes your menstrual cycle to be irregular, or you may have no periods at all. PCOS can make it hard for you to become pregnant. It causes other problems as well.

The two ovaries are part of the female reproductive system. They produce eggs and the female hormones--estrogen and progesterone. Ovarian cysts are fluid-filled sacs that form on the ovaries when the follicles (sacs) on the ovary that contain an egg mature but do not release the egg into the fallopian tube.

PCOS increases your risk of uterine cancer, diabetes, and heart disease. If you have PCOS, it is important for you to be checked by your health care provider for these other problems and to get treatment to help prevent these problems.

PCOS is most common in women less than 30 years old. It has also been called Stein-Leventhal syndrome.

How does it occur?

No one knows the exact cause of PCOS. Studies are looking at whether it is caused by genetics. Also, because many women with PCOS also have diabetes, studies are examining the relationship between PCOS and the level of insulin in the body. High levels of insulin appear to cause the body to make more of the male hormone testosterone, which worsens the symptoms of PCOS. A problem called insulin resistance (inefficient use of insulin in the body) can cause the high levels of insulin. Too much insulin in the body increases the risk for other problems, such as obesity, diabetes, high blood pressure, and heart disease.

What are the symptoms?

The symptoms may include:

• irregular menstrual periods, particularly long cycles, or no periods at all
• very light or very heavy bleeding during your period
• trouble getting pregnant
• more hair on your face, chest, and lower abdomen
• balding in some women
• obesity
• acne.

Many young women with polycystic ovaries start having menstrual periods at a normal age. But then, after a year or two of regular menstruation, the periods become quite irregular and then infrequent.

How is it diagnosed?

Your health care provider will ask about your medical history and do these tests and exams:

• a physical exam, including a pelvic exam
• blood tests
• an ultrasound scan of the ovaries.

Your provider may measure insulin and blood sugar levels to check for diabetes or insulin resistance.

How is it treated?

There is no cure for PCOS, but treatment is important to prevent further problems. The 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, usually birth control pills. If you take hormones or birth control pills, you will have regular menstrual cycles. Having normal menstrual cycles helps reduce your risk of uterine cancer. The birth control pills also lessen production of male hormones, so unwanted hair growth and acne should improve. Your provider may prescribe other medicines with the birth control pills to help with excessive hair growth.

If you are trying to get pregnant, your provider may prescribe fertility drugs, which may be combined with another medicine to help increase your chances of getting pregnant.

Eating a healthy diet and maintaining a healthy weight can help lessen the symptoms of PCOS. If you are obese, your health care provider may suggest a weight control program. Regular exercise helps weight loss and also aids the body in reducing blood glucose levels and using insulin more efficiently.

Your provider may prescribe diabetes medicine, such as metformin, to help keep the insulin in the blood at normal levels. Metformin can decrease testosterone levels, restore normal menstrual cycles, and improve fertility.

In rare cases, you may have surgery to remove or destroy a wedge of ovarian tissue. This usually results in regular menstrual cycles for at least a while.

How long will the effects last?

With treatment your symptoms may improve, but there is no cure for PCOS. The problem will continue until your ovaries stop producing hormones at menopause.

In rare cases PCOS does not recur after you have a baby.

How can I take care of myself?

• Follow your health care provider's prescribed treatment.
• 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 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.