Polycystic Ovary Syndrome (PCOS) is a hormone or endocrine syndrome or group of clinical symptoms and was first described by doctors in the 1930s.

In PCOS characteristically there is an excess of androgens (male-like hormones) and lack of regular ovulation (release of an egg from the ovary). It is sometimes also referred to as “hyperandrogen anovulation syndrome” or “Stein Leventhal Syndrome”.

Incidence

PCOS (with clinical symptoms) affects between 5-10% of all women of childbearing age. However around 20-25% of premenopausal women have polycystic ovaries mostly with no symptoms and therefore do not have the “syndrome”.

Cause

The exact cause is unknown but there appears to be a hereditary and a lifestyle component e.g. sisters of PCOS sufferers have up to a 50% chance of having the disorder and 70% of women with PCOS are overweight and not physically active.

The ovary produces excessive androgens (eg testosterone), which may be caused by the body not producing and/or processing the hormone insulin normally.

The “cysts” seen in the ovary in PCOS are follicles or eggs which have matured but not released, so giving a “space-craft like” appearance. On pelvic ultrasound the diagnosis of polycystic ovaries is confirmed if there are more than 15 follicles visible in an ovary.

In a normal ovary only one egg matures and is released (ovulation) each menstrual cycle.

Symptoms

There are many symptoms but each woman will be quite individual in her presentation. Symptoms may present from puberty but may begin in the twenties.

The following are a list of symptoms:

• period problems:
  some women have normal regular periods whereas most will have some changes to their cycle. Sometimes bleeding is heavy but it can also be lighter. The periods may be or become irregular and may stop altogether. In the teenage years this maybe normal and can delay diagnosis of PCOS. When chronic anovulation (lack of egg being released regularly) occurs the lining of the uterus (endometrium) may thicken and may lead to abnormal cell changes and an increased risk of uterine and endometrial cancer as women age.
• hirsutism:
  is an excess of hair on the face and body due to the excess in androgens. The hair can increase of the sideburn area, chin, upper lip, around nipples, lower abdomen, chest and thighs.
• acne:
  can increase on face and body with the increase in androgens.
• alopecia:
  loss or thinning of scalp hair in a “male-like” pattern.
• weight problems or obesity:
  two thirds of PCOS sufferers are affected. The weight gain is usually in the abdominal region giving an “apple” shape. This shape carries a higher risk of cardiovascular disease including high blood pressure and heart disease. The weight gain is associated with the body not processing insulin normally. Insulin resistance is caused by weight gain and in itself does not necessarily cause weight gain. The remainder of PCOS sufferers are either normal or underweight.
• reduced fertility or infertility
  This is usually related to the lack of egg release or ovulation and can be complicated by being overweight.

Risks

With the increase in androgens, menstrual problems and changes in insulin there is an increased risk of:

• lipid abnormalities including high cholesterol, low HDL & high LDL cholesterol (the different forms of cholesterol)
• diabetes, insulin resistance or elevated insulin levels

Potential risks

There may be an increased risk of cardiovascular disease including high blood pressure and heart disease, this has yet to be clarified.

• endometrial or uterine cancer may be increased as oestrogens produced by the ovaries can overstimulate and thicken the endometrium or womb lining and is associated with chronic anovulation

Psychological Effects

Self-esteem and a sense of one’s body image may be affected by the symptoms of hirsutism, acne, hair loss, obesity and fertility problems. Other psychological reactions may occur relating to issues of femaleness, femininity and sexuality and can contribute to depression, social isolation and other mood changes.

Content updated December 11, 2005