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Polycystic Ovary Syndrome

By JoAnn V. Pinkerton, MD

Polycystic ovary syndrome is characterized by slight obesity, irregular or no menstrual periods, and symptoms caused by high levels of male hormones (androgens). It involves disruption of the menstrual cycle and a tendency to have high levels of male hormones (androgens).

  • Typically, women are obese and develop acne and masculine characteristics—the voice deepens, breast size decreases, and excess body hair appears.

  • Doctors often base the diagnosis on symptoms, but blood tests to measure hormone levels and ultrasonography may also be done.

  • Exercise, weight loss, and estrogen plus a progestin or a progestin alone may help reduce symptoms (including excess body hair) and restore hormone levels to normal.

  • If women wish to become pregnant, losing weight and taking clomiphene, sometimes with metformin, may stimulate release of an egg.

Polycystic ovary syndrome affects about 5 to 10% of women. In the United States, it is the most common cause of infertility. It gets its name from the many fluid-filled sacs (cysts) that often develop in the ovaries, causing them to enlarge.

What causes polycystic ovary syndrome is not clear. Some evidence suggests that the enzyme controlling the production of male hormones malfunctions. As a result, the production of male hormones (androgens) increases. High levels of male hormones increase the risk of metabolic syndrome (with high blood pressure, high cholesterol levels, and resistance to the effects of insulin ). If male hormone levels remain high, the risk of diabetes, heart and blood vessel disorders, and high blood pressure is increased. Also, some of the male hormones may be converted to estrogen , increasing estrogen levels. Not enough progesterone is produced to balance the increased level of estrogen . If this situation continues a long time, the lining of the uterus (endometrium) may become extremely thick (a condition called endometrial hyperplasia). Also, the risk of cancer of the lining of the uterus (endometrial cancer) may be increased.

In many women with polycystic ovary syndrome, the body’s cells resist the effects of insulin (called insulin resistance or sometimes prediabetes). Insulin helps sugar (glucose) pass into cells so that they can use it for energy. When cells resist its effects, sugar accumulates in the blood, and the pancreas produces more insulin to try to lower sugar levels in the blood. If insulin resistance becomes moderate or severe, diabetes is diagnosed.

Did You Know...

  • Polycystic ovary syndrome is the most common cause of infertility in the United States.

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