Polycystic ovary syndrome or PCOS is one of the most common disorders seen in women of reproductive age. This is a hormonal imbalance which leads to problems of menstruation and is a major cause of problems during conception and pregnancy. Prolonged persistence of polycystic ovary syndrome can have serious consequences like changes in the appearance, diabetes or heart disease. It can be treated in a number of ways including medication, surgery or lifestyle modification.

In order to understand the polycystic ovary syndrome or PCOS, it is necessary to understand the endocrine system of the body. Your body creates a number of chemical substances called hormones, each of which performs different functions. Sometimes, in women of reproductive age, these hormones get out of balance. Some of them increase too much while others decrease. The result of this imbalance can be felt in a number of different systems of the body. One of the impacts is the polycystic ovary syndrome. According to some research, the secretion of insulin can also be linked to the incidence of PCOS.

It is actually quite a common condition. 5% to 10% women of reproductive age (between ages 12 to 45) experience this condition to various extents. According to one study, the incidence of the polycystic ovary syndrome varies between 1 in 10 to 1 in 20 women. A conservative estimate says that up to 5 million women in USA may be suffering from this disease and it may occur in girls as young as 11 years old.

Causes of polycystic ovary syndrome

While it is fairly well established that polycystic ovary syndrome is caused by hormonal imbalance, the specific nature and causes of such imbalance are not clearly known. Here are some of the causes of polycystic ovary syndrome:

  • Genetic factors probably play an important role in the incidence of polycystic ovary syndrome. It is seen that if you have the disease, your sisters and daughters have a 50% chance of developing this condition. It will also be passed to your sons and their daughters too will have a chance of developing this disease.
  • The hormones released by the ovaries may be out of balance. This interferes with normal ovulation which has an impact on the menstrual cycle.
  • The hormonal imbalance also leads to the secretion of a higher level of male sex hormone or androgen. This intensifies the condition and can also leave its imprint on your physical features.
  • When the pituitary gland releases excess amount of luteinizing hormone or LH, it may lead to excessive production of androgen.
  • High levels of the hormone insulin can also lead to the development of polycystic ovary syndrome. Many women who have PCOS also have a problem in the way in which their bodies process the hormone insulin. This is called insulin resistance. If the body cannot use insulin well, it may build up in the body. Excess insulin tends to release excess androgen which further complicates the problem.
  • According to some ongoing studies, if the levels of globulins which bind the sex hormones are reduced, it leads to excess secretion of androgen.

What happens in polycystic ovary syndrome?

So, what exactly happens in this hormonal disorder and why is this name given?

  • In normal cases, your ovaries produce the egg or the ovum. The ovaries are lined by tiny fluid filled sacs called follicles. As the egg matures, the follicles too begin to grow and fill up with fluids. At the time of maturity, the follicles break open. The egg is released. It travels via the fallopian tubes to your uterus or the womb. Here it is either fertilized by a sperm and leads to a pregnancy, or it is lost through normal menstrual bleeding.
  • When you have polycystic ovary syndrome, the hormone secretion of the ovaries are not proper. As a result, the eggs fail to mature.
  • Follicles begin to grow and fill up with fluids, but when the time comes for them to rupture; they do not do so but remain as cysts.
  • As ovulation is incomplete, the hormone progesterone is either not released or released in small quantities. This is the female sex hormone. The reduced level of this hormone leads to disturbance of the menstrual cycle.
  • In addition, the ovaries secrete excess amount of male hormones or androgen. This also leads to interference in the menstrual cycle.
  • The name of the disorder is derived from the fact that an ultrasound examination of the ovaries of the patient reveals a line of 'cysts' which are not actually cyst at all but dried up follicles. They are arranged like a string of pearls.

Symptoms of PCOS

How will you know if you have the polycystic ovary syndrome? It is a progressive disorder where the symptoms tend to intensify with time. Some of them are:

  • Menstrual disorders of different types are the most common symptoms of polycystic ovary syndrome. The most common ones are oligomenorrhea (few menstrual periods) and amenorrhea (no menstrual periods). In former case, there may be a gap of 35 days between your periods. Sometimes, you may have regular periods but your ovaries may not be releasing the egg. You can also have hypermanurrhea where you have too frequent menstrual periods.
  • Another common menstrual problem faced by almost 30% women who have this disorder is extremely heavy bleeding during menstruation.
  • Directly related to menstrual problems is the incidence of infertility. Chronic anovulation or lack of ovulation may lead to this problem.
  • Higher incidence of miscarriage is also reported by women suffering from polycystic ovary syndrome. The exact mechanism is not known, but the causes may be many. The egg itself may be defective or the hormonal imbalances prevent the egg from being properly implanted in the uterus. High insulin levels also possibly interfere with fertilization.
  • One common factor in PCOS is an increased level of the male hormone androgen in the body. One result of this is excessive facial hair. This is a complaint made by 70% women in USA who suffer from PCOS. The growth of hair on face, stomach, back, chest and toes is generally accompanied by loss of hair from the scalp. This condition is known as hirsutism. It can also lead to alopecia.
  • The high level of androgen also leads to acne and oily skin.
  • Metabolic disorders like obesity are often found in conjunction with this condition. The extra weight tends to accumulate around the waist resulting in central obesity.
  • Women with polycystic ovary syndrome have a strong chance of developing diabetes. You need to monitor your blood sugar levels very closely. In that case, the symptoms of diabetes like weight gain in upper body and dark velvety patches on arm, neck and groin are likely to appear.
  • Obstruction sleep apnea or difficulty in breathing while sleeping is another common symptom and it is aggravated by obesity.
  • Depressions and mood swings are common in the condition as these are essentially triggered by the hormonal imbalance.

How will you know if you have polycystic ovary syndrome?

Most women do not suspect that they have the polycystic ovary syndrome. Instead, they go to the doctor due to other problems like obesity and high blood sugar. Apart from this, male type hair growth on the body with hair loss in the scalp, menstrual irregularities and excess acne are the normal causes to consult a doctor. But there is no one tests to find out whether you have polycystic ovary syndrome. Instead, a number of diagnostic tools are used:

  1. Your medical history is taken. You will have to supply information about the following:
    • Recent changes in weight
    • Hair gain or loss
    • Family history of hormonal problems
    • History of problems regarding insulin
    • Menstrual irregularities
    • Difficulty in conception.
  2. A physical examination is done. This includes checking your weight, BMI, blood pressure and areas of hair growth or loss.
  3. A pelvic exam is also common. It helps your doctor to identify any irregularity or abnormality in your ovaries.
  4. Several blood tests are done to determine if you have the disease. Levels of insulin, androgen, prolactin, triglycerides, thyroid and cholesterol are checked. In fact, if the diagnosis of PCOS is confirmed, you should get regularly screened for diabetes.
  5. Finally, an ultrasound may be done to check if your ovaries are normal or if they exhibit the signs of polycystic ovary syndrome. The presence of the cysts can be detected. Your endometrium or the lining of the womb is also checked. If you have menstrual irregularities, this lining will be abnormally thick.

Once the diagnosis is confirmed, several treatment options are suggested to deal with the disorder.