A Quick Look at PCOS

• Is also known as Stein-Leventhal Syndrome, Polycystic Ovary Disease (PCOD), Syndrome O or Syndrome X
  
• Is the leading causes of infertility in Women.
  
• PCOS is generally considered a syndrome rather than a disease (though it is sometimes called Polycystic Ovary Disease) because it manifests itself through a group of signs and symptoms that can occur in any combination, rather than having one known cause or presentation.
  
• There is no cure for PCOS. It is a condition that is managed through medications, diet and lifestyle changes, rather than cured.
  
• Is an endocrine disorder as opposed to a gynecological disorder
  
• At this time, there is no single definitive test for PCOS. This is because no exact cause of PCOS has been established yet. This is why there is a wide-range of opinion on how to diagnose and treat PCOS.
  
• Treatment of the symptoms of PCOS can help reduce risks of future health problems.
  
• PCOS is associated with increased risk for endometrial hyperplasia, endometrial cancer, insulin resistance, type II diabetes, high blood pressure, high cholesterol, and heart disease.
  
• Although up to 15 million women in the U.S. alone have PCOS, less than half know they have it!

• Amenorrhea (no menstrual period), infrequent menses, and/or oligomenorrhea (irregular bleeding) — Cycles are often greater than six weeks in length, with eight or fewer periods in a year. Irregular bleeding may include lengthy bleeding episodes, scant or heavy periods, or frequent spotting.
  
• Oligo or anovulation (infrequent or absent ovulation) — While women with PCOS produce follicles — which are fluid-filled sacs on the ovary that contain an egg — the follicles often do not mature and release as needed for ovulation. It is these immature follicles that create the cysts.
  
• Hyperandrogenism — Increased serum levels of male hormones. Specifically, testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS).
  
• Infertility — Infertility is the inability to get pregnant within six to 12 months of unprotected intercourse, depending on age. With PCOS, infertility is usually due to ovulatory dysfunction.
  
• Cystic ovaries — Classic PCOS ovaries have a "string of pearls" or "pearl necklace" appearance with many cysts (fluid-filled sacs). It is difficult to diagnose PCOS without the presence of some cysts or ovarian enlargement, but sometimes more subtle alterations may not have been recorded, or are not recognized as abnormal, by the ultrasonographer.
  
• Enlarged ovaries — Polycystic ovaries are usually 1.5 to 3 times larger than normal.
  
• Chronic pelvic pain — The exact cause of this pain isn't known, but it may be due to enlarged ovaries leading to pelvic crowding. It is considered chronic when it has been noted for greater than six months.
  
• Obesity or weight gain — Commonly a woman with PCOS will have what is called an apple figure where excess weight is concentrated heavily in the abdomen, similar to the way men often gain weight, with comparatively narrower arms and legs. The hip:waist ratio is smaller than on a pear-shaped woman — meaning there is less difference between hip and waist measurements. It should be noted that most, but not all, women with PCOS are overweight.
  
• Insulin resistance, hyperinsulinemia, and diabetes — Insulin resistance is a condition where the body's use of insulin is inefficient. It is usually accompanied by compensatory hyperinsulinemia — an over-production of insulin. Both conditions often occur with normal glucose levels, and may be a precursor to diabetes, in which glucose intolerance is further decreased and blood glucose levels may also be elevated.
  
• Hypertension (high blood pressure) — Blood pressure readings over 140/90.
  
• Hirsutism (excess hair) — Excess hair growth such as on the face, chest, abdomen, thumbs, or toes.
  
• Alopecia (male-pattern baldness or thinning hair) — The balding is more common on the top of the head than at the temples.
  
• Acne/Oily Skin/Seborrhea — Oil production is stimulated by overproduction of androgens. Seborrhea is dandruff — flaking skin on the scalp caused by excess oil.
  
• Acanthosis nigricans (dark patches of skin, tan to dark brown/black) — Most commonly on the back of the neck, but also but also in skin creases under arms, breasts, and between thighs, occasionally on the hands, elbows and knees. The darkened skin is usually velvety or rough to the touch.
  
• Acrochordons (skin tags) — Tiny flaps (tags) of skin that usually cause no symptoms unless irritated by rubbing.
  

Your doctor will be looking for a combination of laboratory results and clinical findings that suggest PCOS. If you are diagnosed with PCOS your doctor may order tests such as lipid profiles and glucose levels to monitor your risk of developing future complications such as diabetes and cardiovascular disease.

Laboratory Tests

• FSH (Follicle Stimulating Hormone), will be normal or low with PCOS
  
• LH (Lutenizing Hormone), will be elevated
  
• LH/FSH ratio, This ratio is normally about 1:1 in premenopausal women, but with PCOS a ratio of greater than 2:1 or 3:1 may be considered diagnostic
  
• Prolactin will be normal or low
  
• Testosterone, total and/or free, usually elevated
  
• DHEAS (may be done to rule out a virilizing adrenal tumor in women with rapidly advancing hirsutism), frequently mildly elevated with PCOS
  
• 17-ketosteroids (urine metabolites of androgens, used to evaluate adrenal function), elevated or decreased?
  
• Estrogens, may be normal or elevated
  
• Sex hormone binding globulin, may be reduced
  
• Androstenedione, may be elevated
  
• hCG (Human chorionic gonadotropin), used to check for pregnancy, negative
  
• CMP (Comprehensive metabolic panel)
  
• Lipid profile (low HDL, high LDL, and cholesterol, elevated triglycerides)
  
• Glucose, fasting or a glucose tolerance, may be elevated
  
• Insulin, often elevated
  
• TSH (Thyroid stimulating hormone) some who have PCOS are also hypothyroid
  

Non-Laboratory Tests

Ultrasound, transvaginal and/or pelvic/abdominal are used to evaluate enlarged ovaries. With PCOS the ovaries may be 1.5 to 3 times larger than normal, and characteristically have more than 8 follicles per ovary, with each follicle less than 10 mm in diameter. Often the cysts are lined up on the surface the ovaries, forming the appearance of a "pearl necklace." These ultrasound findings are not diagnostic. They are present in more than 90% of women with PCOS but they are also found in up to 25% of women without PCOS.