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Polycystic Ovarian Syndrome (PCOS)
Polycystic ovarian syndrome is the most common endocrinologic disorder in women of reproductive age. Approximately 5-10% of reproductive-age women have polycystic ovarian syndrome. The syndrome may have many symptoms. However, it is fairly easy to diagnose.
How To Diagnose PCOS
Patient’s with polycystic ovarian syndrome need to have two of the following criteria: The first includes chronic anovulation, or the inability to release an egg. Another factor is clinical hyperandrogenism, or increase in male-type hormones. This may be manifested in excess facial and body hair, male-pattern balding, or acne of the face, back, and chest. Occasionally, this can also be discovered with elevated male hormones. The last criteria is multiple small cysts of the ovaries. This is where the acronym of polycystic ovarian syndrome originates. It should be kept in mind that patients only need two out of the last three criteria to be diagnosed with polycystic ovarian syndrome.
Associated Problems with PCOS
Some women with polycystic ovarian syndrome also suffer from subtle endocrine abnormalities. One of these is insulin resistance, which affects sugar and fat metabolism and may increase the long-term effects of heart disease, diabetes, and high cholesterol. Because of the increased risk of diabetes, we generally recommend an initial glucose tolerance test. This test is performed in a fasting state. A glucose load is administered and serum glucose level is determined 2 hours later. If this is abnormal, we generally refer the patient to an endocrinologist for potential treatment. It is important to exclude diabetes prior to pregnancy to ensure optimal outcome of pregnancy. With diabetes, miscarriages and abnormalities of the fetus may occur. In general, we also evaluate thyroid by performing a blood test, and we also ensure that the patient’s prolactin level is normal via a blood test. Long-term followup in women with polycystic ovarian syndrome reveals that up to 40% develop impaired glucose processing or diabetes by age 40. The prevalence of diabetes in women with polycystic ovarian syndrome is seven times higher than the non-PCOS population.
Causes of PCOS
The causes of polycystic ovarian syndrome are unknown. We know that the imbalance of ovarian hormones exist, which prevents the eggs from growing and ovulating every month. Additionally, this imbalance contributes to an excess of male hormone production by the ovaries, which can be worsened by insulin resistance. There is no cure for polycystic ovarian syndrome, but various symptoms can be addressed and managed, thereby reducing the risks of long-term health consequences.
