Polycystic ovary syndrome
| Polycystic ovary syndrome | |
|---|---|
| Other names | Hyperandrogenic anovulation (HA), Stein–Leventhal syndrome |
| A polycystic ovary | |
| Specialty | Gynecology, endocrinology |
| Symptoms | Irregular menstrual periods, heavy periods, excess hair, acne, difficulty getting pregnant, patches of thick, darker, velvety skin |
| Complications | Type 2 diabetes, obesity, obstructive sleep apnea, heart disease, mood disorders, endometrial cancer |
| Duration | Long term |
| Causes | Genetic and environmental factors |
| Risk factors | Family history, obesity |
| Diagnostic method | Based on irregular periods, high androgen levels, ovarian cysts |
| Differential diagnosis | Adrenal hyperplasia, hypothyroidism, high blood levels of prolactin |
| Management | Healthy lifestyle, medication |
| Medication | Birth control pills, metformin, anti-androgens, fertility treatments such as letrozole |
| Frequency | 5–18% of women of childbearing age |
Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women of reproductive age. The name comes from the observation of small follicles (or "cysts") that often appear on the ovaries. However, not everyone with PCOS has these follicles, and they are not the cause of the condition.
PCOS is diagnosed when a woman has at least two of the following three features: irregular menstrual periods, high testosterone or related symptoms (like excess facial hair), or polycystic ovaries found on an ultrasound. A blood test for high levels of anti-Müllerian hormone can replace the ultrasound in the diagnosis. Other symptoms associated with PCOS are heavy periods, acne, difficulty getting pregnant, and patches of darker skin.
The exact cause of PCOS remains uncertain. There is a clear genetic component, but environmental factors are also thought to contribute. PCOS occurs in between 5% and 18% of women. The disorder is linked to insulin resistance, which is made worse by obesity. Insulin resistance and related excess insulin levels increase the risk of complications such as type 2 diabetes and liver disease. Women with PCOS also have higher risk of endometrial cancer.
Management focuses on relieving symptoms and reducing long-term risks. A healthy lifestyle and weight control are recommended for general management. In addition, hormonal contraception can help to regulate menstrual cycles, to reduce acne and excess hair growth. Metformin, a common anti-diabetes drug, increases insulin sensitivity. For fertility, ovulation can be induced with letrozole, among other methods. In addition, women can be monitored for cardiometabolic risks, and during pregnancy.