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Polycystic ovary syndrome

Polycystic ovaries; Polycystic ovary disease; Stein-Leventhal syndrome; Polyfollicular ovarian disease; PCOS

Polycystic ovary syndrome (PCOS) is a condition in which a woman has increased levels of male hormones (androgens). Many problems occur as a result of this increase of hormones, including:

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Endocrine glands
Pelvic laparoscopy
Female reproductive anatomy
Stein-Leventhal syndrome
Uterus
Follicle development

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Causes

PCOS is linked to changes in hormone levels that make it harder for the ovaries to release fully-grown (mature) eggs. The reasons for these changes are unclear. The hormones affected are:

Normally, one or more eggs are released during a woman's cycle. This is known as ovulation. In most cases, this release of eggs occurs about 2 weeks after the start of a menstrual period.

In PCOS, mature eggs are not released. Instead, they stay in the ovaries with a small amount of fluid (cyst) around them. There can be many of these. However, not all women with the condition will have ovaries with this appearance.

Women with PCOS have cycles where ovulation does not occur every month which may contribute to infertility The other symptoms of this disorder are due to the high levels of male hormones.

Most of the time, PCOS is diagnosed in women in their 20s or 30s. However, it may also affect teenage girls. The symptoms often begin when a girl's periods start. Women with this disorder often have a mother or sister who has similar symptoms.

Symptoms

Symptoms of PCOS include changes in the menstrual cycle, such as:

Other symptoms of PCOS include:

The development of male characteristics is not typical of PCOS and may indicate another problem. The following changes may indicate another problem apart from PCOS:

Exams and Tests

Your health care provider will perform a physical exam. This will include a pelvic exam. The exam may show:

The following health conditions are common in women with PCOS:

Your provider will check your weight and body mass index (BMI) and measure your belly size.

Blood tests can be done to check hormone levels. These tests may include:

Other blood tests that may be done include:

Your provider may also order ultrasound of your pelvis to look at your ovaries.

Treatment

Weight gain and obesity are common in women with PCOS. Losing even a small amount of weight can help treat:

Your provider may prescribe birth control pills to make your periods more regular. These pills may also help reduce abnormal hair growth and acne if you take them for several months. Long acting methods of contraception hormones, such as the Mirena IUD, may help to stop irregular periods and the abnormal growth of the uterine lining.

A diabetes medicine called Glucophage (metformin) may also be prescribed to:

Other medicines that may be prescribed to help make your periods regular and help you get pregnant are:

These medicines work better if your body mass index (BMI) is 30 or less (below the obese range).

Your provider may also suggest other treatments for abnormal hair growth. Some are:

Effective methods of hair removal include electrolysis and laser hair removal. However, many treatments may be needed. Treatments are expensive and the results are often not permanent.

A pelvic laparoscopy may be done to remove or alter an ovary to treat infertility. This improves the chances of releasing an egg. The effects are temporary.

Outlook (Prognosis)

With treatment, women with PCOS are very often able to get pregnant. During pregnancy, there is an increased risk of:

Possible Complications

Women with PCOS are more likely to develop:

When to Contact a Medical Professional

Call your provider if you have symptoms of this disorder.

Related Information

Absent menstrual periods - primary
Endometrial cancer

References

Bulun SE. Physiology and pathology of the female reproductive axis. In Melmed S, Auchus RJ, Goldfine AB, Loenig RJ, et al, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 17.

Catherino WH. Reproductive endocrinology and infertility. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 223.

Lobo RA. Polycystic ovary syndrome. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 41.

Rosenfield RL, Barnes RB, Ehrmann DA. Hyperandrogenism, hirsutism, and polycystic ovary syndrome. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 133.

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Review Date: 1/27/2020  

Reviewed By: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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