Polycystic ovary syndrome overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

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Overview

PCOS is the most common form of chronic anovulation associated with androgen excess. Polycystic ovary syndrome occurs in approximately 5% to 10% of reproductive-age women. The diagnosis of PCOS is made by excluding other hyper androgenic disorders like nonclassic adrenal hyperplasia, androgen-secreting tumors, hyperprolactinemia in women with chronic anovulation and androgen excess. During the reproductive years, PCOS is associated with important reproductive morbidity, including infertility, irregular uterine bleeding, and increased pregnancy loss. The endometrium of the patient with PCOS must be evaluated by biopsy because long-term unopposed estrogen stimulation leaves these patients at increased risk for endometrial cancer. PCOS is also associated with increased metabolic and cardiovascular risk factors. These risks are linked to insulin resistance and are compounded by the common occurrence of obesity, although insulin resistance also occurs in nonobese women with PCOS. PCOS is considered to be a heterogeneous disorder with multifactorial causes. PCOS risk is significantly increased with a positive family history of chronic anovulation and androgen excess, and this complex disorder may be inherited in a polygenic fashion

Historical Perspective

PCOS was first described in 1935 by American gynecologists Irving F. Stein, Sr. and Michael L. Leventhal, from whom its original name of Stein–Leventhal syndrome is taken. The earliest published description of PCOS was in 1721 in Italy. Cyst-related changes to the ovaries were described in 1844

Classification

PCOS may be classified into 4 types based upon severity of symptoms into asymptomatic form, mild form, classical form and metabolic form

Causes

The underlying defect in patients with PCOS remains unknown, but the harmonal imbalance between LH, FSH and estrogen are mainly responsible for the development of polycystic ovary syndrome. Most studies suggest that more than one factor could play a role in developing PCOS.

Differentiating Polycystic ovary syndrome overview from Other Diseases

Polycystic ovary syndrome must be differentiated from other causes of irregular or absent menstruation and hirsutism, such as congenital adrenal hyperplasia, cushing's syndrome, hyperprolactinemia, and other pituitary or adrenal disorders.

Epidemiology and Demographics

Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders of reproductive-age women, with a prevalence of 4-12% in the United States. Up to 10% of women are diagnosed with PCOS.

Risk Factors

Common risk factors in the development of Polycystic ovary syndrome are hyperinsulinemia secondary to insulin resistance, obesity, family history of PCOS among first-degree relatives, premature adrenarche, fetal androgen exposure, and low birth weight

Screening

According to Royal College of Obstetricians and Gynaecologists (RCOG) thyroid function tests, serum prolactin levels, and a free androgen index are baseline screening tests recommended for women with suspected polycystic ovarian syndrome (PCOS).

Natural History, Complications, and Prognosis

If left untreated patients with PCOS can develop heart disease due to elevated cholesterol and increased levels of androgens. Increased lengths of time without a menstrual period leads to unopposed exposure of endometrium to estrogen can result in uterus cancer. Complications that can develop as a result of polycystic ovary syndrome are insulin resistance/type II diabetes, high blood pressure, dyslipidemia, strokes, miscarriage, and infertility. The prognosis for fertility in patients with polycystic ovary syndrome is good with treatment, unless there are other unknown fertility problems.

References

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