Women's Health Specialists of St. Louis
Obstetrics and Gynecology

Articles - Polycystic Ovaries

Literally, polycystic ovaries are ovaries with many cysts. Polycystic ovarian syndrome (PCOS) affects about 5% of women of reproductive age. It is a collection of symptoms rather than a disease. The symptoms can arise when a woman experiences lack of ovulation (release of an egg) for many months. In fact, it will affect 75% of women who have persistent lack of ovulation. The hormone imbalance that ensues may present with a variety of signs and symptoms. These may include acne, weight gain, hair growth on the face and irregular menstrual periods. Not all of these symptoms have to be present for the diagnosis of PCOS to be made. If PCOS is left untreated, the hormone imbalance causes higher levels of male hormones. These increase the risk of high cholesterol, atherosclerosis, and heart disease. Insulin resistance also is often associated with PCOS. If insulin resistance is untreated, it can be the cause of continued weight gain despite attempts to diet and may progress to adult onset diabetes. Longstanding lack of ovulation with or without PCOS is a common cause of infertility and also increases the risk of cancer of the uterus.

Because the hormone imbalance associated with PCOS can cause disease, diagnosis and treatment of PCOS is important. The diagnosis of PCOS is confirmed by laboratory evaluation and ultrasound. The laboratory tests may include evaluation for elevated testosterone, abnormal thyroid function, elevated insulin levels, as well as many other hormones affected by ovarian function. The ultrasound will evaluate the size and appearance of the ovaries. Ovaries in a woman with PCOS typically are enlarged with several small cysts lining the edge of the ovary. Remember, PCOS is a sign not a disease so sometimes the classic signs are not all present. For example, a woman may have abnormally high levels of male hormone but normal-appearing ovaries by ultrasound. Conversely, a woman may have enlarged polycystic-appearing ovaries by ultrasound but no hormonal abnormalities. In this case, no intervention is necessary.

Treatment is dependant on the symptoms and laboratory abnormalities. In most cases, birth control pills are used to get the ovaries back into a normal pattern. For women who are not candidates for birth control pills, the specific symptoms are treated. For example, there are individual medications to treat elevated insulin, unwanted hair growth, elevated cholesterol, etc. For women who are experiencing difficulty getting pregnant, medications are available to help jump start the ovaries.

PCOS has a strong association with weight gain and obesity. We know that if women lose weight then the PCOS often resolves. We also know that when the PCOS is treated, then weight loss usually occurs. As the American population becomes more overweight, the incidence of PCOS will likely increase. PCOS is not considered to be genetic, however, it tends to be more common in women with a family history of obesity. Also, in families with a history of adult-onset diabetes or who are of Hispanic descent, insulin resistance and PCOS are more common. The best prevention of PCOS is diet and exercise to keep a normal body mass. Birth control pills can also be used to help prevent recurrence of this hormone imbalance.