Overview of Polycystic Ovary Syndrome
During ovulation, the ovaries release an egg from a fully mature follicle. Follicles are round structures associated with the ovary that form and release a new egg just once a month, coinciding with the menstrual cycle. If, for some reason, the follicle does not fully mature, it will not rupture to release the egg. The immature follicle itself will instead remain associated with the ovary, appearing on an ultrasound as a "cyst." Should these cysts continue to form through successive cycles, the ovaries will enlarge due to all the extra follicles, hence the term polycystic ovaries.
Some women with polycystic ovaries additionally develop polycystic ovary syndrome (PCOS). PCOS is a hormonal disorder characterized by irregular ovulation and menstruation, with an accompanying increase in male hormones. It is not entirely understood why some women with polycystic ovaries develop PCOS while others don't, though PCOS seems to coincide health conditions such as obesity or diabetes. PCOS is fairly common, occurring in approximately 5% of women of reproductive age, and is the leading cause of female infertility.
Symptoms of Polycystic Ovary Syndrome
Some women with PCOS will experience amenorrhea, a lack of menstruation, sometimes for many years. Others may menstruate, but their cycles are usually irregular due to periodic lack of ovulation. Menstruation may also vary significantly in heaviness from cycle to cycle. Women with PCOS also experience difficulties conceiving due to the unpredictable nature or complete absence of ovulation.
The hormonal imbalances associated with PCOS may lead to other physical symptoms, as well, including acne and obesity. Some women note physical changes possibly caused by increased testosterone, including excessive hair growth on the face and body, thinning of the hair on the head, and deepening of the voice. Ovarian hormone balance can also influence mood, so PCOS can also lead to depression and mood swings.
Risk Factors of Polycystic Ovary Syndrome
Because women with PCOS do not menstruate and shed the uterine lining as frequently, they are at risk for developing uterine cancer. Decreased estrogen secretion from the ovaries may also lead to premature osteoporosis, reducing the density of the bones and increasing the possibility of developing fractures.
There are also indications that PCOS can lead to insulin resistance, meaning that much more insulin than normal is required to maintain balanced blood sugar. A blood sugar imbalance can lead to diabetes, obesity, and put the patient at risk for all the complications that accompany both. If untreated, the metabolic and hormonal imbalances associated with PCOS can result in high blood pressure and unhealthy cholesterol levels, potentially leading to heart disease and stroke.
Causes of Polycystic Ovary Syndrome
Polycystic ovaries develop during the course of hormonal imbalances that result in "cysts" on the ovaries. These "cysts" are actually follicles that remained associated with the ovary because they were incompletely developed. This can occur in women producing excessive amounts of testosterone, excessive luteinizing hormone (LH, which, at normal levels triggers ovulation), or high levels of blood insulin. As these follicles accumulate on the ovaries, they are visible by ultrasound.
Not all women that have polycystic ovaries develop PCOS, which is defined by the collection of symptoms described above. Why some women with polycystic ovaries develop symptoms while others don't is unclear, though the symptoms appear to stem from a shift in proper hormonal balance. Obesity, for example, often coincides with insulin resistance and blood sugar imbalance, which can lead to improper stimulation of LH production, which interferes with ovulation. Without ovulation, additional cysts can form and the overall interference of proper ovary function can lead to imbalances of estrogen, progesterone, and testosterone, creating additional symptoms. Human physiology is defined by a series of interconnected, delicately balanced feedback loops, and disruption of any one of them could cause a cascade of effects.
Conventional Treatment of Polycystic Ovary Syndrome
Conventional medical treatment of PCOS varies from patient to patient depending on the symptoms. Overcoming obesity is nearly always the priority, as it can often completely restore normal ovulation and menstruation, thus relieving the other symptoms of PCOS by re-establishing hormonal balance. Regular exercise and a healthy diet can reduce adipose tissue and improve blood sugar and insulin balance. Medications that can help increase insulin sensitivity may also be prescribed if insulin resistance appears to be a factor. Metformin, for example, is a drug typically used to treat diabetes that is often prescribed for PCOS.
To reduce unwanted hair growth and acne, oral contraceptives may also be prescribed. These symptoms are thought to be caused by an excess of testosterone, so birth control pills containing anti-androgens (such as cyproterone acetate) which suppress testosterone activity are sometimes recommended. Facial creams that inhibit hair growth are also available.
Oral contraceptives are also commonly recommended to attempt regulation of the menstrual cycle. By supplementing the hormones necessary to promote regular shedding of the uterine wall, patients with PCOS can significantly reduce their risk of developing uterine cancer.
Patients Medical's Treatment of Polycystic Ovary Syndrome
Because PCOS is a many-layered syndrome, your treatment program at Patients Medical will be designed in collaboration with specialists appropriate to your symptoms and concerns. Through this integrative approach, we will help alleviate your symptoms, re-establish a healthy hormonal balance, and return you to optimal reproductive health. During your initial consultation, our doctors will perform a medical interview to get a complete picture of your current health, lifestyle, and any factors that may be contributing to your PCOS. They may also order ultrasounds and other diagnostic tests to assess the severity of the hormonal imbalance you're experiencing.
Following the interview and medical tests, our doctors can being to formulate a treatment designed for your case. Healthy body composition appears to be of the critical factors in determining whether a woman with polycystic ovaries develops PCOS, so our first approach is often nutritional. We have specialists that can devise a diet that will help you lose weight…
During the course of this lifestyle change, the doctors will work with you closely to monitor the health of your ovaries, in addition to the other symptoms you may have had. In most cases, a return to balanced blood sugar and healthy body weight will restore the natural menstrual cycle, including ovulation. If your fertility is a concern and you are still able to become pregnant after completing our PCOS treatment program, you will be referred to our fertility specialists. (Please see our article on Female Infertility to learn more about our treatments.)
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