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Polycystic ovarian syndrome (PCOS) is a disorder that results in abnormal hormonal stimulation to the ovaries and abnormal hormonal response of the ovaries to that stimulation resulting in high estrogen levels and failure of the ovaries to ovulate regularly. In a normal ovary, a single egg develops and is released during ovulation each month. A polycystic ovary will have many eggs that are never released.

What is going on in the body?

Polycystic ovarian syndrome often begins with puberty and worsens with time. The cause of PCOS has not yet been completely identified. The symptoms of PCOS are related to an excess of the various forms of estrogen which results, in turn, in elevated levels of androgens (male hormones). Androgens can cause masculine features such as facial hair, increased acne, weight gain, and male-pattern baldness in women. Polycystic ovaries may be normal in size, or they may be enlarged, with smooth, thick coverings.

What are the signs and symptoms of the disease?

The symptoms of polycystic ovarian syndrome include:

• acne
• irregular menses
• excess body hair
• infertility
• obesity
• oligomenorrhea or scanty menstruation

The woman may have several ovarian cysts, or fluid-filled sacs which are actually eggs that cannot rupture (ovulate) and are positioned all around the ovarian surface. Small ovarian cysts usually don't produce symptoms.

• abdominal pain
• abnormal uterine bleeding
• low back pain
• pelvic pain

Ovarian cysts may sometimes rupture, although this is rare. They may also start to twist. This can cause sudden abdominal pain and tenderness.

What are the causes and risks of the disease?

• certain medicines, such as those used for seizure disorders or mood disorders
• an enzyme abnormality that causes an excess of the hormone androgen
• genetic disorders that cause an increase in the production of the hormone testosterone
• inherited metabolic disorders that interfere with the body's normal use of insulin

• breast cancer
• high blood pressure
• obesity
• uterine cancer

What can be done to prevent the disease?

There is no known way to prevent polycystic ovarian syndrome.

How is the disease diagnosed?

Diagnosis of PCOS begins with a medical history and physical exam. A pelvic exam may reveal enlarged ovaries. Ovarian cysts may be detected using ultrasound. Laparoscopy, or the placement of a scope through a small incision in the abdomen, can be used to look directly at the ovaries.

A small sample of ovarian tissue, called a biopsy, may be taken during laparoscopy to be checked in a laboratory. Blood and urine tests may be used to check hormone levels. Documentation of the failure to ovulate can be detected by use of temperature charts or ovulation-indicator tests.

What are the long-term effects of the disease?

The long-term effects of polycystic ovarian syndrome depend on the woman's condition and her response to treatment, but they may include:

• endometrial hyperplasia, or a buildup of cells that line the uterus, which increases her risk for cancer of the uterus. This condition occurs because high levels of estrogen, without the balancing effect of progesterone, stimulate the lining cells to change
• heart disease later in life, due to the estrogen/progesterone imbalance and elevated androgen levels
• infertility, because of irregular ovulation
• insulin resistance, which can contribute to obesity and diabetes

What are the risks to others?

Polycystic ovarian syndrome is not contagious and poses no risk to others.

What are the treatments for the disease?

There are many ways to treat polycystic ovarian syndrome, depending on a woman's symptoms. Treatment can include:

• bleaching, electrolysis, waxing, and other cosmetic treatment of unwanted hair
• diet and exercise for weight loss
• infertility treatments to stimulate ovulation
• oral birth control pills or progesterone to regulate menstrual periods and reduce male hormone levels
• spironolactone (i.e., Aldactone), a mild diuretic that blocks the effects of male hormones
• bromocriptine (i.e., Parlodel) is prolactin is elevated
• prednisone or dexamethasone (i.e., Decadron) is DHEA-S is elevated
• surgery, such as ovarian drilling

Newer treatments focus on lowering insulin levels in the blood. This may help reduce the production of male hormones. It may also reduce the symptoms of PCOS and help to allow for more frequent ovulation. Metformin (i.e., Glucophage) is one medicine that has been used for this purpose and has been shown to improve hyperandrogenism and restore ovulation.

What are the side effects of the treatments?

Surgery may be complicated by bleeding, infection, and allergic reaction to the anesthetic. Medicine side effects will vary, but they include allergic reactions.

What happens after treatment for the disease?

The symptoms of polycystic ovarian syndrome can often be managed over time with proper treatment. Ovulation may allow pregnancy to be achieved.

How is the disease monitored?

A woman's healthcare professional will monitor her condition with regular pelvic exams and other tests. Any new or worsening symptoms should be reported to the healthcare professional.