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Polycystic Ovary System

by Athena L. Richardson, M.D.

Once a girl develops the signs of puberty, she will undoubtedly notice many changes in her body. Typical signs in females are breast development, body odor, body hair, acne, mood swings, and menstruation. If you have experienced growth of facial hair or excess body hair, significant weight gain, worsening acne, and infrequent or prolonged periods, you might have Polycystic Ovary Syndrome (PCOS).

PCOS is the most common hormonal disorder among females of childbearing age. It is estimated that 5-10% of teens and young women have this diagnosis. Generally, PCOS begins during the teenage years around the start of menstruation. It can run in families; so if someone in your family has it, you might be more likely to develop it.

The exact cause of polycystic ovary syndrome is unknown. What is known is that in girls with PCOS, the sex hormones become out of balance. Normally, the ovaries make a tiny amount of male sex hormones (androgens). In PCOS, they start making slightly more androgens, which can interfere with egg development and release. Instead of an egg being released during ovulation, small sacs (cysts) form and become enlarged. Because girls with PCOS are not releasing an egg each month, it's common for them to have irregular or missed periods. In addition, they may develop insulin resistance. This means their body doesn't use its insulin well and blood sugar levels go up. Over time this increases the chance of developing diabetes.

Young women with PCOS commonly have one or more symptoms and signs:

  • Irregular periods - periods that come every few months, not at all, or too frequently
  • Hirsutism - extra hair on the face or other body parts due to the excess of male hormones
  • Acne
  • Weight gain, trouble losing weight, or obesity
  • Acanthosis nigricans - patches of dark skin on the back of the neck and other areas
  • Thinning of the hair
  • Infertility or impaired fertility due to irregular periods or lack of ovulation
  • Depression
  • Prediabetes or diabetes

 

There's no specific test to definitively diagnose polycystic ovary syndrome. A young woman with at least two of the above symptoms should probably check in with her health care provider, who will ask questions about your family history, symptoms, and menstrual cycle patterns and do a complete physical exam to look for signs of PCOS. The doctor may also order a number of lab tests to check blood sugar, insulin, and other hormone levels, and may consider obtaining an ultrasound of the ovaries to determine if cysts or other abnormalities are present. Because cysts are sometimes not visible, this test is not always used.

Early diagnosis and treatment for PCOS are important because the condition can put girls at risk for long-term problems such as:

  • Type 2 diabetes
  • High blood pressure
  • Cholesterol abnormalities, such as high triglycerides or low levels of high-density lipoprotein (HDL) cholesterol, the so-called "good" cholesterol
  • Metabolic syndrome, a cluster of signs and symptoms that indicate a significantly increased risk of cardiovascular disease
  • Sleep apnea
  • Abnormal uterine bleeding
  • Cancer of the uterine lining (endometrial cancer) due to prolonged exposure to high levels of estrogen.

 

Early treatment for PCOS is also a good idea for women who want to have a baby someday. PCOS often causes infertility if it is not treated. However, with proper treatment many women with the condition have healthy babies.

 

Treatment options for PCOS may include:
  • Regular exercise and a heart-healthy diet. This can help lower blood pressure and cholesterol and reduce the risk of diabetes and heart disease.
     
  • Weight loss can be very effective in reducing the risk of many of the health conditions associated with PCOS, such as high blood pressure and diabetes. Sometimes weight loss alone can restore hormone levels to normal, causing many of the symptoms to disappear or become less severe.
     
  • Prescription medications such as birth control pills or progesterone help control hormone levels and regulate the menstrual cycle. In some cases, birth control pills can also help control excess body hair and acne. An androgen-lowering medicine, spironolactone, may be used with birth control pills to help reduce symptoms even more. A diabetes medicine called metformin helps restore regular menstrual cycles and fertility, as well as control blood sugar.
     
  • Avoidance or cessation of tobacco use. Women who smoke have higher androgen levels that may contribute to PCOS symptoms.

 

If you are experiencing symptoms of PCOS, don’t hesitate to contact your pediatrician who can evaluate and treat your condition and provide guidance as you transition to womanhood.