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Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS, also known clinically as Stein-Leventhal syndrome), is an endocrine disorder that affects 5-10% of women. It occurs amongst all races and nationalities, is the most common hormonal disorder among women of reproductive age, and is a leading cause of infertility.

Other names for this disorder include:

PCOS develops when the ovaries are stimulated to produce excessive amounts of male hormones (androgens), particularly testosterone - either through the release of excessive luteinizing hormone (LH) by the pituitary gland, or due to high levels of insulin in the blood (hyperinsulinaemia) in women whose ovaries are sensitive to this stimulus.

This syndrome acquired its most widely-used name because a common symptom is multiple (poly) ovarian cysts. These form where egg follicles matured, but were never released from the ovary due to abnormal hormone levels. These generally take on a 'string of pearls' appearance. The condition was first described in 1935 by Dr. Stein and Dr. Leventhal, hence its original name of Stein-Leventhal syndrome.

Although the cause of PCOS is not known, research to date suggests that it may be a genetically-linked condition, and further research into this possibility is currently taking place.

Common symptoms of PCOS include:

In addition, women with PCOS are at risk for the following: Women with PCOS have a risk of miscarriage that is approximately 5 times higher than other women. As well, many women with PCOS have a difficult time conceiving, due to the irregular cycles and lack of ovulation. However, it is possible for these women to have normal pregnancies with the aid of medication and diet.

It is vital to note that not all women with PCOS have polycystic ovaries, nor do all women with ovarian cysts have PCOS; although a pelvic ultrasound is a major diagnostic tool, it is not the only one. Diagnosis can be difficult, particularly because of the wide range of symptoms, and the variability of how they present in individuals (which is why this disorder is characterized as a syndrome rather than a disease). There are several blood tests that should be done to diagnose PCOS:

Also, a measurement of TSH levels should be done, as a number of women with PCOS also have an under-active thyroid, aggravating the problem with obesity.

As well, other causes of irregular/absent menstruation and hirsutism such as congenital adrenal hyperplasia, Cushing's syndrome, and other pituitary and/or adrenal disorders, should be investigated.

Medical treatment of PCOS used to be directed mainly at the symptoms (ovarian and adrenal suppression, and anti-androgen therapy) and restoring ovulation. Some medications used for these purposes are:

Recent research suggests that the insulin resistance and over-release of insulin may be the at the root of PCOS. Many women find insulin-sensitising medications such as metformin hydrochloride (Glucophage), pioglitazone hydrochloride (Actos), and rosiglitazone maleate (Avandia) helpful to them. Low-carbohydrate diets and sustained regular exercise are also beneficial. As well, initial research suggests that the risk of miscarriage is significantly reduced when metformin is taken throughout pregnancy (9% as opposed to 45%); however, further research needs to be done in this area.

For patients who do not respond to these and related medications/procedures, the polycystic ovaries can be treated with surgical procedures such as:

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