Polycystic Ovary Syndrome, or PCOS, is a metabolic disorder that affects the female reproductive system. The key characteristics include irregular menstruation, obesity, infertility, acne and hair growth on the face, chest, and back (hirsutism) and ovarian cysts. Polycystic means "many cysts," and the ovaries in women with PCOS are usually large and full of cysts, although they may not have symptoms. About 6% to 10% of women have PCOS. To be diagnosed with PCOS, a woman must have at least one of the clinical signs mentioned above. Many women with PCOS are insulin resistant and overweight or obese and some may have Type 2 diabetes.
Women who have PCOS have a hormonal imbalance. Their ovaries and adrenal glands produce more androgens, specifically testerone, and often less estrogen and progesterone than normal. This imbalance causes many of the symptoms. Cysts develop in the follicles where the ovary produces eggs. As many as a dozen cysts may occur at once and eventually may damage the follicle. This is the cause of the infertility.
It is generally believed that PCOS has a genetic component that is influenced by environmental factors such as diet and exercise. It is not clear whether PCOS causes obesity or obesity causes PCOS. Obesity increases the insulin resistance that often occurs with PCOS. Some women see their symptoms disappear with weight loss, regular exercise and a diet lower in fat and carbohydrates.
A person with PCOS often has other signs of Syndrome X which are insulin resistance, Type 2 diabetes, high blood pressure, high cholesterol levels, especially high LDL and triglycerides, and heart disease. Insulin resistance may be at the center of PCOS. High levels of insulin in the blood stream stimulate the ovaries to increase androgen production.
Many of the symptoms of PCOS respond to weight loss probably because it improves insulin sensitivity which reduces insulin's interference with normal sex hormone production and action. This can be effectively combined with hormones, insulin sensitizing medications such as metformin or Avandia and Actos, and sometimes androgen-blocking drugs. The particular combination used depends on the severity of symptoms and how well the person tolerates the medications' effects.
Some symptoms take longer to go away than others, even with medical treatment. Acne typically clears up within a few weeks, while hirsutism can take six months to a year to even begin to disappear.
The effects of the insulin sensitizing drugs on a developing fetus are not known so using these to restore fertility should be combined with other birth control measures so a pregnancy is not begun while on these drugs. The best way to restore fertility is hormone based drugs but they can have the side effect of a multiple pregnancy.