Polycystic ovary syndrome (PCOS) is one of the most common female endocrine disorders.These patients have a steady state of relatively high estrogen, androgen and LH levels rather than the fluctuating levels seen in ovulating women.
There are two definitions or diagnostic criteria that are commonly used:
In 1990 a consensus workshop sponsored by the NIH(National Institutes of Health)/NICHD(National Institute of Child Health and Human Disease) suggested that a patient has PCOS if she has all of the following:
- Signs of androgen excess (clinical or biochemical)
- Other entities are excluded that can result in menstrual irregularity and hyperandrogenism.
- Oligoovulation and/or anovualation manifested as oligomenorrhea or amenorrhea
- Excess androgen activity (clinical or biochemical evidence)
- polycystic ovaries (as seen on gynecologic ultrasound)
Increased level of estrogen comes from obesity due to conversion of ovarian and adrenal androgen to estrone in body fat. High estrogen level suppresses FSH and causes relative increase in LH. Constant LH stimulation of ovary results in anovulation, multiple cysts and theca cell hyperplasia with excess androgen production.
A patient with polycystic ovary syndrome presents with following clinical features:
- Hirsutism (male pattern of hair growth).
- Virilization (development of male-like characteristics).
- Amenorrhea (no menstrual periods).
- Abnormal uterine bleeding.
- Insulin resistance and hyperinsulinemia with increased risk of type II diabetes.
- Infertility (This generally results directly from lack of ovulation)
- Increased risk of cancer of breast and endometrium due to unopposed estrogen production.