Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome is a general (almost catch-all) term characterized by menstrual irregularity and hyperandrogenism. Some women with symptoms of PCO have normal-sized ovaries and regular menstrual cycles, and no inherent abnormalities are associated with the syndrome. Recent emphasis is on hormonal involvement. Obesity, hirsutism, acne, infertility, heavy vaginal bleeding, endometrial hyperplasia, adenocarcinoma, Cushing’s syndrome, and an ovarian or adrenal tumor may be associated. Stein-Levinthal Syndrome is a more narrow term sometimes used. PCO is relatively common and begins soon after menarche. In particular, a pattern of infrequent and irregular menstruation commencing at time of puberty is highly suggestive. Test for total testosterone and DHEA-S are recommended, with a level greater than 200ng/dl raising suspicion of an androgen-producing tumor. Serum DHEA-S greater than 700ng/dl implies a possible neoplasm.
Treatment of PCOS is directed primarily at hirsutism, menstrual irregularity and infertility. Treatment for hirsutism include ovarian and adrenal suppression, anti-androgen therapy and local depilatories. Oral contraceptives can be used for ovarian suppression. Progestins can inhibit 5 alpha reductase enzyme and create competition for androgen receptors. When DHEA-S levels are elevated, the addition of dexamethasone may be helpful. Spironolactone is a preferred anti- androgenic compound. Cimetidine and cyproheptadine (a serotonin and histamine antagonist) are weak anti- androgenics.
Clomiphene citrate is commonly used to induce ovulation and human chorionic gonadotropin may be beneficial. Dexamethasone (0.25-0.5mg/day) is used to increase ovulation and pregnancy rates. Human menopausal gonadotrophin (HMG) is sometimes used in combination with clomiphene citrate. Laparoscopy electrocauterization or laser cauterization are experimental.
New knowledge about PCO was discussed in detail at and international symposium organized in Boston by Serono Symposia USA in 1995. According to a report by R. Jeffrey Chang:
“Ovarian physiology, including the fate of the follicular unit, was a central focus with several presentations on the genesis, growth and death of ovarian cellular components. A discussion of the regulation of ovarian cell function was also highlighted and comprised a major portion of the program. In particular, the recognition that a family of growth factors may modify ovarian responses to gonadotropin stimulation or perhaps act independently of gonadotropin action tempted the seductive notion of related or resultant pathologic processes. Abnormalities of steroid production by both the ovary and adrenal gland also continued to be examined with the likelihood of an enzyme defect being an enticing possibility. Moreover, the implications for genetic alteration in PCO were compelling. This program also included a clinical perspective which served to update current considerations of presentation, evaluation, long-term sequelae, and therapeutic strategies for patients suffering from this disorder. ”
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