The Merck Manual of Medical Information–PCOS

Polycystic Ovary Syndrome
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Polycystic ovary syndrome (Stein-Leventhal syndrome) is a disorder in which the ovaries are enlarged and contain many fluid-filled sacs (cysts), and levels of male hormones (androgens) may be high, sometimes producing masculine characteristics.

In this syndrome, the pituitary gland commonly secretes large amounts of luteinizing hormone. The excess luteinizing hormone increases the production of androgens, and high levels of androgens sometimes cause a woman to develop such characteristics as acne and coarse hair. If the disorder isn’t treated, some of the androgens may be converted to estrogens, and the chronically high levels of estrogens may increase the risk of cancer of the uterine lining (endometrial cancer).

Symptoms and Diagnosis
Symptoms typically develop during puberty, when menstrual periods may or may not begin. Symptoms may include obesity and an increase in body hair growing in a male pattern, such as on the chest and face. Alternatively, irregular, profuse vaginal bleeding may occur, with no increase in weight or body hair.

Often, the diagnosis is made on the basis of the symptoms. Blood levels of luteinizing hormone and male hormones are measured, and ultrasound scanning may be used to view the ovaries. A variety of procedures are used to determine whether the male hormones are being produced by a tumor.

Treatment
No ideal treatment is available. The choice of treatment depends on the type and severity of symptoms, the woman’s age, and her plans regarding pregnancy.

A woman who doesn’t have increased body hair may be given a synthetic progestin (a progesterone-like drug) or oral contraceptives unless she wants to become pregnant, has reached menopause, or has other significant risk factors for heart or blood vessel disease. A synthetic progestin may also be given to reduce the risk of endometrial cancer from the high estrogen levels. Often, a sample of the uterine lining is removed and examined under a microscope before drug treatment is started to make sure no cancer is present.

A woman who has increased body hair can use a hair removal method, such as electrolysis, plucking, waxing, or hair-removing liquids or creams (depilatories), or bleaching. No drug treatment for removing excess hair is ideal or completely effective. Oral contraceptives may be tried, although they must be taken for several months before any effect, which is often slight, can be seen.

Spironolactone, a drug that blocks the production and action of male hormones, can be effective in reducing unwanted body hair. Side effects include increased urine production, low blood pressure (sometimes to the point of fainting) when sitting up or standing quickly, painful breasts, and irregular vaginal bleeding. Because spironolactone may not be safe for a developing fetus, any sexually active woman taking the drug should use effective birth control methods.

If a woman who has polycystic ovary syndrome wants to become pregnant, she may be given clomiphene, a drug that stimulates the ovaries to release eggs. If clomiphene isn’t effective, a variety of hormones may be tried; these include follicle-stimulating hormone and gonadotropin-releasing hormone, which stimulates the release of follicle-stimulating hormone. If drugs aren’t effective, the woman may consider having surgery to remove a wedge of ovary (wedge resection) or to cauterize the ovarian cysts (destroy them with an electric current). Although these treatments may induce ovulation for a period of time, surgical procedures are generally considered last because scar tissue can form and may reduce the woman’s ability to become pregnant.

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