Polycystic ovaries

Definition

Cysts in the ovaries.

Epidemiology

About 1 in 10 women has PCOS! It is the most common cause for infertility in women.

Pathophysiology

The cause is unknown, but it leads to irregular or missed periods, excess androgens and large, cystic ovaries. There is some genetic link, and there is a link with diabetes. Patients with PCOS often have excess insulin in the body.

There is a strong link with obesity - somewhat chicken or egg. Overweight women are more likely to get PCOS, but PCOS may lead to weight gain.

Risk Factors

Due to the uncertainty of the cause, it is difficult to associate risk factors with this syndrome. Hence, I don't really know what else to write. If anybody does some badass study into it, please feel free to concisely add the findings to this section.

Clinical Features

• Oligomenorrhea, amenorrhea - irregular, few, or absent menstrual periods.
• Infertility - generally resulting from chronic anovulation (lack of ovulation).
• Hirsutism - excessive and increased body hair, typically in a male pattern affecting face, chest and legs.
• Hair loss - appearing as thinning hair on the top of the head
• Acne, oily skin, seborrhea.
• Obesity - one in two women with PCOS are obese.
• Depression.

Investigations

• History taking is a key point - some consider it to be diagnostically conclusive.
• Ultrasound - looking for a characteristic string of pearls appearance.
• Elevated free testosterone levels.

To rule out other conditions

• TSH - hypothyroidism can present in a similar way
• Prolactin - to rule out hyperprolactinemia

Management

Split into 3 areas

Non pharmacological

• Get them to lose weight if they are fat. This is the most important single thing they can do to manage their condition!
• Do blood glucose/pressure etc to check they don't have hypertension or diabetes.

Pharmacological

• Clomiphene - this is makes the pituitary gland less receptive to oestrogen. As such, FSH and LH levels rise, inducing ovulation.
• Combined oral contraceptive - these sort out the amenorrhoea, and the androgen overload
• Insulin sensitisers - such as metformin and thiazolidinediones
• Medroxyprogesterone acetate - used in endometriosis sometimes, it helps reduce some of the cancer risks. Don't really understand it - brand name is Dianette.

Surgical

Sometime hysterectomy or removal of the ovaries is necessary. But usually its controllable with the drugs.

Prognosis

Women with PCOS are more at risk of type 2 diabetes, endometrial cancer, hypertension, heart disease and strokes.