Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (Stein-Leventhal syndrome) involves enlarged ovaries, which contain many fluid-filled sacs (cysts), and a tendency to have high levels of male hormones (androgens).
Polycystic ovary syndrome affects about 7 to 10% of women. A common cause is excess production of luteinizing hormone by the pituitary gland. The excess luteinizing hormone increases the production of male hormones (androgens). If the disorder is not treated, some of the male hormones may be converted to estrogen. Not enough progesterone is produced to balance the estrogen's effects. If this situation continues a long time, the lining of the uterus (endometrium) may become extremely thickened (a condition called endometrial hyperplasia) . Also, the risk of cancer of the lining of the uterus (endometrial cancer) may be increased.

Symptoms and Diagnosis
Symptoms typically develop during puberty. In some women, menstrual periods do not start at puberty. Thus, these women do not release an egg from the ovaries (ovulate). These women also develop symptoms related to the high levels of male hormones-a process called masculinization or virilization.
Symptoms include acne, a deepened voice, a decrease in breast size, and an increase in muscle size and in body hair (hirsutism) growing in a male pattern, such as on the chest and face. Many women with polycystic ovary syndrome produce too much insulin, or the insulin they produce does not function normally. Consequently, these women tend to gain weight or have a hard time losing weight. Most women are obese. Other women have irregular vaginal bleeding, with no increase in weight or body hair. Women with polycystic ovary syndrome also have an increased risk of heart disease, diabetes, and high blood pressure.
Often, the diagnosis is based on symptoms. Blood tests to measure levels of luteinizing hormone and male hormones are performed, and ultrasonography of the ovaries may be performed. Ultrasonography or computed tomography (CT) may be used to determine whether the male hormones are being produced by a tumor in an ovary or adrenal gland.

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. Often, a biopsy of the uterine lining is performed to make sure no cancer is present.
If insulin levels are high, lowering them may help. Exercising (at least 30 minutes a day) and reducing consumption of carbohydrates (found in breads, pasta, potatoes, and sweets) can help lower insulin levels. In some women, weight loss lowers insulin levels enough that ovulation can begin. Weight loss may help reduce hair growth and the risk of thickening of the uterine
lining.
Women who do not wish to become pregnant may take a progestin by mouth or a combination oral contraceptive (which contains estrogen and a progestin). Either treatment may reduce the risk of cancer of the uterine lining due to the high estrogen level and help lower the levels of male hormones. However, oral contraceptives are not given to women who have reached menopause or who have other significant risk factors for heart or blood vessel disorders. Women who wish to become pregnant may take clomiphene. This drug stimulates ovulation. If clomiphene is not effective, other hormones may be tried. They include follicle-stimulatin g hormone (to stimulate the ovaries), a gonadotropin- releasing hormone agonist (to stimulate the release of follicle-stimulatin g hormone), and human chorionic gonadotropin (to trigger ovulation).
Increased body hair can be bleached or removed by electrolysis, plucking, waxing, hair-removing liquids or creams (depilatories) , or laser. No drug treatment for removing excess hair is ideal or completely effective. Oral contraceptives may help, but 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 reduce unwanted body hair. Side effects include increased urine production and low blood pressure (sometimes causing fainting). Spironolactone may not be safe for a developing fetus, so sexually active women taking the drug are advised to use effective birth control methods. Cyproterone, a strong progestin that blocks the action of male hormones, reduces unwanted body hair in 50 to 75% of affected women. Gonadotropin- releasing hormone agonists and antagonists are being studied as treatment for unwanted body hair. Both types of drugs inhibit the production of sex hormones by the ovaries. But both can cause bone loss and lead to osteoporosis.
(Merck)