Polycystic Ovarian Syndrome: An Overview

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Polycystic ovarian syndrome (PCOS) was formerly called Stein-Levinthal Syndrome. In 1935 Drs. Stein and Levinthal described a syndrome in which women suffered irregular and usually rare periods, hirsutism (hair growth), and varying degrees of infertility. Its most general definition is a syndrome in which there is too much male-type (androgen) hormone produced by the ovaries (and sometimes the adrenal glands) with associated disruption of the normal hormonal cycle.

The exact cause of PCOS is unknown, but it seems to be hereditary. About one in 10 women of reproductive age has it, and it is one of the most common causes of infertility. It is also one of the most underdiagnosed conditions in women. Now that other health consequences have been implicated in association with PCOS, a lot of attention has been given to making the diagnosis in women who otherwise would have been overlooked.

Standard View of PCOS

The most simplistic thinking about PCOS in the past was the concept of ovulation failure: Certain areas of the ovarian capsule, for some reason, had trouble releasing an egg. This misconception was further explained as the rest of the cycle getting hung up with a build-up of precursor hormones, like testosterone. Ovarian wedge resection, a surgical procedure in which a portion of the ovarian capsule was cut out, was the standard treatment until the invention of birth control pills which overrode the entire hormonal cycle and with it, any abnormalities.

Today's PCOS treatment entails suppressing the entire cycle with birth control pills until a woman is ready for pregnancy. At that point, ovulation induction is carried out. Wedge resection is an outdated surgical treatment. Although it will more than likely improve ovulation, it won't do anything to help the effects of androgen excess. But ovulation is not the only complication with PCOS.

Problems Associated with PCOS

Recent advances in understanding this disorder have demonstrated other problems besides alterations in the menstrual cycle and ovulation. For one thing, there's a certain tendency toward diabetes with a phenomenon called insulin resistance. It's not that there's too little insulin, but that the insulin made is not as good (or just not well utilized) and blood sugar management is impaired. The body responds by making even more insulin, and the extra insulin tends to stimulate other tissues that aren't particularly responsive to normal levels of insulin. One of these tissues is the ovary, which is stimulated to make extra androgen (testosterone). Additional effects on other tissues include:

• Stimulation of the lining of blood vessels, causing hypertension.
• Effects on the liver and on cholesterol metabolism, contributing further to heart disease.
• A decrease in sex hormone-binding globulin (SHBG), which means less sex hormone is bound ("tied up") and therefore free to act.