what causes polycystic ovarian syndrome

8/13/2019 What Causes Polycystic Ovarian Syndrome

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What causes polycystic ovarian syndrome

(PCOS)?

No one is quite sure what causes PCOS, and it is likely tobe the result of a number of both genetic (inherited) as well

as environmental factors. Women with PCOS often have a

mother or sister with the condition, and researchers are

examining the role that genetics or gene mutations might

play in its development. The ovaries of women with PCOS

frequently contain a number of small cysts, hence the name

poly=many cystic ovarian syndrome. A similar number of

cysts may occur in women without PCOS. Therefore, the

cysts themselves do not seem to be the cause of the

problem.

A malfunction of the body's blood sugarcontrol system

(insulin system) is frequent in women with PCOS, who often

have insulin resistance and elevated blood insulin levels,

and researchers believe that these abnormalities may be

related to the development of PCOS. It is also known that

the ovaries of women with PCOS produce excess amounts

of male hormones known as androgens. This excessive

production of male hormones may be a result of or related

to the abnormalities in insulin production.

Another hormonal abnormality in women with PCOS is

excessive production of the hormone LH, which is involved


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in stimulating the ovaries to produce hormones and is

released from the pituitary gland in the brain.

Other possible contributing factors in the development of

PCOS may include a low level of chronic inflammation in the

body and fetal exposure to male hormones.

How is PCOS diagnosed?

Comment on thisRead 1 CommentShare Your StoryThe PCOS diagnosis is generally made through clinical

signs and symptoms. The doctor will want to exclude other

illnesses that have similar features, such as low thyroid

hormone blood levels (hypothyroidism) or elevated levels of

a milk-producing hormone (prolactin). Also, tumors of the

ovary or adrenal glands can produce elevated malehormone (androgen) blood levels that cause acne or excess

hair growth, mimicking symptoms of PCOS.

Other laboratory tests can be helpful in making the

diagnosis of PCOS. Serum levels of male hormones ( DHEA

and testosterone ) may be elevated. However, levels oftestosterone that are highly elevated are not unusual with

PCOS and call for additional evaluation. Additionally, levels

of a hormone released by the pituitary gland in the brain
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(LH) that is involved in ovarian hormone production are

elevated.

The cysts (fluid filled sacs) in the ovaries can be identified

with imaging technology. (However, as noted above, women

without PCOS can have many cysts as well.)Ultrasound,

which passes sound waves through the body to create a

picture of the kidneys, is used most often to look for cysts in

the ovaries. Ultrasound imaging employs no injected dyes or

radiation and is safe for all patients including pregnant

women. It can also detect cysts in the kidneys of a fetus.

Because women without PCOS can haveovarian cysts, and

because ovarian cysts are not part of the definition of

PCOS, ultrasound is not routinely ordered to diagnose

PCOS. The diagnosis is usually a clinical one based on the

patient's history, physical examination, and laboratory

testing.

More powerful and expensive imaging methods such

as computed tomography(CT scan) and magnetic

resonance imaging (MRI) also can detect cysts, but they are

generally reserved for situations in which other conditions

that may cause related symptoms, such as ovarian or

adrenal gland tumors are suspected. CT scans require X-
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rays and sometimes injected dyes, which can be associated

with some degree of complications in certain patients.

What conditions or complications can be

associated with PCOS?Comment on thisShare Your Story

Women with PCOS are at a higher risk for a number of

illnesses, including high bloodpressure, diabetes, heart

disease , andcancerof the uterus(endometrial cancer).Because of the menstrual and hormonal irregularities,

infertility is common in women with PCOS. Because of the

lack of ovulation, progesterone secretion in women with

PCOS is diminished, leading to long-term unopposed

estrogen stimulation of the uterine lining. This situation can

lead to abnormal periods, breakthrough bleeding, or

prolonged uterine bleeding in some women. Unopposed

estrogen stimulation of the uterus is also a risk factor for the

development of endometrial hyperplasia and cancer of the

endometrium (uterine lining). However, medications can be

given to induce regular periods and reduce the estrogenic

stimulation of the endometrium (see below).

Obesity is associated with PCOS. Obesity not only

compounds the problem of insulin resistance and type 2

diabetes (see below), but it also imparts cardiovascular
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risks. PCOS and obesity are associated with a higher risk of

developingmetabolic syndrome, a group of symptoms,

including high blood pressure, that increase the chances of

developing cardiovascular disease. It has also been shown

that levels ofC-reactive protein(CRP), a biochemical

marker that can predict the risk of developing cardiovascular

disease, are elevated in women with PCOS. Reducing the

medical risks from PCOS-associated obesity is possible.

The risk of developing prediabetes and type 2 diabetes is

increased in women with PCOS, particularly if they have a

family history of diabetes. Obesity and insulin resistance,

both associated with PCOS, are significant risk factor for the

development of type 2 diabetes. 4444Several studies have

shown that women with PCOS have abnormal levels of LDL

("bad") cholesterol and lowered levels of HDL ("good")

cholesterol in the blood. Elevated levels ofbloodtriglycerideshave also been described in women with

PCOS.

Changes in skin pigmentation can also occur with PCOS.

Acanthosis nigricans refers to the presence of velvety,

brown to black pigmentation often seen on the neck, under

the arms, or in the groin. This condition is associated with

obesity and insulin resistance and occurs in some women

with PCOS.
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What treatments are available for PCOS?Comment on thisRead 26 CommentsShare Your Story

Treatment of PCOS depends partially on the woman's stage

of life. For younger women who desire birth control, the birth

control pill, especially those with low androgenic (male

hormone-like) side effects can cause regular periods and

prevent the risk ofuterine cancer.Another option is

intermittent therapy with the hormone

progesterone. Progesterone therapywill induce menstrual

periods and reduce the risk of uterine cancer, but will not

provide contraceptive protection.

For acne or excess hair growth, a water pill (diuretic)

calledspironolactone(Aldactone) may be prescribed to help

reverse these problems. The use of spironolactone requires

occasional monitoring of blood tests because of its potential

effect on the blood potassium levels and kidney

function.Eflornithine(Vaniqa) is a cream medication that can

be used to slow facial hair growth in women.Electrolysisand

over-the-counter depilatory creams are other options for

controlling excess hair growth.

For women who desirepregnancy, a medication called

clomiphene (Clomid) can be used to induce ovulation(cause egg production). In addition,weight losscan

normalize menstrual cycles and often increases the

possibility of pregnancy in women with PCOS. Other, more
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aggressive, treatments for infertility (including injection of

gonadotropin hormones and assisted reproductive

technologies) may also be required in women who desire

pregnancy and do not become pregnant on Clomid therapy.

Metformin(Glucophage) is a medication used to treat type 2

diabetes. This drug affects the action of insulin and is useful

in reducing a number of the symptoms and complications of

PCOS. Metformin has been shown to be useful in the

management of irregular periods, ovulation induction, weight

loss, prevention of type 2 diabetes, and prevention

ofgestational diabetesmellitus in women with PCOS.

Obesity that occurs with PCOS needs to be treated because

it can cause numerous additional medical problems. The

management of obesity in PCOS is similar to the

management of obesity in general. Weight loss can help

reduce or prevent many of the complications associated

with PCOS, including type 2 diabetes and heart disease.

Consultation with a dietician on a frequent basis is helpful

until just the right individualized program is established for

each woman.

Finally, a surgical procedure known as ovarian drilling can

help induce ovulation in some women who have not
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responded to other treatments for PCOS. In this procedure

a small portion of ovarian tissue is destroyed by an electric

current delivered through a needle inserted into the ovary.

what causes polycystic ovarian syndrome

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