American Medical Association Family Medical Guide - American Medical Association [583]
Polycystic Ovarian Syndrome
Polycystic ovarian syndrome is a condition characterized by the presence of multiple small ovarian cysts that do not go away on their own, as do most ovarian cysts. The disorder is relatively common, affecting 5 to 10 percent of all women. Because most women with polycystic ovarian syndrome see their doctor primarily when they are having irregular periods or seeking infertility treatment (see page 498), many doctors consider the syndrome a gynecologic disorder.
However, polycystic ovarian syndrome is recognized as a complication of insulin resistance, a condition in which the body must produce abnormally high amounts of insulin to regulate blood sugar. The high levels of insulin, in turn, stimulate the ovaries to produce too much testosterone and other male sex hormones (androgens), which brings on the disorder’s characteristic symptoms (see below). Polycystic ovarian syndrome is thought to be a form of metabolic syndrome (also called prediabetes; see page 53) with a strong link to type 2 diabetes (see page 894) and heart disease (see page 558).
The disorder usually appears in late childhood, around the time of puberty, and lasts throughout an affected woman’s life. Although the precise cause is not known, polycystic ovarian syndrome tends to run in families.
Symptoms
In addition to having multiple ovarian cysts, women with polycystic ovarian syndrome have no menstrual periods or irregular periods because they fail to ovulate. The failure to ovulate makes them infertile. Elevated levels of androgens result from the abnormally high amount of insulin circulating in the blood. The excess androgen production can cause acne and excess hair growth on the face and body. Most affected women are overweight and tend to carry their weight around the abdomen.
Polycystic ovarian syndrome
The ovaries of women with polycystic ovarian syndrome contain multiple small cysts that never disappear. The cysts are caused by overproduction of male hormones by the ovaries and adrenal glands. This overproduction of male hormones is stimulated by excessively high levels of the hormone insulin.
Diagnosis
Polycystic ovarian syndrome can mimic a number of other disorders, such as adrenal gland problems and thyroid disease, so a doctor will first try to rule these out when making a diagnosis. He or she will diagnose polycystic ovarian syndrome by the presence of its characteristic symptoms, along with a blood test to detect abnormally high levels of testosterone. An ultrasound of the pelvis usually shows enlarged ovaries with many small cysts.
Treatment
Many women who seek treatment for missed periods or infertility caused by polycystic ovarian syndrome receive treatment for these symptoms only. Doctors often prescribe oral contraceptives to regulate a woman’s menstrual cycles and suppress the production of testosterone (to reduce symptoms such as excessive hair growth). Other drugs may be prescribed to stimulate ovulation if a woman wants to become pregnant. The best long-term treatment, however, addresses the insulin resistance that underlies the disorder. The most effective drug for treating polycystic ovarian syndrome is metformin, which improves the body’s use of insulin and helps restore regular menstrual cycles and ovulation. Metformin may also help lower a woman’s risk of developing type 2 diabetes and heart disease later in life.
Ovarian Cancer
Cancer of the ovary is one of the leading causes of death from cancer in women. Although ovarian cancer can occur at any age, it is most common after age 50. The cancer can originate in the ovary or appear as a secondary growth that has spread to the ovary from elsewhere in the body. Mutations in the BRCA1 and BRCA2 genes (see page 858) increase a woman’s risk of both breast and ovarian cancer. In women without these genetic mutations, the cause of ovarian cancer is not known.
Several factors can increase a woman’s chances of developing ovarian cancer. Risk factors include having a close relative (mother, sister, or daughter) with the disorder, or a