by Walter Futterweit, MD, FACP
Polycystic ovary syndrome (PCOS) is the most common endocrine problem in women, affecting 5 to 7.5 percent of reproductive-aged women, yet it is only in the past decade that ideas about its causes and treatment are being pieced together. Although what causes it remains unclear, the main cornerstones of diagnosis and treatment are well established. While the syndrome has a wide spectrum of clinical presentations, in most cases it causes the ovaries to become enlarged with multiple small cysts. This condition eventually results in the secretion of excess androgens, mostly testosterone. The endocrine abnormality is marked by erratic menstrual cycles and infertility. The excess androgens also exert effects on the hair follicles and sweat gland unit of the skin (pilosebaceous unit), often leading to acne, excessive facial and body hair growth (hirsutism), and thinning of scalp hair (alopecia).
Many of the latter features are variable, and the characteristics of the classical symptom complex described above may occur either singly or in combination. For example, menstrual abnormalities may occur early at puberty and vary over time, while other women present with persistent acne even in their 30s in association with abnormal menstrual cycles. Obesity is present in about 50 to 60 percent of patients and there is a frequent tendency for fat to take on a central distribution (apple-shaped, rather than pear-shaped obesity). The resulting increase in the so-called waist-to-hip ratio (WHR) is a marker that often indicates the potential for metabolic or cardiovascular complications.
The cause of polycystic ovary syndrome is still unclear, but several characteristics are now firmly established:
The frequent presence of insulin resistance (IR) may be at times selective, (i.e., lean or normal-weight women who tend to have more regular cycles tend to be less likely to have insulin resistance) so that not all patients demonstrate the major consequences of hyperinsulinemia.
It should be noted that polycystic ovary syndrome is a syndrome, not a disease, and authorities have differed on the definition of the entity. The classic findings that most doctors agree on include the following: