Polycystic Ovary Syndrome: Facts and Treatments

  • Chronic anovulation (erratic menses).
  • Signs of male hormone excess alone or in combination with biochemical evidence of androgen excess.
  • The exclusion of other problems that can mimic the syndrome. Syndromes and diseases that can be easily confused with PCOS include adult onset adrenocortical hyperplasia, or what is often referred to as nonclassical congenital adrenal hyperplasia (NCCAH), excess prolactin states, thyroid disorders, and others.

Although insulin resistance is often present in most women with PCOS, it's not a distinct requirement for diagnosis of the syndrome. In PCOS, pelvic ultrasound scanning frequently reveals multiple follicular cysts present under the outer cortex of normal-sized or enlarged ovaries. However, even this finding is considered to be nonspecific.

Certain laboratory tests are useful in diagnosing and tracking the progression of the syndrome. These include testing the levels of the following:

  • Serum testosterone (T)
  • Serum biologically free testosterone (the active fraction of testosterone)
  • Serum luteinizing hormone and follicle stimulating hormone (Often there is an increased ratio of LH/FSH)
  • Serum dehydroepiandrosterone sulfate (DHEAS) (An androgen that is a precursor to testosterone; this is useful in evaluation of the significance of the role of the adrenal cortex in the syndrome)
  • Serum 17-hydroxyprogesterone as an initial screen for NCCAH; fasting plasma insulin and a blood glucose level
  • Serum prolactin

It has been reported that about 10 to 20 percent of PCOS patients have high levels of prolactin. This should be recognized early, since management of women with high prolactin levels may differ from that of other women with the syndrome. Once PCOS is considered, lipid studies including total cholesterol and its sub-fractions (HDL, LDL), as well as serum triglycerides should be obtained. A number of authorities also recommend that patients take a two-hour glucose tolerance test to assess the extent of insulin dysregulation. An ultrasound of the pelvis is also useful to find changes relating to treatment as well as potential complications, such as uterine changes and the development of benign ovarian growths (usually dermoid cysts, with an incidence ranging from 5 to 15 percent).

Potential Complications of PCOS

Menstrual dysfunction and associated infertility, as well as skin and scalp manifestations are often what brings patients to their physicians. However, it's the potential of metabolic and cardiovascular complications that pose the greatest risk to those with PCOS. There's a wealth of data indicating that hyperinsulinism and the associated insulin resistance (often accompanied by an increase in the waist-to-hip ratio) not only allows for androgen excess, but also may lead to a higher incidence of type 2 diabetes mellitus and the possibility of cardiovascular events later in life. Additionally, a small but convincing series of reports suggest that hypertension and premature calcifications in the carotid arteries may already be present at a relatively early stage in life (30s and 40s).

Obesity and PCOS
There is no question that there is a significant incidence of abnormal glucose tolerance in 40 percent of obese patients with PCOS and 10 percent in normal-weight women with the syndrome. Some of these patients may already be diabetic (approximately 10 percent of the obese women with PCOS). With time, the incidence increases. The associated risk factors such as lipid abnormalities, high triglyceride levels, and increased clotting factors may predispose these patients to coronary heart disease. Studies assessing the long-term complications of these symptoms are currently in progress. Whether newer treatments for PCOS and lifestyle modifications may mitigate these risks remains to be seen.