Her får man svar på det meste om PCOS
Polycystic Ovarian Syndrome
(PCOS, POS, POD, Stein-Leventhal Syndrome)
What is polycystic ovarian syndrome (PCOS)?
Polycystic ovarian syndrome (PCOS), also known by the name
Stein-Leventhal syndrome, is a hormonal problem that causes women to
have a variety of symptoms. It should be noted that most women with the
condition have a number of small cysts in the ovaries. However, women
may have cysts in the ovaries for a number of reasons, and it is the
characteristic constellation of symptoms, rather than the presence of
the cysts themselves, that is important in establishing the diagnosis of
PCOS.
PCOS occurs in 5% to 10% of women and is the most common cause of infertility in women. The symptoms of PCOS may begin in adolescence with menstrual irregularities,
or a woman may not know she has PCOS until later in life when symptoms
and/or infertility occur. Women of all ethnicities may be affected.
What are the symptoms of polycystic ovarian syndrome (PCOS)?
The principal signs and symptoms of PCOS are related to menstrual
disturbances and elevated levels of male hormones (androgens). Menstrual
disturbances can include delay of
normal menstruation (primary amenorrhea), the presence of fewer than normal menstrual
periods (oligomenorrhea), or the absence of menstruation for more than
three months (secondary amenorrhea). Menstrual cycles may not be associated with ovulation (anovulatory cycles) and may result in heavy bleeding.
Symptoms related to elevated androgen levels include
acne, excess hair growth on the body (hirsutism), and male-pattern hair loss.
Other signs and symptoms of PCOS include:
Any of the above
symptoms and signs may be absent in PCOS, with the exception of irregular or no
menstrual periods. All women with PCOS will have
irregular or no menstrual
periods. Women who have PCOS do not regularly ovulate; that is, they do not
release an egg every month. This is why they do not have regular periods and
typically have difficulty
conceiving.
What causes polycystic ovarian syndrome (PCOS)?
No one is quite sure what causes PCOS, and it is likely to be 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 sugar control 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 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?
The diagnosis of PCOS is generally made on the basis of clinical signs and
symptoms as discussed above. 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 male hormone
(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
of testosterone 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
(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 have ovarian 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-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?
Women with PCOS are at a higher risk for a number of illnesses, including high blood pressure, diabetes,
heart disease, and
cancer of 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; about 60% of those diagnosed with PCOS
in the U.S. are obese. Obesity not only compounds the problem of insulin
resistance and
type 2 diabetes (see below), but it also imparts cardiovascular risks. PCOS and obesity are associated with a higher risk of developing
metabolic syndrome,
a group of symptoms, including high blood pressure, that increase the
chances of developing cardiovascular disease. It has also been shown
that levels of
C-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. Several 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 of blood triglycerides have 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.
What treatments are available for PCOS?
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 of uterine cancer.
Another option is intermittent therapy with the hormone progesterone.
Progesterone therapy will 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) called
spironolactone (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. Electrolysis and over-the-counter depilatory creams are
other options for controlling excess hair growth.
For women who desire pregnancy, a medication called
clomiphene (Clomid) can
be used to induce ovulation (cause egg production). In addition, weight loss can
normalize menstrual cycles and often increases the
possibility of pregnancy in
women with PCOS. Other, more 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 of
gestational diabetes mellitus 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 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.
Polycystic Ovarian Syndrome (PCOS) At A Glance
- Polycystic ovarian syndrome (PCOS) is an illness characterized by irregular
or no periods, acne, obesity, and excess hair growth.
- Women with PCOS are at a higher risk for obesity, diabetes, high blood
pressure, and heart disease.
- With proper treatment, risks can be minimized. Ideal treatment is directed
to each of the manifestations of PCOS.
REFERENCES:
American Association of Clinical Endocrinologists Polycystic Ovary Syndrome
Writing Committee; American Association of Clinical Endocrinologists Position
Statement on Metabolic and Cardiovascular Consequences of Polycystic Ovary
Syndrome. Endocr Pract. 2005 Mar-Apr;11(2):126-34. No abstract available.
Azziz R; Sanchez LA; Knochenhauer ES; Moran C; Lazenby J;
Stephens KC; Taylor K; Boots LR. Androgen excess in women: experience
with over 1000 consecutive patients. J Clin Endocrinol Metab 2004
Feb;89(2):453-62.
Azziz R; Woods KS; Reyna R; Key TJ; Knochenhauer ES; Yildiz BO. The
prevalence and features of the polycystic ovary syndrome in an
unselected population. J Clin Endocrinol Metab 2004 Jun;89(6):2745-9.
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised
2003 consensus on diagnostic criteria and long-term health risks
related to polycystic ovary syndrome. Fertil Steril. 2004 Jan;81(1):19-25.
Schroeder BM; American College of Obstetricians and Gynecologists. ACOG
releases guidelines on diagnosis and management of polycystic ovary
syndrome. Am Fam Physician. 2003 Apr 1;67(7):1619-20, 1622. No abstract available.
Previous contributing medical author: Carolyn J. Crandall, MD
Last Editorial Review: 2/22/2010