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PCOS: Polycystic Ovary Syndrome

Polycystic ovary syndrome, or PCOS, is a leading cause of infertility in women, striking between 6 and 10 percent; yet it is one of the most under-diagnosed reproductive conditions and many women aren't even aware they have it. It is treatable with diet, exercise, medication, and surgery, but there is no cure.

According to the National Infertility Association less than 25 percent of women with PCOS have been diagnosed, due to the fact that the wide range of symptoms associated with PCOS are often mistaken for separate, unrelated conditions. Many women aren't diagnosed until they struggle to conceive and seek the help of a fertility expert.

Researchers are still trying to determine the precise cause of PCOS (also called Stein-Leventhal Syndrome or Polycystic Ovarian Disease), but there are three current theories: PCOS is caused by an abnormality in the hypothalamus, which tells the ovaries to produce too much testosterone; there is something wrong with the ovaries, making them produce too many androgens (male hormones); or that insulin resistance causes the ovaries to produce too many male hormones, throwing the entire system out of balance. Women with PCOS often have a family member who also has the condition, infertility, hirsutism, or menstrual problems; and male and female relatives with adult-onset diabetes, obesity, elevated blood triglycerides, and high blood pressure.

The condition derives its name from the cysts that develop on affected women's ovaries. These cysts are egg follicles that have matured but never release an egg. Because ovulation occurs only rarely, if at all, the hormonal imbalance persists and the woman is rendered infertile.

Symptoms of PCOS include:

  • Irregular or absent menstruation
  • Vaginal yeast infections
  • High blood pressure
  • Acne
  • Darkened color and change in texture of the skin on the neck and around the armpits, groin area, and inner thigh
  • Elevated insulin levels, insulin resistance, or diabetes
  • Excess hair on the face and body (hirsutism)
  • Hair loss (alopecia)
  • Weight problems or obesity

Doctors generally diagnose PCOS by ruling out other possible conditions (such as thyroid problems or Cushing's disease), by testing insulin and glucose levels, and measuring hormone levels. They may also use ultrasound to look for cysts on the ovaries.

PCOS is incurable; however, the symptoms and associated medical conditions can be treated. Treatment usually involves birth control pills to regulate menstrual cycles, reduce male hormones, and help clear up acne. However, for women who want to become pregnant, treatment includes weight loss, ovulation medications, ART (advanced reproductive technology), and ovarian drilling surgery. Ovarian drilling is performed using laparoscopy to puncture the ovary 10 to 12 times and has been shown to dramatically lower male hormones in 80 percent of women within days after the procedure. Many women who didn't ovulate after using hormone therapy begin to respond to the medication after ovarian drilling. Side effects from drilling are rare, but include the formation of adhesions and ovarian failure. Medications called insulin sensitizers may also be used to control abnormal insulin production and sugar metabolism. When used alone or with other fertility medications, they often restore ovulation and maintain regular menstrual cycles, allowing many women with PCOS to become pregnant.

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