MEDICAL CONDITIONS
Polycystic Ovarian Disease
(Stein-Leventhal Syndrome) Medical Editor: Carolyn J. Crandall, MD
What is polycystic ovarian disease?
Polycystic ovarian disease (PCO), also known by the name Stein-Leventhal syndrome, is a hormonal problem that causes women to have a variety of symptoms including: - Irregular or no periods
- Acne
- Obesity , and
- Excess hair growth.
Any of the above symptoms and signs may be absent with the exception of irregular or no periods. All women with PCO will have irregular or no menses. Women who have PCO do not regularly ovulate; that is, they do not release an egg every month. This is why they do not have regular periods. No one is quite sure what causes PCO. However, the ovaries of women with PCO frequently contain a number of small cysts, hence the name poly (many) cystic ovarian disease. A similar number of cysts may occur in women without PCO. 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 PCO. The result is an inadequate response to insulin (insulin resistance) that can lead to abnormally elevated blood sugar (glucose) levels. The insuliin disturbance is thought to also be the trigger for the development of symptoms such as acne and excess hair growth that is seen with PCO.
How is PCO diagnosed?
The diagnosis of PCO 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 PCO.
Other laboratory tests can be helpful in making the diagnosis of PCO. Serum levels of male hormones (DHEA and testosterone) may be elevated. However, levels of testosterone that are highly elevated are not unusual with PCO and call for additional evaluation. Additionally, levels of a hormone released by the brain (LH) is elevated.
Cysts are fluid-filled sacs. The cysts in the ovaries can be identified with imaging technology. (However, as noted above, women without PCO 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. 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 PCO can have ovarian cysts , and because ovarian cysts are not part of the definition of PCO, ultrasound is not routinely ordered to diagnose PCO. The diagnosis is a clinical on 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 where other conditions, 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 can be associated with PCO?
Women with PCO are at a higher risk for a number of illnesses, including high blood pressure , diabetes, heart disease , and cancer of the uterus (endometrial cancer). Much of this risk can be reversed by exercise and weight loss. Additionally, it is important for women with PCO to have regular periods. If a woman does not have regular periods, her risk of cancer of the uterus (endometrial cancer) is increased. Medication is generally prescribed to induce regular periods. Obesity is a complication of PCO. Reducing the medical risks from PCO-associated obesity requires hard work on the part of the woman with PCO and is often frustrating. For more information about obesity and management, please read the Obesity article.
What treatments are available for PCO?
It depends 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. For women who do not require birth control, causing a woman to have a period 4 times a year is all that is required.
For acne or excess hair growth, a water pill (diuretic) called spironolactone may be prescribed to help reverse these problems. The use of spironolactone requires occasional monitoring of blood tests because its potential effect on the blood potassium levels and kidney function. 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 PCO. Obesity that occurs with PCO needs to be treated because it can cause numerous additional medical problems. Consultation with a dietician on a frequent basis is helpful until just the right individualized program is established for each woman.
More recently, studies have indicated that medications that improve the action of the body's natural blood sugar-control hormone, insulin, could benefit women with PCO. Long-term studies of these insulin-sensitizing drugs (for example, rosiglitazone , pioglitazone , glucophage ) for PCO patients are underway.
Finally, a type of surgery called a "wedge resection," in which a piece of the ovary is removed, seems to help some women.
In conclusion, women with PCO should be able to have children and lead an active normal life. Contact your health care practitioner if you have irregular periods and think that you might have PCO. - Polycystic ovarian disease (PCO) is an illness characterized by irregular or no periods, acne, obesity, and excess hair growth.
- Women with PCO are at a higher risk for uterine cancer (endometrial cancer), diabetes, high blood pressure, and heart disease.
- With proper treatment, risks can be minimized. Ideal treatment is directed to each of the manifestations of PCO.
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