Polycystic ovarian syndrome (PCOS), also known as chronic ovarian androgenism, is an endocrine imbalance resulting from insulin.
Average age of onset is 15-35 years.
Causes include:
A diagnosis requires two of the following three:
Infertility
Family history of diabetes
Patients are often obese, showing signs of hirsutism and virilization
acanthosis nigricans, or the browning of skin folds, may also be present
Insulin resistance in people of various body types; OGTT may be positive
LH:FSH of >2:1, with LH chronically high
Transvaginal ultrasound shows polycystic ovaries appearing like a string of pearls
Laparoscopy is not necessary, but shows a white ovary with multiple follicular cysts
Differential includes:
Obesity leads to increased aromatase conversion to estrogen, which decreases FSH secretion and increases that of LH. Increased ovarian secretion of androgens ensues, leading to hirsutism.
Decreased FSH and increased LH lead to anovulation, oligomenorrhea, and infertility.
Weight-loss through excercise and diet is critical to reduce peripheral production of estrogen.
OCP or cyclic Provera can be used to prevent endometrial hyperplasia from excess levels of estrogen, as well as reduce hirsutism.
oral hypoglycemics (metformin) to reduce insulin resistance
Medications can be used to induce ovulation (clomiphene citrate - an estrogen receptor blocker which works on the hypothalamus to induce LH/FSH)
Spironolactone, finasteride, or flutamide may all be used to reduce excess androgen production.
In vitro fertilization
Consequences include: