Introduction to Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) also known as Stein-Leventhal syndrome or functional ovarian hyperandrogenism, is a complex endocrine disorder associated with anovulation, (lack of ovulation) and hyperandrogenism (excess of male sex hormones). Hormones are substances made by one organ and transported in the bloodstream to another organ where they cause a particular function to occur. There are three primary male sex hormones produced in women:

  • Testosterone, which is produced by the ovaries and adrenal glands equally
  • Androstenedione, which is produced mostly (more than 90%) in the ovaries
  • Dehydroepiandrosterone sulfate (DHEA-S), which is produced in the adrenal gland.

Approximately 70% of women with PCOS have elevated androgen levels. Hyperandrogenism in PCOS is thought to be related mostly to ovarian production, rather than of adrenal origin.

Women with PCOS may also have high levels of:

  • Estrogen (hyperestrogenemia) - this is associated with infertility and also raises the risk of hormone related cancers
  • Gonadotropins - these are hormones whose high levels affect fertility and the menstrual cycle
  • Insulin (hyperinsulinemia) - this is related to many of the symptoms of PCOS and is associated with insulin resistance and glucose intolerance.

For many but not all women with PCOS, there is formation of multiple cysts on the ovaries, a process related to the failure of the ovary to release an egg (ovum). In the majority of cases, the ovaries become enlarged.

The most common issues causing significant distress to women suffering from PCOS are:

  • Menstrual irregularities - up to 90% of women by some estimates

    • amenorrhea (absence of menses)
    • oligomenorrhea (absence of menses for at least three months after having experienced menses)

  • Anovulation (absence of ovulation) and infertility - up to 75% by some estimates

  • Obesity - up to 40% by some estimates

  • Hyperandrogenism which causes:

    • hirsutism (excessive body and facial hair) - up to 70% by some estimates
    • acne - up to 35%
    • alopecia - in approximately 8% of patients