What is pcos syndrome

Polycystic ovary syndrome (PCOS) - Care at Mayo Clinic

Polycystic ovary syndrome (PCOS) care at Mayo Clinic

Your Mayo Clinic care team

Mayo Clinic's care team for PCOS includes specialists trained in female reproductive medicine (gynecologists), hormone disorders (endocrinologists) and infertility (reproductive endocrinologists).

Specialists in the division of Reproductive Endocrinology and Infertility are frequently involved in care. Every staff doctor in that division is board certified in obstetrics and gynecology as well as reproductive endocrinology and infertility. These reproductive and infertility specialists work frequently with other specialists in endocrinology, metabolism and nutrition.

Mayo Clinic also has registered dietitians and certified diabetes care and education specialists to help with weight loss or diabetes prevention and treatment.

Having all of this expertise in a single place, focused on you, means that you're not just getting one opinion. Your care is discussed among the team, appointments are scheduled in coordination, and highly specialized PCOS experts work together to determine what's best for you.

Advanced diagnosis and treatment

Mayo Clinic has comprehensive diagnostic testing to identify PCOS. The disorder requires lifelong management to avoid complications such as diabetes and cardiovascular disease. Mayo Clinic has the multispecialty expertise to treat all of your health concerns, including infertility.

Many Mayo Clinic doctors who treat PCOS are also active researchers. They are working to improve treatment of PCOS. When you seek care at Mayo Clinic, you have access to the expertise of these Mayo Clinic care providers and researchers.

Nationally recognized expertise

Mayo Clinic in Rochester, Minnesota, ranks among the Best Hospitals for gynecology in the U. S. News & World Report Best Hospitals rankings.

The Mayo Clinic experience and patient stories

Our patients tell us that the quality of their interactions, our attention to detail and the efficiency of their visits mean health care like they've never experienced. See the stories of satisfied Mayo Clinic patients.

1. Collaboration that changes lives

   Elyn Simmons was 31 years old and eager to start a family with her husband, Guy. But in 2016, she was diagnosed with a hormonal disorder — PCOS, or polycystic ovary syndrome — that causes fertility problems. Then Elyn began experiencing other symptoms, including unexplained weight gain, increased body hair, migraines, and severe fatigue. Teamwork by Mayo Clinic clinicians and specialists in Mayo’s Department of Laboratory Medicine and Pathology found the source of Elyn's problem. In 2018, she was…

Expertise and rankings

• Experience. Mayo Clinic experts care for more than 2,100 women who have PCOS every year, using research-based treatments and teaching helpful lifestyle changes.
• Teamwork. Managing PCOS can require expertise in infertility, hirsutism, diabetes and cardiovascular care. Mayo Clinic experts work together closely to address all of your health concerns.
• Research. Mayo Clinic experts are continually studying how to improve the diagnosis and treatment of PCOS.

Learn more about Mayo Clinic's obstetrics and gynecology and endocrinology departments' expertise and rankings.

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Polycystic Ovary Syndrome (PCOS) | Johns Hopkins Medicine

Polycystic ovary syndrome (PCOS) is a condition in which the ovaries produce an abnormal amount of androgens, male sex hormones that are usually present in women in small amounts. The name polycystic ovary syndrome describes the numerous small cysts (fluid-filled sacs) that form in the ovaries. However, some women with this disorder do not have cysts, while some women without the disorder do develop cysts.

Ovulation occurs when a mature egg is released from an ovary. This happens so it can be fertilized by a male sperm. If the egg is not fertilized, it is sent out of the body during your period.

In some cases, a woman doesn’t make enough of the hormones needed to ovulate. When ovulation doesn’t happen, the ovaries can develop many small cysts. These cysts make hormones called androgens. Women with PCOS often have high levels of androgens. This can cause more problems with a woman’s menstrual cycle. And it can cause many of the symptoms of PCOS.

Treatment for PCOS is often done with medication. This can’t cure PCOS, but it helps reduce symptoms and prevent some health problems.

What causes PCOS?

The exact cause of PCOS is not clear. Many women with PCOS have insulin resistance. This means the body can't use insulin well. Insulin levels build up in the body and may cause higher androgen levels. Obesity can also increase insulin levels and make PCOS symptoms worse.

PCOS may also run in families. It's common for sisters or a mother and daughter to have PCOS.

What are the risks for PCOS?

You may be more likely to have PCOS if your mother or sister has it. You may also be more likely to have it if you have insulin resistance or are obese.

What are the symptoms of PCOS?

The symptoms of PCOS may include:

• Missed periods, irregular periods, or very light periods

• Ovaries that are large or have many cysts

• Excess body hair, including the chest, stomach, and back (hirsutism)

• Weight gain, especially around the belly (abdomen)

• Acne or oily skin

• Male-pattern baldness or thinning hair

• Infertility 

• Small pieces of excess skin on the neck or armpits (skin tags)

• Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts

How is PCOS diagnosed?

Your health care provider will ask about your medical history and your symptoms. You will also have a physical exam. This will likely include a pelvic exam. This exam checks the health of your reproductive organs, both inside and outside your body.

Some of the symptoms of PCOS are like those caused by other health problems. Because of this, you may also have tests such as:

• Ultrasound. This test uses sound waves and a computer to create images of blood vessels, tissues, and organs. This test is used to look at the size of the ovaries and see if they have cysts. The test can also look at the thickness of the lining of the uterus (endometrium).

• Blood tests. These look for high levels of androgens and other hormones. Your health care provider may also check your blood glucose levels. And you may have your cholesterol and triglyceride levels checked.

How is PCOS treated?

Treatment for PCOS depends on a number of factors. These may include your age, how severe your symptoms are, and your overall health. The type of treatment may also depend on whether you want to become pregnant in the future.

If you do plan to become pregnant, your treatment may include:

• A change in diet and activity. A healthy diet and more physical activity can help you lose weight and reduce your symptoms. They can also help your body use insulin more efficiently, lower blood glucose levels, and may help you ovulate.

• Medications to cause ovulation. Medications can help the ovaries to release eggs normally. These medications also have certain risks. They can increase the chance for a multiple birth (twins or more). And they can cause ovarian hyperstimulation. This is when the ovaries release too many hormones. It can cause symptoms such as abdominal bloating and pelvic pain.

If you do not plan to become pregnant, your treatment may include:

• Birth control pills. These help to control menstrual cycles, lower androgen levels, and reduce acne.

• Diabetes medication. This is often used to lower insulin resistance in PCOS. It may also help reduce androgen levels, slow hair growth, and help you ovulate more regularly.

• A change in diet and activity. A healthy diet and more physical activity can help you lose weight and reduce your symptoms. They can also help your body use insulin more efficiently, lower blood glucose levels, and may help you ovulate.

• Medications to treat other symptoms. Some medications can help reduce hair growth or acne.

What are the complications of PCOS?

Women with PCOS are more likely to develop certain serious health problems. These include type 2 diabetes, high blood pressure, problems with the heart and blood vessels, and uterine cancer. Women with PCOS often have problems with their ability to get pregnant (fertility).

Living with PCOS

Some women struggle with the physical symptoms of PCOS, such as weight gain, hair growth, and acne. Cosmetic treatments, such as electrolysis and laser hair removal, may help you feel better about your appearance. Talk with your health care provider about the best ways to treat the symptoms that bother you.

When should I seek medical care?

If you have missed or irregular periods, excess hair growth, acne, and weight gain, call your doctor for an evaluation.

Key points

• PCOS is a very common hormone problem for women of childbearing age.

• Women with PCOS may not ovulate, have high levels of androgens, and have many small cysts on the ovaries.

• PCOS can cause missed or irregular menstrual periods, excess hair growth, acne, infertility, and weight gain. 

• Women with PCOS may be at higher risk for type 2 diabetes, high blood pressure, heart problems, and endometrial cancer.

• The types of treatment for PCOS may depend on whether or not a woman plans to become pregnant. Women who plan to become pregnant in the future may take different kinds of medications.

Next steps

Tips to help you get the most from a visit to your health care provider:

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.

Polycystic ovary syndrome - symptoms, causes, features, diagnosis and treatment in medical centers "K + 31

Causes of polycystic ovary syndrome

PCOS is a dyshormonal disease that leads to the formation of a dense membrane around the ovaries that prevents the release of an egg (ovulation) . For the first time, the clinical picture of this pathology was described by Stein and Leventhal in the last century. For this reason, PCOS is also called Stein-Leventhal syndrome.

The mechanisms by which PCOS develops are not fully understood. At present, the role of hereditary factors in its occurrence has been proven. With PCOS, the conversion of male sex hormones into female sex hormones is disrupted in the ovaries. As a result, an excess of androgens appears in the blood, the maturation of follicles in the ovaries stops, many cysts form, and their albuginea thickens.

These disorders are based on increased activity of insulin during puberty, the effect of which on the ovaries is mediated through the main regulatory center - the pituitary gland and its hormones: follicle-stimulating (FSH) and luteinizing (LH).

How does polycystic ovary syndrome manifest itself?

Violation of the production of sex hormones in the ovaries leads to a decrease in estrogen levels. As a result, menstruation becomes rare until their complete disappearance. In some cases, on the contrary, uterine bleeding is noted due to the formed hyperplastic process of the endometrium.

An excess of androgens in the body leads to the development of hirsutism (excessive growth of hair on the body and face). At the same time, there may even be baldness or hair loss with bald patches on the sides of the forehead and on the top of the head. Many women develop acne, seborrhea, the skin becomes oily. One of the main reasons for patients with PCOS to see a doctor is infertility due to the lack of ovulation.

A characteristic symptom of polycystic ovaries is male-type obesity, in which the bulk of adipose tissue is deposited in the lower abdomen and in the abdominal cavity. As a result of a rapid increase in body weight against the background of hormonal imbalance, stretch marks appear on the skin of the abdomen, hips, buttocks - striae.

Patients with PCOS often experience:

• depression,
• decreased libido,
• irritability,
• nervousness,
• aggressiveness,
• often drowsiness,
• lethargy,
• complaints about "fog in the head".

With this pathology, there is a dysfunction not only of the ovaries, but also of other organs: the hypothalamus, pituitary gland, adrenal glands, thyroid gland. Therefore, the clinical picture and the severity of manifestations are very diverse.

Absence of ovulation

Any woman may suspect the presence of polycystic ovaries. As we said, with PCOS, a dense capsule forms around the ovary, which prevents ovulation. Its absence can be registered using the basal temperature (BT) chart, which is recommended for a patient with infertility to be measured within 3-6 months. With PCOS, the BBT schedule will be monotonous without a characteristic ovulatory peak in the middle of the cycle throughout the entire observation period.

You can also detect anovulation with home tests, which are carried out starting from the 17th day before the expected period. With PCOS, all tests will be negative. The absence of ovulation according to BT and tests for several months requires further examination, first of all, ultrasound.

What will the ultrasound show?

Ultrasound can detect the following signs of PCOS:

• bilateral ovarian enlargement 2-3 times;
• many small cysts (more than 10) on the periphery of the ovaries, which look like a "pearl necklace", an accumulation of whitish bubbles or "fruit seeds";
• thickened to 5 mm or more capsule;
• reduction in the size of the uterus.

Ultrasound is highly informative for PCOS. However, the data of this method alone is not enough to establish a diagnosis. A laboratory study of the patient's blood is necessary.

Hormonal disorders

An important step in the examination of patients with suspected PCOS is the study of the hormonal profile, which is carried out on the 2nd-4th day of the menstrual cycle. With this pathology in the serum, there is an increase in the level of LH, testosterone, dehydroepiandrosterone (DHEA), estradiol deficiency.

Patients with PCOS also often have decreased thyroid function. Therefore, the concentrations of thyroid-stimulating hormone (TSH), thyroxine (T4) and prolactin should be additionally assessed, which can be changed.

An anti-Mullerian hormone (AMH) test plays an important role in the detection of PCOS. Normally, its level is 1-2.5 ng / ml. With polycystic it increases.

How to distinguish between PCOS and adrenal pathology?

Often, PCOS has to be distinguished from adrenogenital syndrome (AGS) - a hereditary pathology of the adrenal glands, which also increases the content of male sex hormones. But with PCOS, unlike AGS, they are synthesized in the ovaries, and not in the adrenal glands.

To establish the diagnosis, tests with glucocorticoids (prednisolone, dexamethasone, cortisone) are carried out, the deficiency of which is present in adrenogenital syndrome and absent in PCOS. In the pathology of the adrenal glands, after the introduction of the missing glucocorticoid, the levels of androgens, their intermediate products and metabolites (DHEA, 17-OK, 17-OP) are normalized. With PCOS, this effect is absent.

Currently, to establish the diagnosis of AGS, genotyping of the 21-hydroxylase gene (CYP21A2) mutation is performed, which makes it possible to identify the deficiency of this enzyme, which is the cause of congenital adrenal pathology.

Run diagnostics

Assessing glucose tolerance

A distinctive feature of PCOS is insulin resistance - a violation of insulin susceptibility by tissues. A similar condition occurs in type 2 diabetes.

For this reason, patients with PCOS have a glucose tolerance test.

With PCOS, there is often a change in the blood lipid spectrum with a predominance of atherogenic components: cholesterol, triglycerides, low and very low density lipoproteins (LDL and VLDL).

We normalize carbohydrate metabolism

Women with PCOS and overweight are advised to change their lifestyle and diet. It is necessary to follow a diet (eating enough pure protein, vegetables, limiting carbohydrates), doing fitness and sports.

Given the decrease in tissue sensitivity to insulin, as in type 2 diabetes, gynecologists-endocrinologists of the gynecology department of the K + 31 Clinic in PCOS prescribe metformin (MF), which increases the susceptibility of cells to insulin. Against the background of taking the drug, carbohydrate metabolism is normalized, the number of male sex hormones in the blood decreases, and ovarian function is restored.

We stimulate ovulation

An important step in the treatment of PCOS is the normalization of the menstrual cycle. For this purpose, combined oral contraceptives (COCs) are used, which include antiandrogens that block the effects of male sex hormones. Taking COCs prevents further progression of the disease. After the withdrawal of hormones, the patient ovulates and there is a chance to become pregnant.

If at the end of the COC course the ovarian function has not returned to normal, and the woman is interested in pregnancy, it is necessary to induce (stimulate) ovulation with special hormonal preparations (clostilbegyt). The scheme is selected by the doctor. Usually, treatment is started with a low dose and, in the absence of a result, it is increased.

Also, in order to correct hyperandrogenism, cyproterone acetate (androkur) and spironolactone (veroshpiron), which have an antiandrogenic effect, are additionally used. Against the background of their intake, the greasiness of the skin decreases, acne disappears, and hair growth improves.

Surgical treatment of polycystic ovary syndrome (PCOS)

If ovulation still does not occur despite 3-6 months of hormone therapy, surgery is performed. When choosing an access, preference is given to laparoscopy. During the operation, either small incisions (wedge resection) or holes (cauterization) are made in the dense shell of the ovaries, through which the egg can leave the ovary and be fertilized. After the intervention, the menstrual cycle becomes ovulatory. This effect lasts up to a year, during which a woman can become pregnant.

Treatment of PCOS takes a long time - from 3 to 12 months. But if it is chosen correctly, the effect is good, and pregnancy occurs in most patients.

PCOS is not a tragedy, not a sentence, but just a barrier that temporarily prevents the achievement of an important goal in life. However, thanks to modern advances in medicine, you will be able to overcome this barrier. You just need to contact the leading specialists, be patient, and the meeting with the baby will take place! from 4 500.00

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