Amy diVasta, MD, MMSc
Polycystic ovary syndrome
(PCOS) is the most common reproductive endocrine disease among women of childbearing age. It affects approximately 5 to 10
percent of all women and is a lifelong
condition. Fortunately, there are
treatments for the symptoms of PCOS.
Causes, symptoms and diagnosis
"We don't know what causes PCOS," says Amy DiVasta, MD, MMSc, a clinician in the Divisions of Adolescent Medicine and Gynecology at Children's Hospital Boston. "We know there's a genetic component since it runs in families, but
it hasn't been linked to a single gene."
PCOS occurs in both normal weight and overweight young women but is more common in overweight teens. Bringing weight within a healthy range can improve the symptoms of PCOS.
PCOS is associated with androgen excess, primarily due to ovarian
overproduction of testosterone. Multiple small follicles may develop in the ovary, which can lead to a slightly enlarged ovary or appear like a string of pearls on ultrasound. Many women with PCOS also have significant insulin resistance; these patients are at increased risk for the development of type 2 diabetes.
Symptoms often begin around menarche and include irregular menstrual cycles (oligomenorrhea or amenorrhea) but occasionally presenting with dysfunctional uterine bleeding. Many patients report difficulties maintaining a healthy weight. Other signs include hirsutism and acne. Girls with high insulin levels may have acanthosis nigricans, a rash of darkened skin around their neck or under their arms.
A clinical diagnosis can usually be made based on information obtained from a
medical history. Dr. DiVasta recommends that key screening questions at routine
physical exams should include:
How often do your periods occur?
Are you having problems keeping your weight where you want it to be?
Do you have any unwanted hair growth or acne?
Do you have a family history of menstrual irregularity, infertility or diabetes?
It's also important to pose this question to parents. Often, mothers who have been treated for PCOS or infertility have daughters who are at higher risk.
If clinicians suspect PCOS, they can order several blood tests and often an ultrasound
of the ovaries. These additional diagnostic tests can help eliminate or identify other
conditions that may cause similar symptoms, including thyroid disease, late-onset l
congenital adrenal hyperplasia or (very rarely) tumors.