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Sonographically: homogenous echotexture, small peripheral cysts/follicles seen in cortex

Ovary: Are almond shaped structures, measure about 3 cm long. Lie posterior to the uterus at the level of the cornua.

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Polycystic Ovarian Syndrome (PCOS), also known as Stein-Leventhal syndrome is an endocrine disorder related to chronic anovulation. This disorder involves the imbalance of Lutenizing hormone (LH) and FSH (follicle-stimulating hormone) and results in abnormal estrogen and androgen (male sex hormones). When ovaries make more androgens, this keeps the ovaries from releasing the egg as it should during ovulation and causes irregular periods.

-LH is high (increased)

-FSH is low (decreased)

-Anti-Müllerian hormone (AMH) levels are generally increased.

PCOS affects the ovaries (female reproductive organs that make eggs) Function of Ovaries: To grow and mature oocytes (eggs) and release them into the fallopian tubes for fertilization or reproduction. The ovaries also produce two main hormones which are estrogen and progesterone.

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Sonographic image of PCOS or "String of Pearls"

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Sonographic image of PCOS or "String of Pearls"

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The EXACT cause of developing PCOS: Not clear.

Women having insulin resistance could play a role (excessive insulin builds up in the body and causes higher androgen levels.

Obesity may cause increased insulin levels

genetics may play a role as well. (*It's common for sisters or mother and daughter to have PCOS)

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Clinical signs/symptoms include:

Infertility

Obesity

Amenorrhea (absence of period)

Missed periods, irregular periods, or very light periods

Acne or oily skin

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

Hirsutism (excessive hair)

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Sonographic findings:

Bilateral multiple cysts

12+ cysts per ovary

Ovarian volume >10 cm3

"String of Pearls" sign

Large ovaries

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Polycystic ovary syndrome (PCOS). Johns Hopkins Medicine. (2022, February 28). https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos#:~:text=The%20exact%20cause%20of%20PCOS,may%20cause%20higher%20androgen%20levels.

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Women with diagnosed PCOS are more at risk of developing certain medical conditions/complications.

Complications of PCOS:

Type 2 Diabetes

Hypertension (high blood pressure)

Cardiovascular disease

Endometrial cancer

Depression and anxiety

sleep disorders

Infertility problems

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Treatment options depend on a few factors such as:

Age

Severity of symptoms

Overall health and well-being

Aiming to become pregnant in the future

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Have plans to become pregnant:

A change in diet and activity

A healthier lifestyle can also help your body use insulin more efficiently, lower blood glucose levels, and may help you ovulate.

Medications to cause ovulation (releasing of an egg or ova)

Medications to cause/ induce ovulation include clomiphene and letrozole are taken orally, while gonadotropins are given by injection.

Another option is IVF (in-vitro fertilization)

IVF is offered when women has PCOS and the medications provided may not seem to cause ovulation. An egg or ova is taken from the ovary and sperm from the partner are fertilized in a lab and inserted into the uterus.

Professinal,C.C. Medical (2023).

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Don't have plans to become pregnant:

Hormonal Birth-control

Such as birth control pills, patches, shots, a vaginal ring or an intrauterine device (IUD).

Diabetes medication ( such as Metformin is a drug used to treat diabetes.) This medication helps the body regulate insulin.

Change in diet and activity (keeping a healthy and balanced diet and exercise)

Medications to treat symptoms such as excessive hair growth and acne. ( such as medications to block the effect of androgens)

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**MRI is NOT routinely used to further evaluate or diagnose PCOS.

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PCOS- describes MANY small cysts (fluid- filled sacs/structures) that form along the edge of the ovary

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PCOS is seen in females in their late teens or early 20's and 30's.

PCOS affects 10-15% of women of childbearing age and is the most common cause of infertility. In the United States, an estimated 5 to 6 million women have PCOS.

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Hagen-Ansert, S. L. (2017). Textbook of diagnostic sonography (8th ed., Vol. 2). Elsevier.

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Professional, C. C. Medical. (2023). PCOS (polycystic ovary syndrome): Symptoms & treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/8316-polycystic-ovary-syndrome-pcos

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Boldis, B. V., Gr&uuml;nberger, I., Cederstr&ouml;m, A., Bj&ouml;rk, J., Nilsson, A., & Helgertz, J. (2024, April 5). Comorbidities in women with polycystic ovary syndrome: A sibling study - BMC Women’s health. BioMed Central. https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-024-03028-9#:~:text=Women%20have%20a%20higher%20risk,syndrome%20as%20well%20%5B30%5D.

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Risk factors of PCOS include:

Genetics (more likely to develop PCOS if mother or sister has been diagnosed with it.)

Obesity

Insulin resistance

female in childbearing years (late teens - 20's and 30's)

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In conclusion, PCOS is an endocrine disorder that is related to anovulating (or not releasing an egg during ovulation) and involves the imbalance of LH and FSH hormones. It's an imbalance of hormones because LH is too high and FSH is too low. I found it most interesting that 10-15% of women have diagnosed PCOS and it's estimated that 50% of women have PCOS but have not been diagnosed. Therefore, this makes PCOS the most common cause of infertility among women. Another thing I found most interesting is that the main cause of PCOS is not clear or unknown, but women having insulin- resistance, obesity, and genetics with PCOS may play a role. In the research conducted, genetics plays a role because it's common for sisters or mother and daughter to have PCOS. This would affect me in a clinical setting, because when imaging an ovary and I see the "string of pearls" sign along with a large ovary, and the patient being in their child-bearing years, this will directly point me to PCOS.