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Polycystic Ovarian Syndrome, also known as Stein-Leventhal Syndrome, is a condition that affects women of reproductive age; it is a set of symptoms in relation to hormonal imbalances, and while it affects all women differently, most experience the same telltale signs of PCOS.

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What Does Having a Hormonal Imbalance Do? 

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What Does Having a Hormonal Imbalance Do? 

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"In women with PCOS, the hormones are out of balance: these women have higher-than-normal levels of androgens and may have lower-than-normal levels of estrogen. High levels of androgens can interfere with signals from the brain that normally result in ovulation, so that ovulation does not occur regularly. It can also cause the follicles to stop developing, causing them to enlarge, as well as produce other symptoms of PCOS, including excess hair growth and acne," according to Eunice Kennedy Shriver of National Institute of Health.

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PCOS is the most common cause of infertility in women of reproductive age. It is a result of an absence in ovulation that many women do not know they suffer from until attempting to become pregnant. This is usually when a PCOS diagnosis comes into play.

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Amenorrhea, oligomenorrhea, menorrhagia, and anovulatory menstrual cycles are all common with Polycystic Ovarian Syndrome.

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Due to the hormonal imbalances, PCOS is also likely to cause varying skin conditions such as a late onset of persistent acne that is not well managed with treatment, oily skin, skin tags, and patches of thickened dark skin.

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Hirsutism is an unusual amount of hair growth on the body. This is due to a large amount of testosterone production, and it leads to facial hair, chest hair, stomach or upper thigh hair in excess amounts.

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One of the more frustrating symptoms of PCOS is weight gain. More often than not, women with Polycystics will be considered obese. Weight gain takes place more so in the waist area, and it is difficult to lose.

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Many women who have PCOS suffer from an insulin resistance, which produces more androgens and causes weight gain. This weight gain worsens the insulin resistance, in turn making the PCOS symptoms worse.

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What Causes Polycystic Ovarian Syndrome? 

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What Causes Polycystic Ovarian Syndrome? 

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While genetic and environmental factors play a role in PCOS development, the direct cause of the condition is unknown. It is presumed that, since the symptoms of PCOS runs in families, the condition is caused by a mutation in one or more genes that could potentially take place in utero.

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Though we do not know the initial cause of the condition, we do know what causes the symptoms. According to Eunice Kennedy Shriver of the National Health Institute, "Most of the symptoms of PCOS are caused by higher-than-normal levels of certain hormones, called androgens.

The ovaries produce hormones, which are chemicals that control functions in the body. One of the hormones that the ovaries make is estrogen—sometimes called the "female hormone" because women's bodies make more of it than men's bodies do. The ovaries also make androgens—sometimes called "male hormones" because men's bodies make more of them than women's bodies do. Men and women need certain levels of both hormones for normal health."

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There is a decrease in Follicle Stimulating Hormone, and an increase in Luteinizing Hormone, Testosterone, and Anti-Mullerian Hormone.

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Poly means many, cystic means cysts. Naturally, this is an indication that a varying amount of cysts can be found on the ovaries. However, this is not a symptom that all women suffer from, yet they can still have a PCOS diagnosis.

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Bilateral multiple cysts less than 1 cm

12+ cysts per ovary

Ovarian volume greater than 10 cm

The classic "string of pearls" sign

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Not only are women who have Polycystic Ovarian Syndrome suffering from the extensive symptoms that come with the condition, they are also more at risk of developing other complications.

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Women with PCOS present with a higher prevalence in risk for cardiovascular disease with hypertension, preeclampsia, dyslipidemia, diabetes, and obesity.

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"Several PCOS comorbidities seemed to contribute to infertility. In particular, insulin resistance and obesity were independently related to an increased risk of abortion and to reduced pregnancy and live-birth rates. Endometrial abnormalities were also reported in PCOS women, affecting potentially the implantation. Finally, ovarian alterations at several levels were described, i.e., ovarian/follicular/corpus luteum vascularity, follicular fluid environment, and subsequent oocytes competence and quality," says Stefano Palomba of National Library of Medicine.

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Polycystic women have an increased chance of developing cancers such as endometrial, ovarian, and breast due to hormonal and metabolic pathogenic mechanisms. The National Library of Medicine states, "At present, based on the most recent meta-analysis, women with PCOS of all ages seem to be at an increased risk of endometrial cancer. In particular, the risk of endometrial cancer may be even higher in the premenopausal subgroup of women with PCOS, while overall the risk of ovarian and breast cancer was not significantly increased."

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Amidst the other issues women with PCOS face, there is also a lower quality of life due to depression and anxiety. The prevalence ranges from 14% - 67%, with the greater percentage occurring in women with a greater BMI.

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Polycystic Ovarian Syndrome is not something that just vanishes, usually it is a lifelong condition because no one specific medication is a cure-all, and it requires fairly drastic life changes in order to reduce or eliminate symptoms. However, treatment depends on varying factors including age, severity of symptoms, and overall health. Another factor is if a woman is planning to get pregnant.

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If a woman has intent to become pregnant, her treatments may look a little like a change in diet and activity to aid in weight loss for a more efficient use of insulin, to lower blood glucose levels, and hopefully cause ovulation. Other options include medication to encourage ovulation, though these medications pose risks such as a chance for a multiple birth, or ovarian hyperstimulation.

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If there is no intent to become pregnant, treatment may include things like contraceptives to aid in normal menstrual cycles to lower androgen levels, and also reduce acne. As well as diabetes medication is offered in an effort to lower insulin resistance, which in turn reduces androgen levels, encourages regular ovulation, and slows hair growth.

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Transvaginal Ultrasound is the ideal modality for imaging Polycystic Ovarian Syndrome. It allows for the images to be very up close and personal, meaning all of the tiniest details are visible. Abdominal Ultrasound is not as high quality as Transvaginal, however, it is still reliable in a scenario when TVU is not accessible.

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MRI is not a routinely performed modality to investigate PCOS, but some characteristics are still visualized from these images.

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Shriver, E. (n.d.). National Institute of Child Health and Human Development - NICHD. Retrieved from www.nichd.nih.gov website: https://www.nichd.nih.gov/health/topics/factsheets/pcos

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Palomba, S., Santagni, S., Falbo, A., & La Sala, G. B. (2015). Complications and challenges associated with polycystic ovary syndrome: Current perspectives. International Journal of Women’s Health, 7, 745. https://doi.org/10.2147/ijwh.s70314

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Kenigsberg, L. E., Agarwal, C., Sin, S., Shifteh, K., Isasi, C. R., Crespi, R., … Arens, R. (2015). Clinical Utility of Magnetic Resonance Imaging (MRI) and Ultrasonography (US) for Diagnosis of Polycystic Ovary Syndrome (PCOS) in Adolescent Girls. Fertility and Sterility, 104(5), 1302-1309.e4. https://doi.org/10.1016/j.fertnstert.2015.08.002

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John Hopkins Medicine. (2019). Polycystic ovary syndrome (PCOS). Retrieved from John Hopkins Medicine website: https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos

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Patience D. Jordan. (1997).

Woman who has PCOS according to her Gynecologist.

Website: https://ihateithere.com