Polycystic Ovarian Syndrome
In the polycystic ovarian syndrome (PCOS) or Stein-Leventhal syndrome, multiple small cysts form in one or both ovaries. It occurs in about 7% of women and tends to run in families.
The cause is unknown, but is probably a combination of genetic and environmental factors. The cysts interfere with the production of sex hormones (eg. oestrogens) by the ovaries and the patient develops facial hairs, develops adult acne, gains weight, stops her menstrual periods, is infertile and losses breast firmness. These patients have an increased risk of developing type two diabetes mellitus and often have raised cholesterol levels.
Abnormal levels of hormones can be measured in the bloodstream, but the syndrome is often discovered on an ultrasound scan while investigating infertility. The presence of cysts in an ovary on ultrasound is not PCOS unless accompanied by the other symptoms of the syndrome associated with hormonal abnormalities.
Treatment involves encouraging the patient to lose weight, using hormones to stimulate the ovary to restart its correct function, and sometimes surgically cutting away part of the affected ovarian tissue. Specific medications (eg. spironolactone or progestogens) are used for excessive hair growth. The diabetes medication metformin may be used to assist in weight loss. Rarely, some women find the discomfort of the condition and the side effects of medication unacceptable and decide to have a total hysterectomy.