Patient Resources

What is polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS) is a hormonal disorder affecting around 5-10% of all women. You may occasionally hear it referred to as Stein-Leventhal syndrome.

The ovaries of women with PCOS are often normal but typically there is an increased incidence of the ovaries containing a number of small cysts, hence the name poly(many)cystic. The cysts are now known to occur in an equal number of women who do not have PCOS so their presence is not the cause of the syndrome. In some women with PCOS the ovaries may be enlarged while in others they may be normal in size. Women with PCOS do not ovulate regularly and so may have fertility problems, which is when the syndrome may first be diagnosed.

The symptoms of PCOS usually begin during puberty and worsen with age.

What are the symptoms of PCOS?

The symptoms of PCOS are largely caused by abnormalities in the levels of the hormones that control the menstrual cycle, usually increased levels of androgens (male hormones) and luteinising hormone and decreased levels of follicle stimulating hormone and progesterone.

Irregular or no periods (amenorrhoea) is the main symptom affecting all women with PCOS. The lack of periods is due to the fact that ovulation is not occurring (anovulation) or does not happen regularly each month.

Excess growth of facial or body hair (hirsutism) is common among women with PCOS due to increased androgen levels, although it is less common in some races, for example the Japanese. Alopecia (thinning of hair on the scalp) may also be a symptom. Obesity is another symptom affecting many women with PCOS. Obesity increases the hormonal imbalance, thereby worsening other problems such as hirsutism. Acne is another symptom that may be caused by the hormonal imbalance. Infertility is often a problem for women with PCOS as a result of anovulation.

Women with PCOS are at increased risk of other illnesses such as high blood pressure, diabetes, heart disease and overgrowth or cancer of the lining of the womb (endometrial hyperplasia or endometrial cancer). Control of obesity and exercise can greatly minimise the risk of developing these conditions. Inducing a menstrual period at least four times a year in women who do not have periods will reduce the risk of endometrial cancer.

What is the cause of PCOS?

The exact cause of PCOS is still not fully understood although some experts believe that insulin resistance may play a part. It is also thought that some women may be genetically predisposed to develop PCOS.

Are there any tests?

A blood test to measure the levels of several hormones (estradiol, follicle-stimulating hormone, luteinising hormone, prolactin, testosterone and thyroid-stimulating hormone) will usually be performed in order to rule out other possible diagnoses. Diagnosis is usually confirmed with a pelvic ultrasound scan to look for small follicles on the ovaries - more than 10 follicles usually indicates PCOS. 

What treatment is available?

Treatment of PCOS is aimed at managing the individual problems caused by the abnormal hormone levels. There is no specific cure for PCOS although in severe cases, surgical removal of a part of the ovary sometimes helps.

It is important for women to have regular periods. For younger women who also require contraception a combined oral contraceptive pill is usually prescribed to ensure regular menstruation patterns.

For acne and hirsutism a medicine called spironolactone (eg, Aldactone®) may be given. Spironolactone is often used as a diuretic (water tablet) but it also inhibits the effects of testosterone, increased levels of which can cause acne and hirsutism.

If infertility is a problem and women wish to become pregnant, medication to induce ovulation so that an egg is released may be prescribed. This medication is called clomifene (eg, Clomid®).

Further information available from:

Verity – The PCOS Self Help Group
New Bond House
124 New Bond Street
London W1S 1DX
Internet: www.verity-pcos.org.uk

Fact sheet provided by MIMS

Date last reviewed: January 2009

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