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the body (hirsutism), and male-pattern hair loss. (PCOS)?

Other signs and symptoms of PCOS include: obesity and weight gain, Polycystic ovarian syndrome (PCOS), also elevated insulin levels and insulin known by the name Stein-Leventhal resistance syndrome, is a hormonal problem that oily skin, causes women to have a variety of dandruff, symptoms. It should be noted that most women with the condition have a number of infertility, skin discolorations, small cysts in the ovaries. However, women high cholesterol levels, may have cysts in the ovaries for a number elevated blood pressure, and of reasons, and it is the characteristic multiple, small cysts in the ovaries. constellation of symptoms, rather than the Any of the above symptoms and signs may presence of the cysts themselves, that is be absent in PCOS, with the exception of important in establishing the diagnosis of irregular or no menstrual periods. All women PCOS. with PCOS will have irregular or no PCOS occurs in 5% to 10% of women and is menstrual periods. Women who have PCOS do not regularly ovulate; that is, they do not the most common cause of infertility in release an egg every month. This is why they women. The symptoms of PCOS may begin in adolescence with menstrual irregularities, do not have regular periods and typically have difficulty conceiving. or a woman may not know she has PCOS until later in life when symptoms and/or What causes polycystic ovarian syndrome infertility occur. Women of all ethnicities (PCOS)? may be affected. What is polycystic ovarian syndrome

and researchers believe that these abnormalities may be related to the development of PCOS. It is also known that the ovaries of women with PCOS produce excess amounts of male hormones known as androgens. This excessive production of male hormones may be a result of or related to the abnormalities in insulin production. Another hormonal abnormality in women with PCOS is excessive production of the hormone LH, which is involved in stimulating the ovaries to produce hormones and is released from the pituitary gland in the brain. Other possible contributing factors in the development of PCOS may include a low level of chronic inflammation in the body and fetal exposure to male hormones. How is PCOS diagnosed?

The cysts (fluid filled sacs) in the ovaries can be identified with imaging technology. (However, as noted above, women without PCOS can have many cysts as well.) Ultrasound, which passes sound waves through the body to create a picture of the kidneys, is used most often to look for cysts in the ovaries. Ultrasound imaging employs no injected dyes or radiation and is safe for all patients including pregnant women. It can also detect cysts in the kidneys of a fetus. Because women without PCOS can have ovarian cysts, and because ovarian cysts are not part of the definition of PCOS, ultrasound is not routinely ordered to diagnose PCOS. The diagnosis is usually a clinical one based on the patient's history, physical examination, and laboratory testing.

More powerful and expensive imaging methods such as computed tomography (CT The diagnosis of PCOS is generally made on scan) and magnetic resonance imaging (MRI) also can detect cysts, but they are generally the basis of clinical signs and symptoms as reserved for situations in which other discussed above. The doctor will want to conditions that may cause related exclude other illnesses that have similar features, such as low thyroid hormone blood symptoms, such as ovarian or adrenal gland No one is quite sure what causes PCOS, and levels (hypothyroidism) or elevated levels of tumors are suspected. CT scans require XWhat are the symptoms of polycystic it is likely to be the result of a number of a milk-producing hormone (prolactin). Also, rays and sometimes injected dyes, which can ovarian syndrome (PCOS)? both genetic (inherited) as well as be associated with some degree of tumors of the ovary or adrenal glands can environmental factors. Women with PCOS The principal signs and symptoms of PCOS produce elevated male hormone (androgen) complications in certain patients. often have a mother or sister with the are related to menstrual disturbances and blood levels that cause acne or excess hair What conditions or complications can be condition, and researchers are examining elevated levels of male hormones growth, mimicking symptoms of PCOS. the role that genetics or gene mutations associated with PCOS? (androgens). Menstrual disturbances can might play in its development. The ovaries of Other laboratory tests can be helpful in include delay of normal Women with PCOS are at a higher risk for a women with PCOS frequently contain a menstruation (primary amenorrhea), the making the diagnosis of PCOS. Serum levels number of illnesses, including high blood number of small cysts, hence the name presence of fewer than normal menstrual of male hormones (DHEA and testosterone) pressure, diabetes, heart disease, andcancer periods (oligomenorrhea), or the absence of poly=many cystic ovarian syndrome. A may be elevated. However, levels of similar number of cysts may occur in women testosterone that are highly elevated are not of the uterus (endometrial cancer). menstruation for more than three months Because of the menstrual and hormonal without PCOS. Therefore, the cysts (secondary amenorrhea). Menstrual cycles unusual with PCOS and call for additional irregularities, infertility is common in women themselves do not seem to be the cause of may not be associated with ovulation evaluation. Additionally, levels of a hormone with PCOS. Because of the lack of ovulation, (anovulatory cycles) and may result in heavy the problem. released by the pituitary gland in the brain progesterone secretion in women with PCOS A malfunction of the body's blood sugar bleeding. (LH) that is involved in ovarian hormone is diminished, leading to long-term control system (insulin system) is frequent in production are elevated. unopposed estrogen stimulation of the women with PCOS, who often have insulin Symptoms related to elevated androgen uterine lining. This situation can lead to resistance and elevated blood insulin levels, levels include acne, excess hair growth on

abnormal periods, breakthrough bleeding, or prolonged uterine bleeding in some women. Unopposed estrogen stimulation of the uterus is also a risk factor for the development of endometrial hyperplasia andcancer of the endometrium (uterine lining). However, medications can be given to induce regular periods and reduce the estrogenic stimulation of the endometrium (see below). Obesity is associated with PCOS; about 60% of those diagnosed with PCOS in the U.S. are obese. Obesity not only compounds the problem of insulin resistance and type 2 diabetes (see below), but it also imparts cardiovascular risks. PCOS and obesity are associated with a higher risk of developing metabolic syndrome, a group of symptoms, including high blood pressure, that increase the chances of developing cardiovascular disease. It has also been shown that levels of C-reactive protein (CRP), a biochemical marker that can predict the risk of developing cardiovascular disease, are elevated in women with PCOS. Reducing the medical risks from PCOSassociated obesity is possible. The risk of developing prediabetes and type 2 diabetes is increased in women with PCOS, particularly if they have a family history of diabetes. Obesity and insulin resistance, both associated with PCOS, are significant risk factor for the development of type 2 diabetes. Several studies have shown that women with PCOS have abnormal levels of LDL ("bad") cholesterol and lowered levels of HDL ("good") cholesterol in the blood. Elevated levels of blood triglycerides have also been described in women with PCOS. Changes in skin pigmentation can also occur with PCOS. Acanthosis nigricans refers to the presence of velvety, brown to black pigmentation often seen on the neck, under the arms, or in the groin. This condition is associated with obesity and insulin

resistance and occurs in some women with PCOS. What treatments are available for PCOS? Treatment of PCOS depends partially on the woman's stage of life. For younger women who desire birth control, the birth control pill, especially those with low androgenic (male hormone-like) side effects can cause regular periods and prevent the risk of uterine cancer. Another option is intermittent therapy with the hormone progesterone. Progesterone therapy will induce menstrual periods and reduce the risk of uterine cancer, but will not provide contraceptive protection. For acne or excess hair growth, a water pill (diuretic) called spironolactone (Aldactone) may be prescribed to help reverse these problems. The use of spironolactone requires occasional monitoring of blood tests because of its potential effect on the blood potassium levels and kidney function.Eflornithine (Vaniqa) is a cream medication that can be used to slow facial hair growth in women. Electrolysis and overthe-counter depilatory creams are other options for controlling excess hair growth. For women who desire pregnancy, a medication called clomiphene (Clomid) can be used to induce ovulation (cause egg production). In addition, weight loss can normalize menstrual cycles and often increases the possibility of pregnancy in women with PCOS. Other, more aggressive, treatments forinfertility (including injection of gonadotropin hormones and assisted reproductive technologies) may also be required in women who desire pregnancy and do not become pregnant on Clomid therapy.

Metformin (Glucophage) is a medication used to treat type 2 diabetes. This drug affects the action of insulin and is useful in reducing a number of the symptoms and complications of PCOS. Metformin has been shown to be useful in the management of irregular periods, ovulation induction, weight loss, prevention of type 2 diabetes, and prevention of gestational diabetes mellitus in women with PCOS. Obesity that occurs with PCOS needs to be treated because it can cause numerous additional medical problems. The management of obesity in PCOS is similar to the management of obesity in general. Weight loss can help reduce or prevent many of the complications associated with PCOS, including type 2 diabetes and heart disease. Consultation with a dietician on a frequent basis is helpful until just the right individualized program is established for each woman. Finally, a surgical procedure known as ovarian drilling can help induce ovulation in some women who have not responded to other treatments for PCOS. In this procedure a small portion of ovarian tissue is destroyed by an electric current delivered through a needle inserted into the ovary.