Polycystic Ovary Syndrome

SUMMARY

Polycystic Ovary Syndrome (PCOS) is a common metabolic and reproductive disorder of women characterized by high levels of male hormones (androgens), insulin resistance, and ovulatory dysfunction. High levels of male hormones manifest themselves in excessive coarse and dark hair growth in women where hair is typically minimal or absent, such as the face, chest, and back, referred to as hirsutism. Acne or scalp hair loss can also occur in combination with hirsutism. Long recognized as a reproductive disorder, PCOS is now well established as a metabolic disorder with long-term health risks, including type 2 diabetes and cardiovascular disease.

Polycystic Ovary Syndrome is a misnomer; although there are numerous cysts in the ovary caused by the disorder, the primary regulator of this process occurs in the brain in an area known as the hypothalamus, which produces a hormone known as Gonadotropin-Releasing-Hormone (GnRH), which when secreted to rapidly alters the secretions of hormones called gonadotropins from the pituitary gland. The primary gonadotropins are Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). In PCOS, an elevation in serum levels of LH results in a high LH/FSH ratio (higher than 2:1) that promotes excess androgen production in the ovarian cells.

Unlike a normal menstrual cycle, where the small androgen-producing follicles ultimately disappear and one dominant follicle emerges to produce an egg for ovulation, the small follicles persist, and a dominant follicle often does not appear, resulting in ovulatory dysfunction. Improved understanding of PCOS is leading to new targeted therapy.