Polycystic ovary syndrome (PCOS), previously known as Stein-Leventhal syndrome, is a disorder in which numerous benign cysts form on the ovaries under a thick, white covering. It is most common in women under 30 years old. The ovaries are the female reproductive organs that contain and release eggs. They also produce the female hormones estrogen and progesterone. Ovarian cysts are fluid-filled sacs that result from ovulation cycles. Many ovarian cysts disappear without treatment. The most common are just enlargements of the normal egg follicles.

Between 5 and 30% of women have some characteristic of PCOS. This is one of the most common hormonal abnormalities in women of reproductive age and is a leading cause of infertility. Often in PCOS patients, periods start at the usual age of 12-13, while some start menstruating earlier. Interestingly, there appears to be variabilities of PCOS clinical manifestations among races. For example, obesity and hirsutism are not prominent among Japanese people, whereas they are much more common among Caucasians.

How does it occur?
Polycystic ovary disease is due to an abnormal production of two of the hormones produced by the pituitary gland in the brain. These two hormones are LH (luteinizing hormone) and FSH (follicle-stimulating hormone). Imbalance of these hormones prevents the ovaries from releasing an egg each month. It also results in an increased production of the male hormone testosterone by the ovaries.

How is it diagnosed?
Your doctor diagnoses polycystic ovary disease with tests and exams including your medical history, a physical exam, blood tests to check hormone levels and an ultrasound. Because it is a syndrome, PCOS includes a set of symptoms. Women with PCOS can suffer from any combinations of the usual symptoms. Some women experience only one of these symptoms, while other women experience all of them. The severity of PCOS symptoms can vary widely from woman to woman.

How is it treated?
The method of treatment depends on the severity of the symptoms and whether you are trying to get pregnant. If you are not trying to conceive, you can be treated with hormones, including the birth control pill. Hormones and birth control pills will give regular menstrual cycles and may reduce abnormal hair growth. They also reduce the risk of developing endometrial hyperplasia, a condition that can become uterine cancer. If you are trying to become pregnant, your health care provider may prescribe fertility drugs, but it can be a long and complicated treatment.

In rare cases a wedge of ovarian tissue may be surgically removed or destroyed. This usually results in regular menstrual cycles for a while. For excess body and facial hair, your health care provider may recommend electrolysis.

It is desirable to have a period at least at intervals, though not necessarily monthly. Hormonal treatment, including the use of natural progesterone, can achieve this where required. The natural approach to PCOS should involve using all of the appropriate therapies at the same time and may require many months before improvement is seen.

The conventional treatment of PCOS is directed primarily at the problems of hirsutism, menstrual irregularity and infertility. Treatment modalities for hirsutism include ovarian and adrenal suppression, anti-androgen therapy and local hair removal measures. Oral contraceptives are simple and relatively safe method of ovarian suppression, in addition the estrogen component increases the sex hormone binding globulin (SHBG) with a resultant decrease in free testosterone. When DHEA-S levels are elevated, the addition of dexamethasone may be helpful. Spironolactone is the preferred anti-androgenic compound. It competitively inhibits intracellular dihydrotestosterone receptors within the hair follicles. Both cimetidine and cyproheptadine (a serotonin and histamine antagonist) have weak anti-androgenic effects.