Polycystic Ovary Syndrome
Under normal circumstances, follicles deep within the ovaries are stimulated to grow, mature, and rise to h surface of the ovary, where they burst and release an egg to the Fallopian tube, a process controlled by pituitary hormones.
The remnants of the burst follicle then begin to produce progesterone, which stimulates the lining of the uterus (endometrium) to grow thicker in case it needs to support a fertilized egg. The effect on the pituitary of an increase in progesterone production is to signal it to stop stimulating the development of eggs.
In polycystic disease, the follicles never erupt from the ovaries. They grow just under the ovaries’ surface, and are produced again and again because the pituitary has not been signaled to shut off. Both ovaries become filled with tiny cysts and can become enlarged. A thickened capsule also grows to encase the ovary.
Polycystic disease is most common in women under 30. It is caused by an endocrine imbalance with increased levels of testosterone, estrogen, and luteinizing hormone (LH) and decreased secretion of follicle-stimulating hormone (FSH).
The increased level of LH associated with this disorder may be the result of an increased sensitivity of the pituitary to stimulation by releasing hormone or of excessive stimulation by the adrenal gland.
Polycystic ovary may also be associated with a variety of problems in the hypothalamic-pituitary-ovarian axis, with extragonadal sources of androgens, or with androgen-producing tumors. It is also called Stein-Leventhal Syndrome.
The symptoms of PCO are:
- Persistent absence of ovulation
- Persistent production of estrogen and higher than normal production of androgens (male hormones)
- Higher than normal production of the pituitary hormone LH (luteinizing hormone) with low or average production of FSH (follicle stimulating hormone)
- Thickened and enlarged ovaries - often twice their normal size
- Abnormal menstrual patterns: absence of menstrual periods (affects 50 percent), or irregular heavy bleeding patterns (affects 25 percent)
- Excessive hair growth and masculine hair texture and distribution (affects 70 percent)
- Infertility (because there is no ovulation)
The goals in treating PCO disease are to protect the patient from the adverse long-term effects that persistent estrogen exposure in the absence of ovulation may have on the uterus and breasts, and to help control the specific symptoms the patient may be having. These goals can be accomplished by:
1. Treatment to induce ovulation
2. Hormone medication to suppress ovary production of estrogen and male hormones
3. Intermittent treatment with progesterone hormone to interrupt the effects of steady estrogen exposure.
If one wants to become pregnant, then ovulation induction is the obvious choice. Treatment with clomiphene is successful in inducing ovulation for approximately 80 percent of patients, and if this is unsuccessful, injections of human menopausal gonadotropin may be a reasonable option.
All of the treatments designed to induce ovulation involve fairly extensive medical supervision and significant medical costs; although ovulation is the real “cure” for PCO problems, these treatments are not recommended unless the patient is actively trying to conceive.
Hormone treatment to suppress ovarian activity is a reasonable choice if the patient does not want to conceive now, and is having problems with excessive hair growth. This treatment also provides the added benefit of contraceptive protection. Regular birth control pills effectively suppress ovarian hormone production, but if these pills are unwise or contraindicated because of other medical problems, then similar suppression can be achieved with daily progesterone tablets or long-acting progesterone injections.
Intermittent progesterone treatment is a reasonable choice if the patient is not trying to conceive, does not need birth control protection, and is not having hair problems. Progesterone tablets such as Provera can protect against the development of precancerous uterine lining abnormalities, can reverse abnormalities already present, and should also control problems with irregular bleeding.
Would you explain what is causing the development of cysts?
Is there something wrong with the pituitary gland?
Has uterine cancer be ruled out?
Do you recommend a blood test for LH and FSH?
(If pregnancy is desired) - what can be done to induce ovulation?
(If pregnancy is not desired) Can you recommend hormonal treatment?
What can be expected from such drugs?
(If experiencing excessive hair growth) What can be done to suppress this symptom?