Polycystic ovary syndrome (PCOS)PCOS OVERVIEWPolycystic ovary syndrome (PCOS) is a condition that causes irregular menstrual periods because monthly ovulation is not occurring and levels of androgens (male hormones) in women are elevated. The condition occurs in approximately 5 to 1.
![]() The elevated androgen levels can sometimes cause excessive facial hair growth, acne, and/or male- pattern scalp hair thinning. Most, but not all, women with PCOS are overweight or obese, and they are at higher- than- average risk of developing diabetes and obstructive sleep apnea. For women with PCOS who want to become pregnant, fertility pills or injections are often needed to help women ovulate. Although PCOS is not completely reversible, there are a number of treatments that can reduce or minimize bothersome symptoms. Most women with PCOS are able to lead a normal life without significant complications. Depo-Provera is the brand name of the drug medroxyprogesterone, which is an injection used to prevent pregnancy. A form of this medication may also be used to treat. PCOS CAUSEThe cause of polycystic ovary syndrome (PCOS) is not completely understood. It is believed that abnormal levels of the pituitary hormone luteinizing hormone (LH) and high levels of male hormones (androgens) interfere with normal function of the ovaries. To explain how these hormones cause symptoms, it is helpful to understand the normal menstrual cycle. ![]() ![]() Normal menstrual cycle — The brain (including the pituitary gland), ovaries, and uterus normally follow a sequence of events once per month; this sequence helps to prepare the body for pregnancy. Two hormones, follicle- stimulating hormone (FSH) and LH, are made by the pituitary gland. Two other hormones, progesterone and estrogen, are made by the ovaries. During the first half of the cycle, small increases in FSH stimulate the ovary to develop a follicle that contains an egg (oocyte). ![]() The follicle produces rising levels of estrogen, which cause the lining of the uterus to thicken and the pituitary to release a very large amount of LH. This midcycle . If the egg is fertilized by a sperm, it develops into an embryo, which travels through the fallopian tube to the uterus. ![]() After ovulation, the ovary produces both estrogen and progesterone, which prepare the uterus for possible embryo implantation and pregnancy. Menstrual cycle in PCOS — In women with polycystic ovary syndrome (PCOS), multiple small follicles (small cysts 4 to 9 mm in diameter) accumulate in the ovary, hence the term polycystic ovaries. None of these small follicles are capable of growing to a size that would trigger ovulation. As a result, the levels of estrogen, progesterone, LH, and FSH become imbalanced. Androgens are normally produced by the ovaries and the adrenal glands. Examples of androgens include testosterone, androstenedione, dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEAS). Androgens may become increased in women with PCOS because of the high levels of LH but also because of high levels of insulin that are usually seen with PCOS. Because hormonal changes vary from one woman to another, patients with PCOS may have mild to severe acne, facial hair growth, or scalp hair loss. Menstrual irregularity — If ovulation does not occur, the lining of the uterus (called the endometrium) does not uniformly shed and regrow as in a normal menstrual cycle. Instead, the endometrium becomes thicker and may shed irregularly, which can result in heavy and/or prolonged bleeding. Irregular or absent menstrual periods can increase a woman's risk of endometrial overgrowth (called endometrial hyperplasia) or even endometrial cancer. Women with PCOS usually have fewer than six to eight menstrual periods per year. Some women have normal cycles during puberty, which may become irregular if the woman becomes overweight. Weight gain and obesity — PCOS is associated with gradual weight gain and obesity in approximately one- half of women. For some women with PCOS, obesity develops at the time of puberty. Hair growth and acne — Male- pattern hair growth (hirsutism) may be seen on the upper lip, chin, neck, sideburn area, chest, upper or lower abdomen, upper arm, and inner thigh. Acne is a skin condition that causes oily skin and blockages in hair follicles. Insulin is a hormone that is produced by specialized cells within the pancreas; insulin regulates blood glucose levels. When blood glucose levels rise (after eating, for example), these cells produce insulin to help the body use glucose for energy. Excess production of insulin is called hyperinsulinemia. Among women with PCOS, up to 3. I couldnt agree more ive been on depo on and off since 2010 and the first two shots were ok then i dec that in jan 2015 to try it one more time and i just got off it.The risk of these conditions is much higher in women with PCOS compared with women without PCOS. A family history of diabetes, overweight and obesity, as well as race and ethnicity (particularly African American and Hispanic), can increase the likelihood of developing diabetes among women with PCOS. Infertility — Many women with PCOS do not ovulate regularly, and it may take these women longer to become pregnant. An infertility evaluation is often recommended after 6 to 1. It is not known for sure if women with PCOS are at increased risk for this condition. Both weight loss and treatment of insulin abnormalities can decrease this risk. Other treatments (eg, cholesterol- lowering medications, treatments for high blood pressure) may also be recommended. Patients with this problem often experience fatigue and daytime sleepiness. In addition, there is evidence that people with untreated sleep apnea have an increased risk of insulin resistance, obesity, diabetes, and cardiovascular problems, such as high blood pressure, heart attack, abnormal heart rhythms, or stroke. Sleep apnea may occur in up to 5. PCOS. The condition can be diagnosed with a sleep study, and several treatments are available. You may be diagnosed with PCOS based upon your symptoms, blood tests, and a physical examination. Expert groups have determined that a woman must have two out of three of the following to be diagnosed with PCOS. The evidence can be based upon signs (excess hair growth, acne, or male- pattern balding) or blood tests (high androgen levels). Blood tests for pregnancy, prolactin level, thyroid- stimulating hormone (TSH), and follicle- stimulating hormone (FSH) may be recommended. Insulin levels are not used to diagnose PCOS, partly because insulin levels are high in people who are above normal body weight and because there is no level of insulin that is . An oral glucose tolerance test is the best way to diagnose prediabetes and/or diabetes. A fasting glucose level is often normal even when prediabetes or diabetes is present. Many clinicians who treat PCOS patients also recommend screening for sleep apnea with questionnaires or overnight sleep studies in a sleep laboratory. In women with moderate to severe hirsutism (excess hair growth), blood tests for testosterone and dehydroepiandrosterone sulfate (DHEAS) may be recommended. All women who are diagnosed with PCOS should be monitored by a health care provider over time. Symptoms of PCOS may seem minor and annoying, and treatment may seem unnecessary. However, untreated PCOS can increase a woman's risk of other health problems over time. PCOS TREATMENTSOral contraceptives — Oral contraceptives (OCs; with combined estrogen and progestin) are the most commonly used treatment for regulating menstrual periods in women with polycystic ovary syndrome (PCOS). OCs protect the woman from endometrial (uterine) hyperplasia or cancer by inducing a monthly menstrual period. OCs are also effective for treating hirsutism and acne. A skin patch and vaginal ring are also available for contraception. Some women choose intrauterine devices (IUDs) containing a type of progesterone to minimize uterine bleeding and protect against uterine cancer. However, unlike OCs, patch, and ring, the IUD is not effective for treating acne or facial hair. Women with PCOS occasionally ovulate, and OCs are useful in providing protection from pregnancy. Although an OC allows for bleeding once per month, this does not mean that the PCOS is . These treatments can be used in combination to reduce and slow hair growth. OCs and antiandrogens can also reduce acne. Other prescription skin treatments (eg, medicated lotions) or oral antibiotics may be recommended in some cases. If a woman has not had a period for six weeks or longer, the clinician may first prescribe a hormone (sample brand name: Provera) to induce a menstrual period. Side effects — Some women who take birth control pills (not just those with PCOS) stop having monthly bleeding or develop irregular spotting and bleeding. Irregular bleeding usually resolves after a few menstrual cycles. Many women worry that they will gain weight on the pill. This is not a concern with the currently available low- dose pills. Some women develop nausea, breast tenderness, and bloating after beginning the pill, but these symptoms usually resolve after two or three months. The pill is safe and effective, although it slightly increases the risk of blood clots in the legs or lungs; this is a rare complication in young, healthy women who do not smoke, but it is more of a concern in women who are obese and in older women. This will induce a period in almost all women with PCOS, but it does not help with the cosmetic concerns (hirsutism and acne) and does not prevent pregnancy. It does reduce the risk of uterine cancer. Hair treatments — Excess hair growth on the face and/or other parts of the body can be removed by shaving or use of depilatories, electrolysis, or laser therapy. Many women worry that these treatments cause hair to grow faster, although this is not true. The first step is to prescribe an estrogen- progestin contraceptive (ie, a birth control pill). If, after six months of hormone treatment, sufficient improvement in excess hair growth has not been achieved, a second medication called spironolactone, an antiandrogen, is added. If hormone treatment with an estrogen- progestin results in a satisfactory reduction in excess hair growth, this therapy is continued. Scalp hair loss can be treated with medications in some situations. Other options include hair replacement and wigs.
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