Polycystic Ovaries
Disease Details
Family Health Simplified
- Description
- Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age, characterized by irregular menstrual periods, excess androgen levels, and polycystic ovaries.
- Type
- Polycystic ovary syndrome (PCOS) is a complex endocrine disorder. The inheritance pattern is not fully understood, but it is considered to have a multifactorial genetic transmission, involving multiple genes and environmental factors.
- Signs And Symptoms
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Signs and symptoms of PCOS include irregular or no menstrual periods, heavy periods, excess body and facial hair, acne, pelvic pain, difficulty getting pregnant, and patches of thick, darker, velvety skin, ovarian cysts, enlarged ovaries, excess androgen, and weight gain.Associated conditions include type 2 diabetes, obesity, obstructive sleep apnea, heart disease, mood disorders, and endometrial cancer.
Common signs and symptoms of PCOS include the following:
Menstrual disorders: PCOS mostly produces oligomenorrhea (fewer than nine menstrual periods in a year) or amenorrhea (no menstrual periods for three or more consecutive months), but other types of menstrual disorders may also occur.
Infertility: This generally results directly from chronic anovulation (lack of ovulation).
High levels of masculinizing hormones: Known as hyperandrogenism, the most common signs are acne and hirsutism (male pattern of hair growth, such as on the chin or chest), but it may produce hypermenorrhea (heavy and prolonged menstrual periods), androgenic alopecia (increased hair thinning or diffuse hair loss), or other symptoms. Approximately three-quarters of women with PCOS (by the diagnostic criteria of NIH/NICHD 1990) have evidence of hyperandrogenemia.
Metabolic syndrome: This appears as a tendency towards central obesity and other symptoms associated with insulin resistance, including low energy levels and food cravings. Serum insulin, insulin resistance, and homocysteine levels are higher in women with PCOS.
Acne: A rise in testosterone levels, increases the oil production within the sebaceous glands and clogs pores. For many people, the emotional impact is great and quality of life can be significantly reduced.
Androgenic Alopecia: Estimates suggest that androgenic alopecia affects 22% of PCOS sufferers. This is a result of high testosterone levels that are converted into the dihydrotestosterone (DHT) hormone. Hair follicles become clogged, making hair fall out and preventing further growth.
Acanthosis Nigricans (AN): A skin condition where dark, thick and "velvety" patches can form. (p. 141)
Polycystic ovaries: PCOS is a complicated disorder characterized by high androgen levels, irregular menstruation, and/or small cysts on one or both ovaries. Ovaries might get enlarged and comprise follicles surrounding the eggs. As result, ovaries might fail to function regularly. This disease is related to the number of follicles per ovary each month growing from the average range of 6-8 to double, triple or more. Women with PCOS have higher risk of multiple diseases including Infertility, type 2 diabetes mellitus (DM-2), cardiovascular risk, metabolic syndrome, obesity, impaired glucose tolerance, depression, obstructive sleep apnea (OSA), endometrial cancer, and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH).Women with PCOS tend to have central obesity, but studies are conflicting as to whether visceral and subcutaneous abdominal fat is increased, unchanged, or decreased in women with PCOS relative to non-PCOS women with the same body mass index. In any case, androgens, such as testosterone, androstanolone (dihydrotestosterone), and nandrolone decanoate have been found to increase visceral fat deposition in both female animals and women.Although 80% of PCOS presents in women with obesity, 20% of women diagnosed with the disease are non-obese or "lean" women. However, obese women that have PCOS have a higher risk of adverse outcomes, such as hypertension, insulin resistance, metabolic syndrome, and endometrial hyperplasia.Even though most women with PCOS are overweight or obese, it is important to acknowledge that non-overweight women can also be diagnosed with PCOS. Up to 30% of women diagnosed with PCOS maintain a normal weight before and after diagnosis. "Lean" women still face the various symptoms of PCOS with the added challenges of having their symptoms properly addressed and recognized. Lean women often go undiagnosed for years, and usually are diagnosed after struggles to conceive. Lean women are likely to have a missed diagnosis of diabetes and cardiovascular disease. These women also have an increased risk of developing insulin resistance, despite not being overweight. Lean women are often taken less seriously with their diagnosis of PCOS, and also face challenges finding appropriate treatment options. This is because most treatment options are limited to approaches of losing weight and healthy dieting. - Prognosis
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Polycystic ovary syndrome (PCOS) is a chronic condition often characterized by hormonal imbalances, irregular menstrual cycles, and the development of multiple small cysts on the ovaries.
Prognosis: The long-term outlook for individuals with PCOS varies but generally involves managing symptoms rather than curing the condition. With appropriate lifestyle changes and medical treatment, many women can effectively manage symptoms and reduce associated health risks such as type 2 diabetes, heart disease, and infertility. Early diagnosis and treatment can improve the quality of life and reduce complications. Long-term monitoring and personalized treatment plans are essential for optimal management. - Onset
- Polycystic ovary syndrome (PCOS) typically begins during a woman's reproductive years, often emerging in the late teens to early 20s. It is characterized by a range of symptoms, including irregular menstrual cycles, excessive hair growth, acne, and obesity. The exact cause of PCOS is unknown, but it is associated with hormonal imbalances, including elevated levels of androgens and insulin. Early diagnosis and treatment can help manage symptoms and reduce the risk of complications such as type 2 diabetes and cardiovascular disease.
- Prevalence
- Polycystic ovary syndrome (PCOS) is a common endocrine disorder among women of reproductive age. The prevalence of PCOS varies depending on the diagnostic criteria used, but it is generally estimated to affect between 5% to 15% of women within this age group.
- Epidemiology
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PCOS is the most common endocrine disorder among women between the ages of 18 and 44. It affects approximately 2% to 20% of this age group depending on how it is defined. When someone is infertile due to lack of ovulation, PCOS is the most common cause and could guide to patients' diagnosis. The earliest known description of what is now recognized as PCOS dates from 1721 in Italy.
The prevalence of PCOS depends on the choice of diagnostic criteria. The World Health Organization estimates that it affects 116 million women worldwide as of 2010 (3.4% of women). Another estimate indicates that 7% of women of reproductive age are affected. Another study using the Rotterdam criteria found that about 18% of women had PCOS, and that 70% of them were previously undiagnosed. Prevalence also varies across countries due to lack of large-scale scientific studies; India, for example, has a purported rate of 1 in 5 women having PCOS.There are few studies that have investigated the racial differences in cardiometabolic factors in women with PCOS. There is also limited data on the racial differences in the risk of metabolic syndrome and cardiovascular disease in adolescents and young adults with PCOS. The first study to comprehensively examine racial differences discovered notable racial differences in risk factors for cardiovascular disease. African American women were found to be significantly more obese, with a significantly higher prevalence of metabolic syndrome compared to white adult women with PCOS. It is important for the further research of racial differences among women with PCOS, to ensure that every woman that is affected by PCOS has the available resources for management.Ultrasonographic findings of polycystic ovaries are found in 8–25% of women non-affected by the syndrome. 14% women on oral contraceptives are found to have polycystic ovaries. Ovarian cysts are also a common side effect of levonorgestrel-releasing intrauterine devices (IUDs).There are few studies that have investigated the racial differences in cardiometabolic factors in women with PCOS. - Intractability
- Polycystic ovary syndrome (PCOS) is not considered intractable, but it is a chronic condition. While there is no cure, symptoms can be managed effectively through lifestyle changes, medications, and other treatments. The approach to management often includes weight loss, diet modifications, exercise, and medications like oral contraceptives or insulin-sensitizing drugs to regulate menstrual cycles, reduce symptoms, and address any metabolic issues. Treatment plans are typically individualized based on the patient's symptoms and health goals.
- Disease Severity
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Polycystic Ovary Syndrome (PCOS) is a condition with varying degrees of severity among individuals. Disease severity can range from mild symptoms to more severe complications. Nan, or not applicable, is not relevant to describing the severity of PCOS. Instead, focus on the specific symptoms and complications, which can include:
- Irregular menstrual cycles
- Excessive hair growth (hirsutism)
- Acne
- Obesity
- Infertility
- Increased risk for type 2 diabetes, high cholesterol, high blood pressure, and heart disease
The severity often depends on how many and which symptoms are present, as well as the individual’s response to treatment. Regular medical follow-up is important to manage and mitigate these risks. - Healthcare Professionals
- Disease Ontology ID - DOID:11612
- Pathophysiology
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The pathophysiology of polycystic ovary syndrome (PCOS) involves a complex interplay of hormonal imbalances and metabolic issues. Key components include:
1. **Hormonal Imbalance:**
- **Increased Androgens:** Elevated levels of male hormones, such as testosterone, lead to symptoms like hirsutism (excess hair growth), acne, and anovulation (lack of ovulation).
- **Insulin Resistance:** Many women with PCOS have insulin resistance, leading to higher insulin levels, which can exacerbate androgen production from the ovaries and adrenal glands.
2. **Ovarian Dysfunction:**
- **Follicular Development:** There is impaired follicular development, leading to the formation of multiple small, fluid-filled sacs (cysts) in the ovaries.
- **Anovulation:** The lack of regular ovulation results in irregular menstrual cycles and potential infertility.
3. **Metabolic Issues:**
- **Obesity:** Often, but not always, associated with PCOS and contributes to insulin resistance.
- **Lipid Abnormalities:** Increased risk of dyslipidemia, characterized by elevated levels of cholesterol and triglycerides.
The exact cause of PCOS is still not fully understood, but it likely involves a combination of genetic, environmental, and lifestyle factors. - Carrier Status
- Polycystic ovary syndrome (PCOS) is not traditionally associated with a "carrier status" as it is not a single-gene inherited condition. Instead, it is a complex disorder influenced by multiple genetic and environmental factors.
- Mechanism
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Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age.
**Mechanism:**
PCOS is characterized by a combination of symptoms including irregular menstrual cycles, hyperandrogenism (elevated levels of male hormones), and polycystic ovaries. The precise cause of PCOS is not fully understood, but it is believed to involve a combination of genetic, hormonal, and environmental factors. Key features often include insulin resistance, elevated luteinizing hormone (LH) levels, low follicle-stimulating hormone (FSH) levels, and an imbalance in androgen and estrogen production.
**Molecular Mechanisms:**
1. **Insulin Resistance:** Many women with PCOS exhibit insulin resistance, which leads to hyperinsulinemia. Elevated insulin levels can exacerbate hyperandrogenism by stimulating the ovaries to produce more androgens and by decreasing the production of sex hormone-binding globulin (SHBG), which increases free testosterone levels.
2. **Hyperandrogenism:** Increased androgen levels are a hallmark of PCOS. Androgens are produced in excess by the ovaries (and sometimes the adrenal glands), which disrupts normal follicular development, leading to anovulation (lack of ovulation) and the formation of ovarian cysts.
3. **LH/FSH Imbalance:** In PCOS, the hypothalamic-pituitary-gonadal axis is often disrupted, resulting in an abnormal ratio of LH to FSH. Elevated LH levels stimulate the theca cells in the ovaries to produce more androgens, while relatively low FSH levels are insufficient to support proper follicular development.
4. **Inflammation and Genetic Factors:** Chronic low-grade inflammation is often observed in PCOS, possibly linked to elevated cytokine levels. Genetic predisposition also plays a role, as there are multiple genes associated with insulin resistance, steroidogenesis, and gonadotropin action that have been implicated in PCOS.
Understanding these mechanisms helps in developing targeted treatments for managing PCOS, including lifestyle changes, insulin-sensitizing drugs, and hormonal therapies to restore normal ovulatory cycles and reduce androgen levels. - Treatment
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Treatment for polycystic ovary syndrome (PCOS) often includes lifestyle changes and medication.
1. **Lifestyle Changes**:
- **Diet and Exercise**: Weight loss through a healthy diet and regular physical activity can help regulate menstrual cycles and improve insulin sensitivity.
- **Weight Management**: Even a modest reduction in weight can alleviate symptoms.
2. **Medications**:
- **Hormonal Birth Control**: Combination pills, patches, or rings that contain estrogen and progestin can regulate menstrual cycles and reduce androgen levels.
- **Metformin**: Often used to treat type 2 diabetes, this medication can help improve insulin resistance and reduce insulin levels.
- **Clomiphene**: A fertility drug used to stimulate ovulation, beneficial for those trying to conceive.
- **Anti-Androgens**: Medications like spironolactone can reduce androgen levels to improve symptoms like excessive hair growth and acne.
- **Other Medications**: Eflornithine for facial hair, and medications to manage symptoms such as acne.
It's important to consult with a healthcare provider for a tailored treatment plan. - Compassionate Use Treatment
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Compassionate use treatment allows patients with serious or life-threatening conditions to access investigational drugs outside of clinical trials. For polycystic ovary syndrome (PCOS), several treatments are being explored or used off-label.
1. **Inositol supplements:** Myo-inositol and D-chiro-inositol are used off-label for improving insulin sensitivity and potentially aiding in ovulation.
2. **Metformin:** Primarily a diabetes drug, it is used off-label to address insulin resistance associated with PCOS, improving menstrual regularity and ovulation.
3. **Letrozole:** A drug approved for breast cancer, it is used off-label as an ovulation induction agent in women with PCOS.
4. **Clomiphene Citrate (Clomid):** Although it is not experimental, it is often used off-label for inducing ovulation in women with PCOS.
5. **Liraglutide:** Primarily used for type 2 diabetes, it's being examined for weight loss and metabolic improvements in women with PCOS.
These treatments are explored for their potential benefits in managing symptoms and improving fertility for women with PCOS. Always consult a healthcare provider for personalized advice and treatment plans. - Lifestyle Recommendations
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For polycystic ovary syndrome (PCOS), lifestyle recommendations include:
1. **Healthy Diet**: A balanced diet rich in whole foods, such as fruits, vegetables, whole grains, and lean proteins, can help manage insulin levels and reduce symptoms. Low-glycemic index foods can be particularly beneficial.
2. **Regular Exercise**: Regular physical activity can help with weight management and improve insulin sensitivity. Aim for at least 150 minutes of moderate aerobic exercise or 75 minutes of vigorous exercise per week, along with strength training twice a week.
3. **Weight Management**: Maintaining a healthy weight can help regulate menstrual cycles and improve insulin resistance.
4. **Stress Reduction**: Techniques such as yoga, meditation, and deep-breathing exercises can help manage stress, which is important for hormonal balance.
5. **Sleep Hygiene**: Ensure you get adequate and quality sleep, ideally 7-9 hours per night. Poor sleep can exacerbate hormonal imbalances.
6. **Avoid Smoking**: Smoking can exacerbate insulin resistance and increase cardiovascular risk in women with PCOS.
Implementing these lifestyle changes can significantly help in managing the symptoms of PCOS and improve overall health. - Medication
- Medications for PCOS include oral contraceptives and metformin. The oral contraceptives increase sex hormone binding globulin production, which increases binding of free testosterone. This reduces the symptoms of hirsutism caused by high testosterone and regulates return to normal menstrual periods. Anti-androgens such as finasteride, flutamide, spironolactone, and bicalutamide do not show advantages over oral contraceptives, but could be an option for people who do not tolerate them. Finasteride is the only oral medication for the treatment of androgenic alopecia, that is FDA approved.Metformin is a medication commonly used in type 2 diabetes mellitus to reduce insulin resistance, and is used off label (in the UK, US, AU and EU) to treat insulin resistance seen in PCOS. In many cases, metformin also supports ovarian function and return to normal ovulation. A newer insulin resistance medication class, the thiazolidinediones (glitazones), have shown equivalent efficacy to metformin, but metformin has a more favorable side effect profile. The United Kingdom's National Institute for Health and Clinical Excellence recommended in 2004 that women with PCOS and a body mass index above 25 be given metformin when other therapy has failed to produce results. Metformin may not be effective in every type of PCOS, and therefore there is some disagreement about whether it should be used as a general first line therapy. In addition to this, metformin is associated with several unpleasant side effects: including abdominal pain, metallic taste in the mouth, diarrhoea and vomiting. Metformin is thought to be safe to use during pregnancy (pregnancy category B in the US). A review in 2014 concluded that the use of metformin does not increase the risk of major birth defects in women treated with metformin during the first trimester. Liraglutide may reduce weight and waist circumference in people with PCOS more than other medications. The use of statins in the management of underlying metabolic syndrome remains unclear.It can be difficult to become pregnant with PCOS because it causes irregular ovulation. Medications to induce fertility when trying to conceive include the ovulation inducer clomiphene or pulsatile leuprorelin. Evidence from randomised controlled trials suggests that in terms of live birth, metformin may be better than placebo, and metform plus clomiphene may be better than clomiphene alone, but that in both cases women may be more likely to experience gastrointestinal side effects with metformin.
- Repurposable Drugs
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Several repurposable drugs have been investigated for the treatment of Polycystic Ovary Syndrome (PCOS). These include:
1. **Metformin** - traditionally used for Type 2 diabetes, it improves insulin sensitivity and can help regulate menstrual cycles and reduce androgen levels.
2. **Letrozole** - an aromatase inhibitor primarily used in breast cancer treatment, it is effective for inducing ovulation.
3. **Spironolactone** - a diuretic used for heart failure and hypertension, it has anti-androgen effects which can help reduce symptoms like hirsutism and acne.
4. **Pioglitazone** - another insulin sensitizer originally for Type 2 diabetes, it can improve ovulatory function and reduce insulin resistance.
5. **Statins (e.g., Atorvastatin)** - primarily for high cholesterol, may help reduce inflammation and improve androgen levels when used alongside other treatments.
Repurposing these drugs offers potential benefits for managing various symptoms of PCOS, although individual responses and side effects can vary. - Metabolites
- There's no standard information available for "nan" in relation to metabolites for polycystic ovary syndrome (PCOS). However, common metabolites studied in PCOS include insulin, androgens like testosterone, and metabolic markers such as glucose and lipid profiles. Elevated insulin levels and insulin resistance are particularly notable in PCOS, contributing to its metabolic disturbances.
- Nutraceuticals
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Polycystic Ovary Syndrome (PCOS) is a hormonal disorder common among women of reproductive age. For management of PCOS, some nutraceuticals have been explored for their potential benefits:
- **Inositol:** Particularly myo-inositol and D-chiro-inositol, which can help improve insulin sensitivity and ovulatory function.
- **Omega-3 Fatty Acids:** These can help reduce inflammation and improve lipid profiles.
- **Vitamin D:** Often recommended since many women with PCOS have vitamin D deficiency, which might impact insulin resistance and androgen levels.
- **N-acetylcysteine (NAC):** Known to improve insulin sensitivity and reduce androgen levels.
- **Chromium:** It may enhance insulin sensitivity.
- **Cinnamon:** Some evidence suggests it can improve menstrual cyclicity and insulin sensitivity.
"Nan" is not clear in this context. If it refers to a specific nanotechnology application in PCOS, there are emerging studies investigating the use of nanotechnology for targeted drug delivery and improving the bioavailability of treatments. However, these are still largely in the experimental stages. - Peptides
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Polycystic Ovary Syndrome (PCOS) is a hormonal disorder affecting women of reproductive age. Peptides, short chains of amino acids, have been studied in relation to PCOS for their potential roles in metabolic and reproductive processes. However, research specific to their direct therapeutic application in PCOS is still limited.
Nanotechnology (nan) holds promise for improving the diagnosis and treatment of PCOS. Nanoparticles can enhance the delivery of drugs to target tissues, potentially offering more effective management strategies for symptoms and underlying metabolic issues associated with PCOS.