My boss's brother is a doctor in Oregon and sent this to her to give to me. I thought I would pass it along. Most of it is stuff we've all heard before, but I thought it gave a great overview.
Polycystic Ovary Syndrome (PCOS)
Cause
The cause of PCOS is not fully known, but genetics may be a factor. Sisters and daughters of a woman with PCOS may have a 50% chance of developing PCOS.
Polycystic ovary syndrome occurs when a hormone imbalance interferes with normal ovulation. Ovarian cysts occur as a result of the normal functioning of the ovaries, but normal cysts usually go away with each menstrual cycle. In PCOS, the ovary becomes enlarged and usually develops many cysts (polycystic) that do not go away with each menstrual cycle. A polycystic ovary may be up to three times larger than normal. Over 90% of women with PCOS have cysts on their ovaries at some time.
Research has also found that when a woman does not ovulate normally for any length of time, polycystic ovaries result. Abnormal insulin production and metabolism may also affect the development of PCOS.
Symptoms
Symptoms of polycystic ovary syndrome (PCOS) that you may notice quickly include:
· Fewer than eight menstrual cycles in a year, cycles longer than 35 days apart, or no menstrual periods. This means you have limited or no ovulation occurring each month. This common symptom occurs in almost 50% of women with PCOS.
· Abnormal vaginal bleeding. This symptom occurs in about 30% of women with PCOS.
· Irregular menstrual cycles.
· Excess hair growth (hirsutism) on the face, chest, back, stomach, thumbs, or toes. Over 70% of women with PCOS complain of excess hair growth.
· Skin problems, such as acne, oily skin, dandruff, dark skin patches on the neck, groin, underarms, or in skin folds, or skin tags (acrochordons) in the armpits or neck area.
· Depression or mood swings. Many women may have emotional problems related to the many physical symptoms of PCOS, such as excess hair, obesity, infertility, or male characteristics.
Symptoms that may develop gradually over time include:
· Pelvic pain for longer than 6 months.
· Weight gain or upper body obesity (more abdominal fat than hip fat). This is also known as android obesity and is related to increased male hormone (testosterone) levels that cause male characteristics, such as excess hair growth.
· Miscarriages or infertility.
· Symptoms of diabetes or insulin resistance. The risk of developing diabetes is five times greater in women with PCOS than in women without ovulatory problems. These women will also develop diabetes at a younger age.
· High blood pressure (hypertension).
· Male pattern baldness or thinning hair (alopecia).
Symptoms of PCOS may start gradually and at first may be related to some other medical problem. You may have a few symptoms or many symptoms. Women with PCOS seek medical care for a specific symptom:
· Infertility (74% of the time)
· Menstrual problems (70%)
· Excess hair growth (hirsutism) (69%)
· Obesity (41%)
What Happens
Polycystic ovary syndrome (PCOS) occurs when a hormone imbalance interferes with normal ovulation. Irregular or absent ovulation causes symptoms of PCOS to develop. Abnormal insulin production and metabolism may also affect the development of PCOS.
Studies have shown that having PCOS may increase the risk of developing other conditions or diseases over time, such as:
· Reproductive problems, such as miscarriage, infertility, endometrial hyperplasia, or endometrial cancer.
· Metabolic problems, such as insulin resistance, gestational diabetes, metabolic syndrome, type 2 diabetes, or obesity.
· Cardiovascular problems, such as high blood pressure, heart disease, high cholesterol, and atherosclerosis.
Other conditions that have symptoms similar to PCOS include:
· High prolactin hormone levels.
· Excess adrenal hormones present from birth (congenital adrenal hyperplasia).
· Cushing's syndrome.
· Tumors of the ovary or adrenal gland that produce male hormones.
· Thyroid problems.
· Eating disorders.
Women with PCOS may have more regular menstrual cycles as they near menopause. The reason for this is not known. However, these older women may still have an increased risk of high blood pressure (hypertension), heart disease, diabetes, or endometrial cancer.
What Increases Your Risk
The main risk factor for PCOS is a family history of PCOS. Sisters and daughters of a woman with PCOS may have a 50% chance of developing PCOS.
When to Call a Doctor
Polycystic ovary syndrome (PCOS) is a chronic condition, so many symptoms may start gradually and initially thought to be related to some other medical problem.
PCOS has a wide range of symptoms, so it may be difficult to determine when to see your health professional. Your health professional should evaluate any of the following problems:
· A teenage girl who has not started menstruating by age 16 or within 2 years of breast and genital hair developing
· A teenage girl with fewer than eight menstrual cycles that continue 2 years after menstruation begins
· A teenage girl with cycles that are longer than 40 days apart that continue 6 months after menstruation begins
· A teenage girl or woman with severe acne
· A teenage girl or woman with excessive hair growth or hair growing in places, such as the chest, back, or face, that is more usual for men
· A teenage girl or woman with menstrual cycles consistently longer than 35 days or under 26 days apart
· A teenage girl or woman with any symptoms of hypoglycemia
· A woman with regular menstrual cycles who has been trying to become pregnant for over 6 months
Early diagnosis may prevent long-term complications, such as diabetes.
Watchful Waiting
When several symptoms of PCOS are present, it is important to be evaluated for PCOS. Many of the symptoms of PCOS appear gradually over time and may be thought to be caused by some other medical problem. Watchful waiting is not appropriate when PCOS is suspected. Early diagnosis and treatment may help prevent future complications such as reproductive, metabolic, or cardiovascular problems.
Who to See
The following health professionals can diagnose and treat PCOS:
· Gynecologist
· Obstetrician
· Family practitioner
· Naturopath
· Nurse practitioner
· Physician's assistant
· Endocrinologist
· Reproductive endocrinologist
Exams and Tests
If you are not pregnant or breast-feeding and have less than eight menstrual cycles in a year, an evaluation for polycystic ovary syndrome (PCOS) or other hormonal problems is needed. PCOS has such a wide range of symptoms that no single test can be used to diagnose the syndrome. Several exams and tests to diagnose PCOS may be done, depending on your symptoms.
These include:
· A medical and family history. Your medical history will include questions about your lifestyle, including what you eat, how you exercise, and how you deal with stress.
· A physical exam, including a pelvic exam.
· A urine pregnancy test to detect an elevated level of the female hormone human chorionic gonadotropin, hCG.
· Blood tests for:
- A chemistry screen that measures the levels of several substances, such as electrolytes levels.
-Human chorionic gonadotropin (hCG), to confirm or rule out pregnancy.
-Abnormal lipid levels, such as cholesterol and triglycerides.
-Abnormal female hormone levels, such as luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
-Glucose levels.
-Adrenal gland hormones, such as dehydroepiandrosterone sulfate (DHEA-S).
Other tests may include:
· Insulin levels.
· Male hormone (testosterone) level testing.
· Prolactin level testing.
· Thyroid tests.
· Transvaginal ultrasound. A PCOS ovary is usually enlarged and has eight or more cysts that appear in a stringlike pattern, like a necklace. Over 90% of women with PCOS will have cysts on their ovaries at some time. However, studies have shown that 8% to 25% of women without PCOS may have ultrasound findings of polycystic ovaries; so, while ultrasound may be useful to confirm the diagnosis of PCOS, it is not used as the only medical test for PCOS.
Additional tests might also be done to determine if other conditions, such as adrenal gland tumors, that have symptoms similar to PCOS might be present.
Regular follow-up testing for women who have PCOS
If you have been diagnosed with PCOS, you will need yearly tests to determine your insulin, glucose, cholesterol, and triglyceride levels. Regular testing will help you and your health professional reduce the risk of any long-term complications.
Early Detection
There is no screening test for PCOS
Treatment Overview
Treatment focuses on managing PCOS symptoms and preventing long-term complications. There is no specific cure for PCOS.
Treatment includes measures to:
· Regulate ovulation and menstrual cycles.
· Support lifestyle changes for weight control.
· Reduce levels of male hormones.
· Protect the endometrium from problems related to the lining of the uterus not being shed with regular menstrual cycles.
· Lower the risk for heart disease.
· Lower the risk for diabetes.
Treatment also depends on what symptoms you are having.
· Treatment for irregular menstrual bleeding or absent menstrual cycles is usually oral contraceptive (OC) therapy (birth control pills). If you are unable to use OCs, progestin pills will likely be recommended for the first 10 days of the month so the endometrial lining will be shed similar to a menstrual period.
· Treatment for infertility will focus on inducing regular ovulation cycles. This may include fertility medications. Studies have shown that 80% of women with PCOS who can have regular cycles successfully become pregnant within a year.
· Treatment for infertility with insulin problems will focus on weight loss and insulin-sensitizing medications, which may help fertility without using fertility medications.
· Treatment options if you are over age 35, do not desire continued fertility, and have increased male hormone levels may include removal of the ovaries or uterus (bilateral salpingo-oophorectomy or hysterectomy). Surgery also has risks and complications. Research has not established a clear reason to have a hysterectomy for PCOS.
· Treatment for obesity will focus on diet, exercise, and weight loss medications.
· Treatment for excess hair growth (hirsutism) may include medications or physical hair removal.
· Treatment for acne may include nonprescription or prescription skin (topical) or oral medications.
Women with emotional problems related to their condition may also need treatment for these symptoms.
What to Think About
Treatment focuses on managing PCOS symptoms and preventing long-term complications. There is no specific cure for PCOS.
The physical changes and reproductive problems of PCOS can affect your body image. This altered body image can increase your risk for stress, depression, and making unhealthy lifestyle choices. Treatment for these symptoms may also be needed.
Any teenage girl with menstrual problems that continue 2 years after menstruation begins may need to be evaluated early for PCOS. Early diagnosis may prevent long term complications, such as diabetes.
Treatment for skin tags is not needed unless they are irritating, such as on an eyelid. Generally they can be easily removed by your health professional.
Prevention
There are no preventive measures for polycystic ovary syndrome (PCOS). However, if you have a family history of PCOS, early diagnosis and treatment may help relieve symptoms.
Home Treatment
Home treatment measures for PCOS include diet and exercise. It is not possible to treat the ovarian cysts with home treatment, but controlling your weight and eating a balanced diet can help reduce the risk of diabetes and high cholesterol.
· Lose weight.
· Exercise.
· Eat a balanced diet.
Medications
Treatment for polycystic ovary syndrome (PCOS) focuses on ovulation or insulin sensitivity or both. Medication treatment for PCOS will depend on your symptoms and your desire for fertility.
Medication Choices
Medications to treat reproductive or metabolic problems of PCOS
· Birth control pills (low dose oral contraceptives). Birth control pills may also reduce male hormone levels, which would then reduce acne problems and excess hair growth.
· Clomiphene citrate (Clomid, Serophene) (fertility medications)
· Metformin (Glucophage). Studies have shown that this medication can be effective in reducing metabolic problems and male hormone levels in PCOS and thus help regular menstrual cycles return. The effectiveness of this medication may be increased by any weight loss occurring at the same time.
Medications to Treat Excess Hair Growth
Medications to treat excess hair growth (hirsutism), such as spironolactone (Aldactone), may be recommended. This would be an unlabeled use of spironolactone.
Some medications to treat hirsutism may increase your risk for metabolic problems, so it is important to discuss medication side effects with your health professional.
Vaniqa is a skin cream (topical) that reduces hair growth. It is helpful in many women with PCOS but hair growth will start again if the medication is stopped.
Medications for Acne
Treatment for acne may include nonprescription or prescription skin (topical) or oral medications. See the topic Acne in Related Information.
What to Think About
Treatment focuses on managing PCOS symptoms and preventing long-term complications. There is no specific cure for PCOS.
Women with PCOS who become pregnant may have an increased risk for developing gestational diabetes during the pregnancy. For more information, see the topic Gestational Diabetes in Related Information.
Surgery
Surgical treatment for polycystic ovary syndrome (PCOS) may include:
· Removing part of the ovary and stimulating ovulation.
· Removing the ovaries if fertility is no longer desired.
Surgery Choices
· Laparoscopic ovarian drilling
· Bilateral salpingo-oophorectomy and hysterectomy
What to Think About
Treatment focuses on managing PCOS symptoms and preventing long-term complications. There is no specific cure for PCOS. Surgery for PCOS may be recommended only for women who have not responded to any other treatment for PCOS.
A hysterectomy with or without a bilateral salpingo-oophorectomy may be an option for some women, but studies have not shown that this specific treatment relieves the symptoms of PCOS. The cause of PCOS is related to both hormone and metabolic problems that may not be helped by removing the reproductive organs.
Other Treatment
Treatment for excess hair growth (hirsutism) may include:
· Electrolysis, in which hair is permanently removed by electric current applied to the hair root.
· Depilatories, chemical hair removal products applied to the skin.
· Waxing, which pulls the hair out by the root.
· Shaving.
· Tweezing.
· Bleaching.
Hair removal methods differ in cost and long-term effectiveness. Some methods have an increased risk of infection.
Other Places to Get Help
On-line
Polycystic Ovary Syndrome
PCOS-Doctors.com
Web Address:
http://www.pcos-doctors.com/IE/index.html
This University of Alabama at Birmingham (USA) web site provides information regarding androgen excess disorders and the Polycystic Ovary Syndrome (PCOS). On this site you will find information about the PCOS, and its signs, symptoms, diagnosis, and treatment. A glossary of useful terms, a number of Frequently Asked Questions (FAQs), and useful Web links are also included. Finally, information about the PCOS-Doctors.Com team and what research studies are available is listed.
Organization
National Women's Health Information Center
8550 Arlington Boulevard
Suite 300
Fairfax, VA 22031
Phone: 1-800-994-WOMAN (1-800-994-9662) 9 a.m. to 6 p.m. Monday through Friday (excluding U.S. federal holidays)
TDD: 1-888-220-5446
E-mail:
4woman@soza.com
Web Address:
http://www.4woman.gov
The National Women's Health Information Center (NWHIC) is a service of the U.S. Public Health Service's Office on Women's Health. NWHIC provides relevant women's health information (including information on insomnia and sleep disorders) to a variety of audiences, such as consumers, health professionals, and researchers.
American College of Obstetricians and Gynecologists (ACOG)
409 12th Street, S.W.
Washington, DC 20024-2188
Phone: 1-800-673-8444
Web Address:
http://www.acog.org
The ACOG Resource Center publishes manuals and patient education materials. The ACOG Web site contains information on many health topics, including quitting smoking.
Polycystic Ovarian Syndrome Association, Inc.
P.O. Box 80517
Portland, Oregon 97280
Phone: (877) 775–PCOS (7267)
E-mail:
info@pcosupport.org
Web Address:
http://www.pcosupport.org
This organization (PCOSA) provides a central and comprehensive set of resources for information on polycystic ovary syndrome (PCOS). PCOSA also provides an advocacy network, including social support, for women with PCOS and their families.
International Council on Infertility Information Dissemination
P.O. Box 6836
Arlington, Virginia 22206
Phone: (703) 379-9178
E-mail:
inciidinfo@inciid.org
Web Address:
http://www.inciid.org/
The International Council on Infertility Information Dissemination (INCIID---pronounced "inside") is a nonprofit consumer advocacy organization dedicated to helping couples explore their family-building options.
Great overview on PCOS . . . 
Thank you 
