Polycystic ovary syndrome (PCOS) is not a disease in the usual sense; rather, it is a collection of symptoms that can affect a woman's reproductive health and heart health, and can have other significant effects on health and lifestyle. It affects 5% to 10% of women in their reproductive years. Its risk factors are not well known, but heredity does play a role.
Causes
The causes of PCOS are unknown. Researchers believe that insulin resistance and an imbalance of male hormones (e.g., testosterone) and female hormones (e.g., estrogens and progestins, those important for the menstrual cycle) contribute to the development of this condition.
Symptoms
There are many possible symptoms, and you can have PCOS without having all of them. Some of the common symptoms include:
acne
difficulty becoming pregnant (infertility)
irregular menstrual periods
obesity
skin discolorations
unwanted hair growth or loss
Symptoms most commonly associated with PCOS are unwanted hair growth and irregular menstrual periods. Women may have fewer menstrual periods (oligomenorrhea) or miss their periods for 6 months or more (amenorrhea).
Many women do not know they have PCOS until they try to become pregnant. Infertility is an issue for about 75% of those with PCOS. If these women do become pregnant, they are at an increased risk of miscarriage. About half of those with PCOS have acanthosis nigricans (a brown-grey skin discoloration), signifying that the body has too much insulin.
About 50% of women with PCOS are obese, and in many cases the extra body weight is centered around the abdomen. Central obesity increases the risk of developing many conditions, including:
cholesterol problems
heart disease
high blood pressure
diabetes
Regardless of their body weight, women with PCOS have an increased risk for developing these conditions.
Acne is another symptom seen by some women with PCOS. 85% of women older than age 20 who suffer from acne likely have PCOS. Loss of hair from the scalp is also possible.
Complications of PCOS can include endometrial cancer: if a woman has irregular menstrual periods for an extended time, the lining of the uterus can build up and develop cancerous cells. This may take many years to develop. Women who do not have regular periods (or any periods at all) should consult their doctor.
Treatment
Given that the cause(s) of PCOS are unknown, there is no treatment for the condition. The focus, instead, is on managing bothersome symptoms or those that increase the risk for other diseases.
A healthy diet and exercise are important parts of managing PCOS regardless of your weight. Weight loss is recommended for women with obesity; while it will not cure PCOS, it will lessen symptoms.
Medications used to manage PCOS often influence how the body uses insulin or restore the balance between male and female hormones in the body.
Oral contraceptives are used to manage many symptoms associated with PCOS for women who are not trying to become pregnant. They regulate menstrual periods and can reduce acne. Other options that affect hormone levels and are used by women not planning pregnancy include progestins and anti-androgens, for example spironolactone* and ketoconazole.
Medications that improve the body's ability to use insulin help to regulate blood sugar. Metformin, an anti-diabetes medication, is an effective treatment for infertility in many women with PCOS. Metformin can also help reduce weight, unwanted body hair, and acne. If metformin is unsuccessful for managing infertility, other hormonal options such as clomiphene or other infertility drugs may be recommended. Other medications affecting insulin that may be used for PCOS include rosiglitazone and pioglitazone.
Hair loss on the scalp may be managed with medications such as minoxidil and spironolactone. Shaving, waxing, or other hair-removal methods may be required to eliminate unwanted body hair. Acne may also be managed with medications available with or without a prescription that can be taken by mouth or applied directly to the skin.
Acanthosis nigricans may fade with the use of prescription medications applied directly to the skin. Examples include 15% urea, alpha hydroxy acid, and salicylic acid. This symptom may lessen with the use of metformin as well.
Lastly, your doctor may suggest ovarian surgery if other therapies are unsuccessful. The most common type of surgery is called ovarian drilling. During this procedure, doctors use a needle to make several tiny holes in the ovary. The surgery helps to reduce androgens (male hormones) and improve regularity of the menstrual cycle, and it may resolve fertility problems. The surgery is successful in up to 50% of women and is considered an option for women who have not been treated successfully with medication, diet, and exercise.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.
Other tips:
PCOS is a diagnosis that is made once other conditions causing similar signs and symptoms have been investigated and ruled out by your doctor.
To rule out other conditions, your doctor performs a physical examination and may order a series of laboratory tests, including:
testosterone
blood sugar
cholesterol
thyroid function
Your doctor may also ask you to have a pelvic ultrasound. This will allow your doctor to visualize your ovaries and the diagnosis of PCOS may be confirmed.
If you have PCOS, the ultrasound may show 8 to 10 cysts smaller than 10 mm in size on each ovary. These are often said to look like a string of pearls. Interestingly, these lesions are not actually cysts but the remains of ovarian follicles that did not successfully make or release an ovum (egg). However, about 20% of all women will have ovarian cysts visible on the ultrasound, so having the cysts does not necessarily mean you have PCOS.
Unfortunately Canada & our neighbours to the South have different reference ranges. Currently across Canada many labs use a range between 0.6 to 5.7 The American Association of Clinical Endocrinologist have updated standards which are 0.3 to 3.0 Finding a doctor that will acknowledge the American standards can be difficult and frustrating. However don't give up when your doctor won't listen to you. Find a new doctor. A good doctor will take in to account more than just your lab values but the way you feel as well. It took me 3 years & numerous doctors across Canada to finally be diagnosed with Hashimotos Thyroiditis. If I would have listened to the first doctor that told me I didn't know what I was talking about...I would still have numerous unexplained symptoms and it would make me another Canadian not in control of my health. Since some Thyroid conditions/symptoms can mimic those of PCOS it is important that your physician do thorough testing.
Be sure to check out the SoulCysters forum dedicated toHypothyroidism
____ I have a family history of thyroid disease ____ I have had my thyroid "monitored" in the past to watch for changes ____ I had a previous diagnosis of goiters/nodules ____ I currently have a goiter ____ I was treated for hypothyroidism in the past ____ I had post-partum thyroiditis in the past ____ I had a temporary thyroiditis in the past ____ I have another autoimmune disease ____ I have had a baby in the past nine months ____ I have a history of miscarriage ____ I have had part/all of my thyroid removed due to cancer ____ I have had part/all of my thyroid removed due to nodules ____ I have had part/all of my thyroid removed due to Graves' Disease/hyperthyroidism ____ I have had radioactive iodine due to Graves' Disease/hyperthyroidism ____ I have had anti-thyroid drugs due to Graves' Disease/hyperthyroidism
I have the following symptoms of hypothyroidism, as detailed by the Merck Manual, the American Association of Clinical Endocrinologists, and the Thyroid Foundation of America
____ I am gaining weight inappropriately ____ I'm unable to lose weight with diet/exercise ____ I am constipated, sometimes severely ____ I have hypothermia/low body temperature (I feel cold when others feel hot, I need extra sweaters, etc.) ____ I feel fatigued, exhausted ____ Feeling run down, sluggish, lethargic ____ My hair is coarse and dry, breaking, brittle, falling out ____ My skin is coarse, dry, scaly, and thick ____ I have a hoarse or gravely voice ____ I have puffiness and swelling around the eyes and face ____ I have pains, aches in joints, hands and feet ____ I have developed carpal-tunnel syndrome, or it's getting worse ____ I am having irregular menstrual cycles (longer, or heavier, or more frequent) ____ I am having trouble conceiving a baby ____ I feel depressed ____ I feel restless ____ My moods change easily ____ I have feelings of worthlessness ____ I have difficulty concentrating ____ I have more feelings of sadness ____ I seem to be losing interest in normal daily activities ____ I'm more forgetful lately
I also have the following additional symptoms, which have been reported more frequently in people with hypothyroidism:
____ My hair is falling out ____ I can't seem to remember things ____ I have no sex drive ____ I am getting more frequent infections, that last longer ____ I'm snoring more lately ____ I have/may have sleep apnea ____ I feel shortness of breath and tightness in the chest ____ I feel the need to yawn to get oxygen ____ My eyes feel gritty and dry ____ My eyes feel sensitive to light ____ My eyes get jumpy/tics in eyes, which makes me dizzy/vertigo and have headaches ____ I have strange feelings in neck or throat ____ I have tinnitus (ringing in ears) ____ I get recurrent sinus infections ____ I have vertigo ____ I feel some lightheadedness ____ I have severe menstrual cramps
This is a must visit link! It's amazing how many things that are recalled and yet so few people are aware of these recalls. Please make sure to forward this link to family & friends. 2007 Recall, warning & advisory list
For those of you looking for reviews of physicians, don't forget to check out this site. Although it is views of people without PCOS, it can still give you a good idea what a doctor is like. Don't forget to share your experiences and hopefully help others avoid dealing with doctors that are less than pleasurable to work with.
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A free service offered that allows you direct access to a dietitian to answer all your diet type questions. Many differest programs available and they can accomodate 130 different languages with their trasnlation services. Check out their website for more information.
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Ontario Government acknowledges PCOS! 
Worldwide PCOS awareness petition! 
Canadian Obesity Network 
PCOS News from Dr. Sheila Laredo 
Canadians with hypothyroidism 
Health Canada Advisories, Warnings & Recalls 
