In each menstrual cycle, follicles grow on the ovaries. Eggs develop within those follicles, one of which will reach maturity faster than the others and be released into the fallopian tubes. This is "ovulation". The remaining follicles will degenerate.

In the case of polycystic ovaries, however, the ovaries are larger than normal, and there are a series of undeveloped follicles that appear in clumps, somewhat like a bunch of grapes. Polycystic ovaries are not especially troublesome and may not even affect your fertility.

However, when the cysts cause a hormonal imbalance, a pattern of symptoms may develop. This pattern of symptoms is called a syndrome. These symptoms are the difference between suffering from polycystic ovary syndrome and from polycystic ovaries.

So you can have polycystic ovaries without having PCOS. However, nearly all women with PCOS will have polycystic ovaries. Polycystic Ovary Syndrome is the name given to a metabolic condition in which a woman will have polycystic ovaries, along with a certain pattern of other symptoms that reflect imbalances in reproductive and other hormones.

We referred to polycystic ovarian syndrome as a "metabolic" disorder. By this we mean that there are numerous factors in basic body processes that have gone awry. Because your body is a unified whole, a problem or dysfunction in one area causes dysfunction in other areas. Polycystic ovarian syndrome is a dysfunction that is related to your whole body, not just your ovaries.

"Polycystic ovary syndrome" is the name given to a metabolic condition in which a woman will have cystic ovaries, along with a certain pattern of other symptoms that reflect imbalances in reproductive and other hormones.

How Common Is PCOS?

What Causes Polycystic Ovarian Syndrome?

There is disagreement and uncertainty as to what causes polycystic ovarian disease. Polycystic ovaries and polycystic ovary syndrome have been associated with one or more of these factors:

• Genetic predisposition.
• Insulin resistance or hyperinsulinism (high blood levels of insulin).
• Obesity.
• Hyperandrogenism (excessive production of male hormones).
• Abnormality of the hypothalamic-pituitary-gonadal axis (organ/hormonal disorder).

PCOS Symptoms

Polycystic ovarian syndrome presents a complex and baffling array of symptoms, consisting of some combination of the following symptoms that vary with each individual:

• Multiple ovarian cysts
• Irregular or absent menses
• Infertility
• Acne
• Depression or mood swings. Hormonal changes are a known cause of emotional symptoms.
• Obesity or inability to lose weight
• Excessive body or facial hair (hirsutism)
• Insulin resistance and possibly diabetes
• Thinning of scalp hair
• Velvety, hyperpigmented skin folds (acanthosis nigricans)
• High blood pressure
• Polycystic ovaries that are 2-5 times larger than healthy ovaries.
• Multiple hormone imbalances, commonly including:
  • Androgens (testosterone)
  • Cortisol
  • Estrogens
  • FSH (follicle stimulating hormone)
  • Insulin.
  • LH (luteinizing hormone)
  • progesterone
  • Prolactin.
  • Thyroid hormones.

• Environmental chemical pollution (hormonal disruptors)
• Food adulterantion (excitatory amino acids, for example)
• Chronic inflammation.

Treatment of PCOS

Many physicians are not very familiar with polycystic ovarian syndrome and therefore only treat the symptom the woman complains about, without digging any deeper. The most common treatment is the prescription of birth control pills.

However, discerning physicians will notice the above constellation of symptoms and realize there is complex metabolic disorder labeled as "polycystic ovary syndrome".

Depending on the physician, the treatment may include hormonal therapy consisting of birth control pills, anti-androgen medications, and other special hormone-regulating drugs.

Because polycystic ovarian syndrome has an insulin resistance component (too much insulin required to store blood sugar), a drug called metformin (Glucophage) is becoming a routine treatment. Approved as an anti-diabetic drug, metformin acts by making insulin more efficient, thus allowing less insulin to perform the same amount of metabolic work. And, some doctors will tell the patient to lose weight.

Ovarian drilling has been helpful for some women. It is a process where between 4 and 30 tiny holes are made in a cystic ovary. Newer surgical techniques minimize previous problems of scaring and adhesions, but they remain a risk.

Rarely, if the ovarian cysts are large and causing problems, a physician may suggest surgical removal.

Conventional treatment is generally aimed at controlling symptoms and shifting levels of the various hormones that are involved in the disease. In some cases, the medical therapy must be continued indefinitely.

PCOS Is a Threat to Your Health, if Left Untreated

The long-term health consequences of polycystic ovarian syndrome may include but not be limited to:

• Cardiovascular disease.
• Diabetes
• Pregnancy-associated disorders.
• Cancers.
• Seizure disorders.

Cardiovascular disease is well recognized as part of insulin resistance syndrome, leading to endothelial dysfunction, microalbuminuria, proatherosclerotic and inflammatory factors, diabetes, dyslipidemia, and a number of other abnormalities.

Insulin resistance normally forces beta-cells in the pancreas to overwork to produce enough insulin, thus eventually leading to beta-cell exhaustion and diabetes. Evidence of inadequate beta-cell compensation is seen frequently in women with PCOS, leading to increased risk of diabetes.

40% of women with polycystic ovary disease have abnormal glucose tolerance, 10% already have type 2 diabetes, and the incidence of diabetes in adolescents with PCOS is comparable to that seen in adults.

Women with PCOS have glucose intolerance rates as high as those in the highest risk ethnic groups in the world, such as the Pima Indians. Even correcting for obesity, polycystic ovary syndrome is associated with elevated LDL "bad" cholesterol, while there is a synergistic effect of PCOS and obesity in causing chronic elevated triglycerides.

High blood pressure is commonly seen in women with both obesity and polycystic ovarian syndrome. PCOS is associated with decreased fibrinolysis, increased C-reactive protein levels, and increased carotid intimal thickness, all of which indicate cardiovascular disorders.

77% of women with abnormally infrequent or scanty menstrual flow have evidence of polycystic ovarian syndrome and 33% have abnormal glucose tolerance. Using menstrual cycle length of 40 days or more as an indicator, the Nurses' Health Study showed a 2.2-fold increase in the risk of type 2 diabetes development. The study also showed that irregular menses was associated with a 53% increase in cardiovascular disease events.

Women with PCOS have reproductive abnormalities, including increased gestational diabetes in both obese and non-obese women, pregnancy-induced hypertension, and preeclampsia. Preeclampsia is a toxic condition developing in late pregnancy that is characterized by a sudden rise in blood pressure, excessive gain in weight, generalized edema, albuminuria, severe headache, and visual disturbances.

PCOS women also have an increased endometrial cancer risk. The risk of ovarian cancer is increased 2.5-fold, particularly among women who had never used oral contraceptives. Breast cancer risk is not clearly increased with polycystic ovarian disease..