The material within represents an opinion offered by Dr. Thatcher alone for the purpose of stimulating thought and discussion. This material is not intended to replace, define, or dictate standard of care. Material is for personal use only. Permission for other use must be obtained from the author.

Introduction

Polycystic ovary syndrome (PCOS) is a complex hormonal disturbance that affects the entire body and has numerous implications for general health. For far too long, PCOS has been in the "closet," underestimated both in prevalence and importance. Now, with a better understanding of the spectrum of the disorder and armed with new treatment options, PCOS is starting to receive the attention it deserves.

Interest, research and most importantly, recognition are increasing in a number of medical disciplines including gynecology, reproductive medicine, internal medicine, endocrinology, dermatology, genetics, pediatrics, radiology, and family medicine. Still, it is quite possible that we are still at the tip of the iceberg as we look at the consequences of PCOS on long-term health and disease.

It has been said that PCOS is the most common hormonal disturbance of premenopausal women and certainly is a leading cause of infertility. Depending on how the disorder is defined, from 5% to 30% of all women have some characteristic of PCOS.

There are three broad reasons why PCOS patients seek medical care: 1) menstrual cycle disturbance and infertility 2) problems of appearance and self esteem arising from obesity and excessive hair growth, and 3) metabolic derangements, including abnormalities in blood fat (lipid) levels, insulin/glucose (sugar), and elevated blood pressure (hypertension).

Often gynecologists, the health care provider to whom many women turn for help, have concerned themselves with only the first of these concerns and have been relatively insensitive to the latter two. Generalists have often failed to make, or understand, the relationship of the different faces of PCOS. A more holistic approach to PCOS is certainly warranted and can have a significant effect in altering quality of life.

History and Terminology

In 1935, Drs. Stein and Leventhal associated infrequent menstrual bleeding with larger than normal ovaries containing many small cysts. They designated this condition "polycystic ovarian disease," since referred to as Stein-Leventhal syndrome. The term "disease" indicates a specific set of symptoms, or constant physical findings.

In this first report of 7 women all had prolonged intervals between periods. Most had a male pattern of hair growth, but at least one patient was reported as "thin." The term "disease" now has been abandoned in favor of "syndrome" to reflect a grouping of symptoms, physical and laboratory findings. It must be realized that the term "syndrome" still might be too restrictive and that this condition is broad "spectrum" with a vast differenceamong patients.

The triad of PCOS has been most simply related to irregular menstruation, skin problems and obesity. Not all patients are obese. There seems to be a distinct group of thin PCOS patients that may have even more firmly entrenched hormonal and fertility problems.

Some patients with abnormal hair growth have been given the diagnosis of idiopathic (no known cause) hirsutism, but on close examination most will have subtle abnormalities of their hormones or polycystic ovaries on ultrasound scan. Some researchers make the distinction between "PCO-appearing" ovaries on ultrasound and PCOS.

Not all PCOS patients are infertile or have obvious menstrual cycle abnormalities. With pelvic ultrasound, it has been found that approximately 20-30% of women of the reproductive age range will have polycystic appearing ovaries, some despite proven fertility and lack of other characteristic findings. How all this fits together is really unknown. There may be a central, yet to be found problem that may be the root of PCOS.

Alternatively, PCOS can be a symptom of a variety of problems, much like a fever is a consequence of a number of diseases. Despite the designation of PCOS, the ovaries may not be the primary source of the problem, but since the designation of PCOS is well entrenched in the literature and medical practice, no better name has emerged. It is much less important what the disorder is called than that it is appropriately recognized. (Continued)

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