Polycystic ovarian syndrome, PCOS, is the most common cause of anovulatory bleeding. This bleeding pattern has infrequent bleeding. Women will often go months without a period. The other classic symptoms of PCOS is obesity and abnormal hair growth called hirsutism. Not all women with PCOS will exhibit all the symptoms. The diagnosis is made based on symptoms but blood tests and often an ultrasound are generally indicated to rule out other causes.
Women with PCOS often go many months or longer without a menstrual period. When the period does finally come it can be very heavy, normal or light. Many women with untreated polycystic ovarian syndrome have infrequent but extremely heavy bleeding. This is because the endometrial lining builds up over time and when the period finally comes there is a large quantity of tissue to pass. In some cases the bleeding can be very severe and can require emergency treatment such as high dose hormones, surgery, or even a blood transfusion.
Women with polcystic ovarian syndrome have a predominately estrogen environment in the uterus. This can overstimulate the endometrium (uterine lining). This is because there is not the regular cyclical effects of progesterone and the monthly shedding of the tissue. This can cause a uterine cancer if not treated. It is very important for women with PCOS to have a menstrual period at least every 3 months to avoid this condition.
PCOS can cause insulin resistance and this can lead to obesity. Women with polcystic ovarian syndrome tend to be overweight, This is because of the metabolic changes that can occur with this syndrome. The obesity tends to make the PCOS worse, this makes weight loss more difficult leading to a vicious cycle. Treating the PCOS can help break this cycle. Because of the insulin resistance, women with PCOS are at increased risk of developing diabetes over time.
Women with polycystic ovarian syndrome tend to have androgenizing symptoms, for most women this manifests as male pattern hair growth. Other androgenizing symptoms such as deepening voice and acne are less common but can be present. The hair growth is often on the face (hirsutism), on the back, chest, or abdomen.
Because women with PCOS tend to ovulate irregularly or not at all, infertility is often a problem. The good news is that this type of infertility is usually very treatable with an inexpensive and safe medication called Clomiphene Citrate. Even if this does not work another medication called Metformin is often very effective as well. Most women with PCOS are able to have children but often require a small amount of help from their doctor.
The evaluation for women with PCOS starts off with a history and physical exam. The diagnosis is made based on the history and physical characteristics. Other tests can be done to rule out other causes of the symptoms. A TSH is often ordered to check the thyroid function. An abnormally functioning thyroid can cause symptoms similar to PCOS but the treatment is thyroid replacement and therefore very different then the treatment for PCOS. Prolactin is another hormone that is often checked. Some doctors will check the ratio between LH and FSH, two hormones that are made by the brain that influence ovarian function. I do not find the LH/FSH ratios to be valuable in most situations and I do not include them in my normal work-up of PCOS. In some cases an androgen secreting tumor needs to be ruled out or a problem called congenital adrenal hyperplasia. An ultrasound and more blood studies can be ordered if there is concern for these problems.
Polycystic ovarian syndrome often has symptoms that are not desirable for the patient. PCOS can also cause dangerously heavy menstrual periods. If left untreated, PCOS can cause long term problems such as uterine cancer and diabetes.