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Polycystic ovary syndrome (PCOS) is a hormone (endocrine) disorder that affects women of reproductive age.
It is characterized by lack of ovulation; menstrual abnormalities, such as irregularity or absence of menstruation (amenorrhea); infertility; pregnancy loss; enlarged ovaries; obesity; blood cholesterol (lipid) abnormalities; and abnormalities in the production and metabolism of male hormones (androgens). Increased levels of luteinizing hormone and decreased levels of follicle-stimulating hormone also occur. Estrogen production does not occur in the normal cycle pattern. The syndrome is the most common cause of anovulatory infertility. Usually there is no well-defined cause of the androgen abnormalities.
Risk: PCOS affects women of reproductive age. The underlying cause of polycystic ovary syndrome is unknown, but it is likely a result of multifactorial elements. The key features include insulin resistance, male hormone (androgen) abnormalities, and abnormal hormone dynamics that affect the function of the ovaries. Polycystic ovary syndrome is often associated with a family history of chronic anovulation and androgen excess. Incidence and Prevalence: Polycystic ovary syndrome is one of the most common hormone (endocrine) disorders, affecting roughly 5% to 10% of women of reproductive age in the US (Williams 635). The syndrome has an onset in the prepubertal years and is progressive. |
Source: Medical Disability Advisor
| History: Most women with PCOS experience the onset of menstrual periods (menarche) at a normal age but soon begin to have irregular menstrual periods: oligomenorrhea (fewer than 9 menstrual periods per year) or amenorrhea (no menstrual periods for at least 3 months). Anovulation (the absence of egg release by the ovary) causes the irregular menstrual periods and may also lead to difficulty conceiving or infertility. Excess male hormones may cause male pattern hairiness or baldness, acne, a deep voice, or increased muscle mass. Obesity is common and may be accompanied by glucose intolerance or frank diabetes mellitus (type II). Physical exam: About 70% of women present with growth of coarse hair in the sideburn area, chin, upper lip, chest, and/or lower abdominal midline. There may be upper-body obesity with the waist being greater in diameter than the hip (waist-to-hip ratio of greater than 0.85). Abnormal darkening and thickening of the skin in the neck, groin or armpit (acanthosis nigricans) may be present in individuals with insulin resistance. Ovarian enlargement, possibly detectable upon pelvic examination, may be present in one or both ovaries. Tests: A urine pregnancy test to detect human chorionic gonadotropin (hCG) should be done to exclude pregnancy in any woman of reproductive age who has menstrual irregularities or amenorrhea. In the absence of pregnancy, hCG is low or absent in women with polycystic ovary syndrome. Blood tests are performed to determine levels of hormones, such as testosterone, androstenedione, luteinizing hormone (LH), estradiol, estrone, follicle-stimulating hormone (FSH), and fasting insulin. A test for a protein called sex hormone-binding globulin may be done to detect reduced levels typically found in this syndrome. An LH-to-FSH ratio of 3:1 is considered diagnostic of the syndrome. Ultrasound of the ovaries and/or insertion of a viewing instrument through a small incision in the abdomen to examine the ovaries (laparoscopy) may reveal multiple follicles in the ovaries (polycystic ovaries), but this is not necessarily diagnostic. Prolactin levels are usually measured to rule out pituitary gland disorders. Fasting blood glucose and blood lipid profile are also routinely performed. |
Source: Medical Disability Advisor
| Treatment is directed at the symptoms of the disorder; few treatment approaches improve all aspects of the syndrome. The goals of treatment should include reducing metabolic abnormalities and insulin resistance when present, reducing the action of androgen hormones on tissues, and correcting anovulation.
Treatment with an insulin-sensitizing agent, such as metformin, may improve insulin sensitivity and decrease blood LH and free testosterone levels. Metformin also restores menstrual cycles in most women treated for at least 4 to 6 months (Williams 635). Recent successes with ovulation-inducing agents have decreased the use of surgery (ovarian wedge resection). Surgical techniques such as ovarian drilling may temporarily reduce male hormone levels (androgens) and improve fertility, but do not permanently address the underlying hormone disturbances. A significant percentage of women who undergo ovarian cauterization or laser vaporization via laparoscopic techniques have spontaneous restoration of ovulation. However, complications from the surgery (primarily adhesion formation) tend to outweigh the benefits. Weight reduction, diet, and exercise are recommended for all women with polycystic ovary syndrome. Genetic counseling is also important, because up to half of first-degree relatives may have polycystic ovary syndrome or components of it and may benefit from preventive interventions (Williams 634). |
Source: Medical Disability Advisor
| Treatment with medication and behavior modification (weight reduction, diet, exercise) is usually successful at managing symptoms and restoring hormonal balance and ovulation. If medication is ineffective, surgery to remove part of the ovaries (wedge resection) has been successful. |
Source: Medical Disability Advisor
| Polycystic ovary syndrome is a progressive disorder that continues from soon after a woman's first menstrual period until menopause. Long-term effects of abnormal estrogen levels place women with the syndrome at considerable risk for endometrial cancer, endometrial hyperplasia and, possibly, breast cancer. The risk of endometrial cancer is 3 times higher in women with the syndrome than in healthy women. Some studies have shown that there is a 3 to 4 times increased risk of breast cancer in the postmenopausal years.
The syndrome is associated with blood lipid abnormalities, high blood pressure, intravascular thrombosis and an increased risk of cardiovascular disease as well as abnormalities in glucose metabolism (glucose intolerance or diabetes). |
Source: Medical Disability Advisor
| Restrictions or accommodations are usually not required. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Was diagnosis of polycystic ovary syndrome confirmed?
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Were other conditions producing anovulation ruled out?
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Are there any underlying conditions that may affect the individual’s recovery?
Regarding treatment:
- Did combination hormone therapy or use of metformin relieve symptoms?
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If drug therapy was not effective in relieving symptoms, is individual candidate for surgical intervention?
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What type of procedure is being considered?
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Has individual complied with behavior modification regimen?
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What can be done to increase compliance?
Regarding prognosis:
- Has drug therapy and behavior modification been successful in managing symptoms while restoring hormone balance and ovulation? Are other medication options or combinations available?
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Would individual benefit from surgery?
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Would benefits of surgical procedure outweigh risk of complications?
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Source: Medical Disability Advisor
| Williams, R. H., and Reed P. Larsen, eds. "Disorders of the Female Reproductive System." Williams Textbook of Endocrinology. 10th ed. Philadelphia: Elsevier, Inc., 2003. 627-637. MD Consult. Elsevier, Inc. 22 Feb. 2005 <http://home.mdconsult.com/das/book/44962992-2/view/1091>. |
Source: Medical Disability Advisor