Polycystic Ovaries PCOD Defined PCOD Causes PCOD Prevalence PCOD Hormone Changes PCOD and Body Weight PCOD and Pelvic Pain
PCOD and Long-Term Health PCOD and Hirsutism PCOD and Amenorrhoea The Pill and Hirsutism PCOD Treatment PCOD and Metformin PCOD / Infertility Treatment
PCOD / Amenorrhoea Treatment PCOD Surgical Treatment Support Groups

What are polycystic ovaries?

Polycystic ovaries are characterised by the presence of many small cysts (fluid filled swellings) around the surface of the ovaries. The cysts are quite small ranging from 2 to 8 mm (Figure 7.1).

Polycystic ovaries are usually larger than normal ovaries and their central substance is generally more dense.

Over recent years, with the advent of ultrasound examination, we have learned that about one woman in five has polycystic ovaries. At ultrasound examination, the ovaries appear larger and more dense and the cysts look like a "necklace" around the periphery of the ovaries.

 

Figure 7.1Polycystic Ovary Picture - Note The Small Cysts Around The Periphery Of The Ovaries

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What is polycystic ovarian disease?

When patients develop symptoms associated with their polycystic ovaries, they are said to have polycystic ovarian disease ( or polyscystic ovarian syndrome).

Of the 20% of women who have PCO only one in three will have symptoms - PCOD.

In addition to abnormal menstrual cycles and infertility, some women may be troubled by skin problems, notably acne and greasy skin or unwanted hair production (hirsutism).

PCOD was first described by Stein and Leventhal in 1935 and the condition is therefore also known as Stein-Leventhal syndrome.

Many women with PCOD find it difficult to understand why they have developed symptoms, such as irregular and infrequent periods (oligomenorrhoea), after many years of normal cycles. Usually, the key factor to account for the change is an increase in weight. In association with PCOD there may be an increased level of insulin which encourages the body to lay down excessive amounts of fat tissue leading to obesity. This excess fat tissue aggravates the hormonal imbalance. A spiral may be set up as the hormone problems increase fat production and the excess fat has a further adverse effect on the hormone balance.  

Part of the difficulty in understanding polycystic ovarian disease (PCOD) and interpreting the large medical literature surrounding it has been that there was no universally accepted clinical definition.(0301)

There has been a recent consensus on the diagnosis of polycystic ovarian disease.(0401)

PCOD is defined as the presence of any two of the following three criteria:

  1. polycystic ovaries (either 12 or more follicles measuring 2-9 mm in diameter, or increased ovarian volume (> 10 cm3) on ultrasound.
  2. oligomenorrheoa / anovulation  (reduced periods / failure to release eggs).
  3. clinical or biochemical evidence of hyperandrogenism (excessive male hormone).

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PCOD Causes

Although a great deal is now known about the polycystic ovarian disease, the exact cause has yet to be determined.

Polycystic ovarian disease is probably an inherited condition. There has been one specific gene implicated and two others also seem to be involved. Premature balding in men is often a manifestation of the same gene that results in PCOD in women.

The hormone chemistry of polycystic ovaries is often deranged. This may result in period problems, particularly reduced or absent periods. Polycystic ovaries tend not to release their eggs regularly and, without treatment, there may be problems with fertility.

In recent years it has become recognised that many of the metabolic (body chemical) changes seen in PCOD may be related to insulin resistance.0301, 9901

Insulin is produced by the pancreas, which is a gland found in the abdomen. This gland has two functions, both related to the way the body deals with food. It secretes enzymes (chemical catalysts) into the small bowel allowing food to be broken down into the basic components that can be absorbed. The pancreas also secretes insulin into the blood stream. Insulin is a hormone  that reduces the blood sugar level, mainly by converting sugar into fat. Diabetes occurs when the pancreas can no longer produced sufficient insulin to prevent the blood sugar level rising too high. It turns out that most women with PCOD are resistant to insulin. Hormones work like a key in a lock. Insulin resistance means that the insulin hormone receptors are defective and a stronger key is required. The result is an increased output of insulin and it is the higher levels of insulin that seems to result in the typical symptoms of PCOD. Women with PCOD are not diabetic and so there is no difference in their response to a glucose (sugar) load (Figure 7.2).

Figure 7.2 Glucose Tolerance Test - Normal and PCOD women

Typically, women with PCOD require greater output of insulin from the pancreas to prevent their sugar rising too high (Figure 7.3).

Figure 7.3 Insulin Response to Glucose Load - Normal and PCOD

 

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It is becoming recognised that some patients have symptoms and blood chemistry (hormone levels) typical of polycystic ovarian disease, although their ovaries do not have a typical PCO picture. The latest definition of PCOD allows for this.0401

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Polycystic Ovaries PCOD Defined PCOD Causes PCOD Prevalence PCOD Hormone Changes PCOD and Body Weight PCOD and Pelvic Pain
PCOD and Long-Term Health PCOD and Hirsutism PCOD and Amenorrhoea The Pill and Hirsutism PCOD Treatment PCOD and Metformin PCOD / Infertility Treatment
PCOD / Amenorrhoea Treatment PCOD Surgical Treatment Support Groups

 

How prevalent is polycystic ovarian disease?

Polycystic ovarian disease is one of the most common endocrine (hormone) disorders. Ultrasound examination provides an excellent window to look at ovarian structure. The ovaries are close to the top of the vagina and therefore transvaginal scanning shows of ovarian structure more clearly than transabdominal scanning.

In adult women, transvaginal scanning reveals an incidence of PCO in the order of 20%. About one in three with ultrasound evidence of PCO will have problems resulting in an incidence of 6-10%.

Before sexual activity has commenced ultrasound is performed by the transabdominal route. Evidence of PCO can be found in 6% of six year old girls and, by the age of ten, 18% of girls have evidence of PCO.

There is evidence that PCOD is more prevalent amongst those that are obese and in those with Type 1 diabetes or who have had gestational diabetes.

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For how long will I have polycystic ovary disease?

Unfortunately, PCOD is a problem that does not disappear. It is almost certainly an inherited condition. Just like the colour of your eyes, it cannot be changed.

Will polycystic ovary syndrome affect my general health?

There is a spectrum of severity of PCOD ranging from a little irregularity of the menstrual cycle to troublesome excess body hair and anovulatory infertility.

Early suggestions that PCOD is a cause of heart disease seems to have been unfounded. Obesity, however, is associated with heart problems and many women with PCOD are overweight. There is evidence that the long-term complications of PCOD are increased by the addition of obesity.

Young, obese women with PCOD have a high prevalence of early asymptomatic coronary atherosclerosis, compared with obese controls. This increased risk is independent of traditional cardiovascular (CV) risk factors and novel markers of inflammation. These findings underscore the need to screen and aggressively counsel and treat these women to prevent symptomatic CV disease.0701

If you have PCOD, you should make every effort to keep your weight down by diet and excercise.

Between 20 and 40% of women found to have polycystic ovarian disease will develop diabetes in later life. As PCOD is associated with anovulation, the endometrium may be subjected to long-term oestrogen without cyclical progesterone protection increasing the risk of endometrial cancer (endometrial cancer).

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What hormone changes are typical of polycystic ovarian disease?

Blood tests to evaluate PCOD should be scheduled early in the menstrual cycle. Some prefer the third day of the cycle and others the eighth day.

Elevated LH (menstrual cycles) concentrations, seems to be the most common finding.

The androgenic hormones (steroid hormones) testosterone and androstenedione tend to be increased and these higher levels tend to be associated with decreased SHBG levels (SHBG).

Prolactin levels (menstrual cycles, hyperprolactinaemia) are often just above the normal range. As hormone levels fluctuate there may be merit in repeating the tests.  After food insulin levels rise higher than normal (PCOD cause;  Figure 7.3). 

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Increased levels of LH can be found in 40% of women with PCO. We know that raised LH levels are associated with difficulty conceiving and increased miscarriage rates.

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What is the significance of body weight in polycystic ovarian disease?

PCOD encourages weight gain and fat has an adverse effect on the hormone balance leading to an escalating spiral of the problems.

Obesity reduces the chances of pregnancy and increases the risk of pregnancy complications including miscarriage, high blood pressure and thromboembolism.

In the long-term obesity, is a major risk factor for heart disease. Every effort to maintain a normal weight by diet as well as exercise is to be encouraged. There is some evidence that women with PCOD lay down fat more easily. They may be overweight without indulging in excessive calorie intake.  

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PCOD and Pelvic Pain

PCOD is not considered to be a cause of pelvic pain

Pelvic pain and PCO are both common and not surprisingly many patients with pelvic pain also have evidence of PCO. However, PCO does not seem to be a cause for pelvic pain.

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Polycystic Ovaries PCOD Defined PCOD Causes PCOD Prevalence PCOD Hormone Changes PCOD and Body Weight PCOD and Pelvic Pain
PCOD and Long-Term Health PCOD and Hirsutism PCOD and Amenorrhoea The Pill and Hirsutism PCOD Treatment PCOD and Metformin PCOD / Infertility Treatment
PCOD / Amenorrhoea Treatment PCOD Surgical Treatment Support Groups

Women's Health


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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.