The polycystic ovarian (PCO) syndrome (also called Stein-Leventhal syndrome) is a condition in which the development of ovarian follicles has gone haywire. In PCO, none of the 10-20 follicles that start to mature in each ovary at the beginning of the menstrual cycle reaches full maturity and releases an ovum. Without ovulation all follicles that] start to mature remain active. The pituitary continues to stimulate more follicles and the ovaries become filled with cysts ranging from pinhead size to 10 mm or so in diameter. The ovarian capsule thickens to contain the cysts, making ovulation more unlikely.
The cells around the walls of the follicles continue to produce hormones (including some male hormones) in the usual manner, but because there are so many more follicles, much more hormone is released into the blood. At first the excess of oestrogen causes the endometrium to become much thicker, making periods heavier. The lack of progesterone (because no corpus luteum has formed from a ruptured follicle) also contributes to heavier periods, and usually makes bleeding irregular.
Later, as more and more cysts form, ovarian function becomes more disturbed and the production of oestrogen diminishes. There may not be enough to cause any growth of the endometrium, so periods stop. There is now a relative excess of male hormone, and signs of masculinisation begin to appear. These include weight gain, acne, increased growth of facial and body hair and occasionally deepening of the voice.
The cause of the disturbance of ovulation in PCO is not clear. The most popular theory at present is that there is a mix-up of the normal control of ovarian function by the hypothalamus and the pituitary gland.
Treatment depends on whether or not subfertility is a problem. For those who want to conceive, treatment with fertility drugs like Clomid (clomiphene) is usually recommended first, and will restore ovulation and fertility in the majority of cases. Knot, an operation called ‘wedge resection’ of the ovaries (which removes part of the thickened capsule of each ovary) is usually successful.
Women who don’t want to become pregnant usually respond well to treatment with the combined contraceptive Pill, which suppresses continuous stimulation of the ovaries by FSH from the pituitary so that no new follicles develop, and the cysts that have already formed subside. Male hormone production goes back to normal levels and signs of masculinisation gradually disappear. PCO rarely recurs when the Pill is stopped.
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