Polycystic ovary syndrome overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
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Overview
PCOS is the most common form of chronic anovulation associated with androgen excess. Polycystic ovary syndrome occurs in approximately 5% to 10% of reproductive-age women. The diagnosis of PCOS is made by excluding other hyper androgenic disorders like nonclassic adrenal hyperplasia, androgen-secreting tumors, hyperprolactinemia in women with chronic anovulation and androgen excess. During the reproductive years, PCOS is associated with important reproductive morbidity, including infertility, irregular uterine bleeding, and increased pregnancy loss. The endometrium of the patient with PCOS must be evaluated by biopsy because long-term unopposed estrogen stimulation leaves these patients at increased risk for endometrial cancer. PCOS is also associated with increased metabolic and cardiovascular risk factors. These risks are linked to insulin resistance and are compounded by the common occurrence of obesity, although insulin resistance also occurs in nonobese women with PCOS. PCOS is considered to be a heterogeneous disorder with multifactorial causes. PCOS risk is significantly increased with a positive family history of chronic anovulation and androgen excess, and this complex disorder may be inherited in a polygenic fashion
Historical Perspective
PCOS was first described in 1935 by American gynecologists Irving F. Stein, Sr. and Michael L. Leventhal, from whom its original name of Stein–Leventhal syndrome is taken. The earliest published description of PCOS was in 1721 in Italy. Cyst-related changes to the ovaries were described in 1844
Classification
PCOS may be classified into 4 types based upon severity of symptoms into asymptomatic form, mild form, classical form and metabolic form
Pathophysiology
Causes
The underlying defect in patients with PCOS remains unknown, but the harmonal imbalance between LH, FSH and estrogen are mainly responsible for the development of polycystic ovary syndrome. Most studies suggest that more than one factor could play a role in developing PCOS.