Polycystic ovarian syndrome (PCOS) is an endocrine disorder in which women experience irregular periods (due to infrequent ovulation), increased hair growth, acne, obesity, and infertility. PCOS also increases a woman's risk of developing diabetes and heart disease later in life. There is no single test that can diagnose PCOS, but rather a thorough evaluation of a woman's menstrual history, hormonal tests on the blood, physical exam and sometimes ultrasound of the ovaries will all aid in making the diagnosis. Lack of regular ovulation is necessary to make the diagnosis of the syndrome.

Polycystic ovarian syndrome is a very common disorder, recognized in about 10% of women in the reproductive age group. Currently, there are many clinical studies and basic science research being conducted to improve our understanding of this problem and provide a guide for the best treatments.

The ovaries of women with PCOS usually contain about ten or more small cysts located on the periphery of the ovary. These cysts usually remain small and do not require surgical removal. The reason for the development of these small cysts is unclear, but may be due to absence of ovulation. Women with PCOS are usually unable to completely develop an egg due to abnormal pituitary FSH and LH secretion. As a result, the ovulatory process is not completed and the partially stimulated follicle becomes cystic followed by degeneration of the egg.

In addition to the ovulatory dysfunction, women with PCOS also have higher than normal levels of male hormones (androgens) that circulate in their blood. This is the reason why acne and increased facial and body hair are associated with this syndrome. The high levels of androgens also have a negative effect on ovulation.

Many women with PCOS will also have a problem related to carbohydrate metabolism known as insulin resistance. In these women, the blood levels of insulin are higher than normal because the tissues are less sensitive to the action of insulin. Insulin has an effect on all body tissue, and higher insulin levels can interfere with the ovary's normal hormone secretion and with ovulation. It is not known whether this problem with insulin is the cause of PCOS or an effect of the disorder. Weight loss, exercise and treatment with insulin sensitizing drugs like metformin (glucophage) can sometimes improve the function of the ovaries in women with PCOS.

Treatment for PCOS depends upon the patient's goals. If a patient's primary goal is to become pregnant, induction of ovulation will be necessary using one of several medication options.

If the patient's primary goal is to reduce the symptoms of excessive androgens, like acne and facial hair, the treatment might include birth control pills and an anti-androgen medication.