Polycystic Ovarian Syndrome is common condition in women that wreaks havoc on hormones and causes physical and psychological damage. Polycystic ovarian syndrome (PCOS) is a complex hormonal disturbance that effects the entire body and has numerous implications for general health. Women with this syndrome have, over the course of their life, an increased risk of coronary disease, diabetes and endometrial cancer. PCOS was first diagnosed in 1935 as Stein-Leventhal syndrome. Between 5 and 30 percent of women have some characteristic of PCOS. The disorder is probably the most common hormonal abnormality in women of reproductive age and certainly is a leading cause of infertility. PCOS patients were once dismissed as"fat" women with no self control. Doctors still can often miss, or dismiss, the diagnosis because they fail to recognize the diverse set of symptoms as being part of one medical condition. There are three broad reasons why PCOS patients seek medical care: 1) menstrual cycle disturbance and infertility 2) problems of appearance and self esteem arising from obesity and excessive hair growth, and 3) metabolic derangements, including abnormalities in blood fat (lipid) levels, insulin/glucose (sugar), and elevated blood pressure (hypertension). Often gynecologists, the health care provider to whom may women turn for help, have concerned themselves with only the first of these concerns and have been relatively insensitive to the latter two.

Making the Diagnosis of PCOS
In no other gynecological condition is the general medical history more important than in PCOS. There are 3 different ways to make the diagnosis of PCOS: 1) by symptoms and physical findings, 2) hormonal testing, and 3) ultrasound. Probably most individuals will have abnormalities in all three, some only in two, and possibly only in one. Some may argue that findings in only a single category may not constitute PCOS. But, until we have PCOS better characterized, or find a different diagnosis for these patients, the diagnosis of PCOS should remain and provides a good starting point for communication. Even the most minor of apparent problems may have significant implications for future general health and well-being. The classic findings of PCOS are: menstrual cycle abnormalities, increased sexual hair growth and obesity.

One of the most important issues is determining whether you have PCOS. There are other endocrine disorders that are similar to PCOS, and it is important that you work with your doctor to determine if you have PCOS, or something else. You can take a short quiz from PCOSupport to help you determine how likely you are to have PCOS.

Menstrual Disturbance
Often in PCOS patients, the menarche occurs at the usual age of 12-13 years. Some PCOS patients may start menstruating earlier. Not uncommonly, PCOS patients may first be seen by a physician for lack of menses. Any female who has not had menses by age 16 should be evaluated. The menstrual cycle may at first be regular, but by high school, cycles start to lengthen and may be skipped. Often during this time, oral contraceptives are started. The "pill" usually regulates the menstrual cycle and may give the false impression that all is well. Usually in the teenage years, the other symptoms of skin and weight problems also start to be seen. Some PCOS patients easily establish a pregnancy in these early years. Occasionally, birth control pills may even increase the chance of pregnancy by suppressing abnormal hormonal production.

Often the PCOS patient is seen by a gynecologist when she is in her 20's after stopping the pill, and her periods. Some PCOS patients have quite regular 28 days cycles, but the diagnosis should be suspected in individuals with cycle length over 35 days. Some patients have no bleeding unless some form of medication, usually a progestin, is given. In some there is excessive bleeding, or long periods of spotting. It is thought that the age of menopause in individuals with PCOS is about the same, age 50, as other women.

While virtually never mentioned in medical publications, or recognized by physicians, it seems that chronic pelvic pain and premenstrual (PMS) symptoms are quite common. Given the chronically abnormal hormonal patterns, the capacity of hormones to alter body fluid and even the enlarged cystic ovaries, these findings should not be surprising.

Please search the PCOS Forum for more information, including answers from OBGYN.net physician advisors.