Polycystic Ovary Syndrome

GR Sridhar, Endocrine and Diabetes Centre, Visakhapatnam - 530002.

Polycystic ovary syndrome (PCOS) is a common hormonal imbalance in women which may cause a variety of problems. Women with this condition may have some or all of a number of symptoms, including excessive hair on the face or body, irregular or absent menstrual periods, and difficulty in becoming pregnant. PCOS is so called because ultrasound scans of the ovaries show they have many small cysts. Polycystic ovaries are the obvious part of an imbalance in the production of several normal hormones from the ovaries, adrenal glands and pituitary gland. PCOS is common. Surveys have shown that perhaps a quarter of normal women, including most of those with slightly irregular periods, suffer from a mild version of the condition.

NORMAL: The PITUITARY GLAND is connected to the underside of the brain, and controls many other hormonal glands in the body.

The ADRENAL GLAND is mostly involved in producing a hormone called cortisol, under the control of ACTH, secreted by the pituitary.
The OVARY produces the normal female hormone, estrogen, and eggs for ovulation, under the influence of pituitary hormones, LH and FSH.
Both the ovary and adrenals normally produce a small amount of ANDROGENS, or male sex hormones.

PCOS: In PCOS both the ovaries and adrenals produce more of the male hormones, androgens, than normal. This is responsible for the excess hair growth and interferes with the normal cycle of ovulation and menstrual periods.

As a result of the changing balance of androgens in the blood, the pattern of pituitary hormone production is also altered (more LH compared to FSH, sometimes more prolactin also). This in turn leads to production of even more androgen, so that a vicious cycle is set up.

It is still not clear where the vicious cycle originates: at the adrenal, the ovary, or even the pituitary.

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