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Johns Hopkins Symptoms and Remedies

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Polycystic Ovarian Disease

What is it?

Polycystic ovarian disease is characterized by the formation of follicle cysts (spherical, thin-walled nodules filled with a thin fluid) within both ovaries. Each ovary contains an abundance of structures known as ovarian follicles. Roughly once a month, hormones stimulate a single follicle to grow and rise to the ovarian surface, where it bursts and releases an egg. At the same time, hormones from the follicles cause the uterine wall to thicken to provide support if the egg becomes fertilized. The egg passes out of the ovary, through the fallopian tube, and into the uterus. If fertilization does not occur, the thickened uterine lining is shed and the egg, excess lining, and blood are all released through the vagina during menstruation. In polycystic ovarian disease the follicle grows but fails to burst. Instead of releasing an egg, the follicle forms a cyst just below the ovary's surface. Normal menstrual periods may be present early in puberty but become widely spaced or cease completely as the ovaries begin to produce cysts instead of releasing eggs. Eventually, both ovaries become filled with tiny cysts. Lack of ovulation results in the cessation of menstrual periods, infertility, and overproduction of the male sex hormone testosterone by the ovaries. The reason for cyst development is not fully understood, but it is believed to involve an imbalance in the production of the two pituitary hormones that normally stimulate the ovaries to function: luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Polycystic ovarian disease affects women during their reproductive years. If left untreated, the relative excess of estrogen compared to progesterone may increase the risk of endometrial hyperplasia and uterine cancer later in life. However, the disease often responds well to treatment, which may restore fertility and eliminate symptoms. Specific treatment depends on the individual needs of the patient, especially whether or not she wishes to have children in the future.

What Causes It?

  • The cause of this condition is unknown, but it may be genetic.

Prevention

  • There is no known way to prevent polycystic ovarian disease.

Diagnosis

  • Patient history and pelvic examination. The gynecologist may be able to detect enlarged ovaries during the bimanual part of a pelvic examination.
  • Blood tests can measure levels of LH, FSH, testosterone, and other hormones that affect function of the ovaries.
  • Ultrasound scans may be performed.
  • Laparoscopic abdominal surgery (use of a lighted scope that is inserted into the abdomen through a small incision) may confirm the diagnosis.

How to Treat It

  • For those women who wish to become pregnant, clomiphene citrate, a fertility drug, or hormones such as human gonadotropins and human chorionic gonadotropin may be prescribed to induce ovulation. Rarely, laparoscopic surgery to reduce the size of the ovary (wedge resection or ovarian drilling) may be performed to create more favorable conditions for ovulation. The management of insulin resistance may contribute to success.
  • For those who do not wish to become pregnant, oral contraceptives or progestins such as medroxyprogesterone acetate may be prescribed to suppress ovulation and reduce the risk of endometrial hyperplasia or uterine cancer later in life.

When to Call a Doctor

  • Call your gynecologist if you develop symptoms of polycystic ovarian disease.