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Polycystic Ovary Syndrome (PCOS)
 Stein-Leventhal Syndrome


General Considerations

  • Polycystic ovary syndrome (PCOS), also known as, Stein-Leventhal syndrome, includes
    • Polycystic ovaries
    • Obesity
    • Hirsutism
    • Infertility
  • Women with PCOS have abnormalities in the metabolism of androgens and estrogen and in the control of androgen production
  • Elevated androgen levels can be of ovarian (eg, testosterone, androstenedione) or adrenal (dehydroepiandrosterone sulfate) origin
  • The luteinizing hormone level is elevated, with reversal of the LH/FSH ratio as LH becomes higher than FSH throughout the menstrual cycle
  • PCOS is also associated with peripheral insulin resistance
    • Approximately 10% of women who are obese and have PCOS also have type 2 diabetes mellitus by age 40 years

Clinical

  • The minimal criteria proposed for the diagnosis of PCOS include
    • Menstrual dysfunction
    • Evidence of hyperandrogenism, whether clinical (eg, hirsutism, acne, male pattern balding) or biochemical (elevated androgen level and other causes of hyperandrogenism must be excluded)

Imaging

  • Ultrasound is the imaging modality of choice 
  • Polycystic ovaries are enlarged and rounder than normal with increased stromal echogenicity
  • There are numerous small cysts, less than 5mm, that line up on the periphery, in a “string-of-pearls” appearance
  • Ultrasonographic criteria for establishing the diagnosis of PCOS are 10 or more cysts that are 2-8 mm in diameter and are peripherally arranged around an echodense stroma

Treatment

  • May include diet, activity and Metformin, an anti-diabetic drug
  • Also spironolactone, eflornithine (to treat hirsutism) and oral contraceptives
  • >Ovarian wedge resection is used less often now
  • Laparoscopic surgery reduces the rate of adhesion formation

Complications

  • May have increased risk of cardiovascular and cerebrovascular disease
  • Type 2 diabetes mellitus
  • Increased risk for endometrial carcinoma

Polycystic Ovary Syndrome

Polycystic Ovary Syndrome

Polycystic Ovary Syndrome. White arrows point to multiple cysts that ring the periphery of both ovaries.
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eMedicine Jordan G Pritzker, MD