Polycystic Ovary Syndrome (PCOS)

Background

Early Stage squarePolycystic Ovary Syndrome (PCOS), also known as Stein-Leventhal syndrome and hyperandrogenic anovulation (HA), is an endocrine disorder frequently involving the growth of small cysts on the ovaries. Polycystic ovaries develop in response to high levels of luteinizing hormone (LH) and/or high levels of insulin in the blood. These imbalances, in turn, cause the ovaries to increase production of male hormones (androgens).

Symptoms come on gradually, usually affecting women of reproductive age, and often include menstrual irregularities, reproductive issues, acne, excess facial and body hair, weight gain and metabolic abnormalities (diabetes, hypertension, dyslipidemia). Early diagnosis is important as it can significantly lower the risk of long-term complications (uterine cancer, heart disease, miscarriages, infertility)

PCOS is the most common endocrine disorder for women ages 15 to 44 and is the leading cause of female infertility. Each year, it is estimated that PCOS affects 116 million women worldwide. However, it is believed that as much of 70 percent of women with the disorder go undiagnosed.

Current Treatment

There is currently no cure for PCOS, so treatment is aimed at controlling symptoms and limiting the risk for long term complications. Lifestyle changes (healthy diet, exercise) can be very beneficial for the many women with PCOS who are overweight, helping to lower blood sugar levels, improve the body’s use of insulin and normalize hormone levels.

Medications such as birth control pills and proper diabetic management are often given to mitigate the symptoms associated with PCOS. In cases where patients do not respond to medication, a form of surgery called laparoscopic ovarian drilling (LOD) is an option. LOD uses a needle which carries an electric current to puncture the ovary and destroy tissue to help reduce the excessive male hormone. However, surgery is invasive, carries the risk of bleeding and infection and may result in ovarian scarring, pelvic adhesions or accidental bowel injury.

Focused Ultrasound Research

Focused ultrasound, which uses ultrasonic beams directed at a target, can thermally ablate tissue with minimal damage to tissues outside the focus. For this reason, focused ultrasound is currently being explored as a non-invasive treatment for patients indicated for laparoscopic drilling. A recent preclinical feasibility study showed that focused ultrasound can ablate tissue inside the ovary without damage to the surface. This promising result illustrates that focused ultrasound could provide doctors with a safer treatment for PCOS. However, more research is needed before research can progress to the clinical stages.

Notable Papers

Shehata IA, Ballard JR, Casper AJ, Hennings LJ, Cressman E, Ebbini ES. High-intensity focused ultrasound for potential treatment of polycystic ovary syndrome: toward a noninvasive surgery. Fertil Steril. 2014 Feb;101(2):545-51.

     

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