Polycystic Ovary Syndrome (PCOS)

Background

EarlyStages keyPolycystic 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).

PCOS is very common in both obese women and women with insulin resistance (type 2 diabetes). This disorder has a genetic component as women with family members that have PCOS are at greater risk of developing the disorder.

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 are often given to mitigate the symptoms associated with PCOS. Birth control pills can help control menstrual cycles and acne while reducing male hormone levels. Diabetes medications help to control insulin and blood sugar levels, reduce the growth of abnormal hair and restore ovulation in some cases. Fertility medications can be given to stimulate ovulation for women who want to become pregnant.

In cases where patients do not respond to medication, a form of surgery called laparoscopic ovarian drilling (LOD) is an option. Using a needle which carries an electric current to puncture the ovary and destroy some tissue, the aim of this procedure is to reduce male hormone levels and help restore ovulation. However, surgery is invasive, carries the risk of bleeding and infection and may result in ovarian scarring, pelvic adhesions or accidental bowel injury. Furthermore, the effects are not permanent and sometimes last only a couple months.

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 to evaluate the safety and efficacy of this procedure 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.

Moussatov AG, Baker AC, Duck FA. A possible approach to the treatment of polycystic ovarian syndrome using focused ultrasound. Ultrasonics. 1998 Jul;36(8):893-900.

     

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