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Your Erratic Periods Might Be Polycystic Ovary Syndrome (PCOS)

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A blog by Dr. Allen Morgan, Morgan Fertility & Reproductive Medicine, March 23, 2015

Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in women, affecting 5-10% of the female population. It is characterized by irregular menstrual periods and infertility due to a lack of ovulation (release of an egg), and by signs of excess male hormones overproduced by the ovaries. Unwanted facial or midline body hair, acne or hair loss from the scalp can all be signs of excess male hormones. The symptoms usually start in adolescence, but can appear in the 20’s or 30’s. Many patients with PCOS are overweight and may have problems associated with obesity such as insulin resistance, an increased risk of diabetes, abnormally high cholesterol levels and high blood pressure. The ovaries are usually enlarged and contain multiple small cysts seen on an ultrasound exam. The small cysts are actually follicles (the small fluid sacs that house the eggs) that have not grown large enough to release their eggs.

The actual cause of PCOS is unknown. It appears that women are genetically prone to this disorder. Female relatives of a patient with PCOS have a 50% chance of having it themselves. Certain lifestyle factors such as a high calorie, high carbohydrate diet and inadequate exercise may worsen many of the symptoms. Many of the symptoms are due to disruption of the menstrual cycle. The normal menstrual cycle begins with a period (menstruation) which is the lining of the uterus sloughing off. At this time, the ovary contains several small fluid sacs called follicles, each of which contains an egg. Under the influence of follicle stimulating hormone (FSH) from the brain, one of these follicles should grow and make estrogen which is the hormonal signal to the uterus to build up a thick lining where the embryo will eventually implant. The brain then uses luteinizing hormone (LH) to signal the follicle to rupture (ovulate) and release the egg into the fallopian tube. After ovulation, the ruptured follicle transforms itself into a progesterone factory called a corpus luteum. Progesterone is the signal to the lining of the uterus to be receptive to the implanting embryo and it keeps the uterus from contracting so as to maintain the pregnancy. The ovary stops making progesterone after about 10-12 days unless it receives a signal from the early embryo that it has implanted. The decline in progesterone levels cause the sloughing of the uterine lining (menstruation).