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POLYCYSTIC OVARIAN DISEASE (PCO) Do You Understand Your Body? POLYCYSTIC OVARIAN SYNDROME ( PCO ) What Is Meant By Polycystic Ovaries? An updated version of this page is available here . This page provides basic knowledge about the medical condition known as polycystic ovarian syndrome or also known as polycystic ovarian disease. This page is just intended to provide information and should not be used as a diagnostic or therapeutic (treatment) guide. We suggest that you familiarize yourself with the contents of page four ( The Normal Ovary ) before you continue. Most of you reading this page are either suffering from or know somebody who is suffering from polycystic ovaries. The presenting symptoms are usually menstrual abnormalities or infertility. It is one of the diseases known as a "hormonal imbalance". We will use the abbreviation PCO to refer to the polycystic ovarian syndrome. We will first discuss the disease and than give a graphic summary. Women suffering from this condition do not ovulate ( they don't release egg cells). The follicles start to develop the normal way(see normal ovary ) but the follicles do not rupture and no egg cells are released. Consequently there are multiple follicles and cysts in the ovary. (A cyst is just a large follicle more than 25 - 30 mm in diameter). Hence the name polycystic ovaries meaning ovaries with many cysts. PCO causes menstrual abnormalities due to the absence of ovulation ( release of an egg cell). The absence of ovulation means an absence of progesterone and therefore an abnormal endometrium . To understand why, familiarize yourself with page 2 ( The Female Organs ) and page 3 ( Normal Menstruation ). The classic symptoms are absence of menstrual bleeding for long periods (months). This is followed by abnormal and prolonged bleeding. This period of bleeding is than again followed by long periods (months) of absence of any bleeding. It also causes periods of abdominal (tummy) pain due to the presence of ovarian cysts. It is very common to find an associated increased secretion of androgens( male hormones).This lead to the development of male characteristics . This include abnormal hair growth (on the face and chest ), voice changes and enlargement of the clitoris, It is therefor important to diagnose and treat the condition early. This condition warrants expert medical care , preferably by a gynecologist or endocrinologist. There is a specific hormonal pattern present that doctors will recognize with blood tests. Ovarian function (and the function of most hormones) is regulated by a small gland underneath the brain and in PCO there is a characteristic disturbance in the substances formed and excreted by this gland ( the pituitary gland)(see Pituitary Gland; FSH ; LH.). The levels of LH (a hormone secreted by the pituitary gland ) are increased . There is also increased levels of androgens ( male hormones ) present. It is also important that the sugar metabolism and blood cholesterol in patients with PCO should be checked. It is associated with a disturbance in the way the body handles sugar due to changes in insulin secretion. ( Insulin is a hormone secreted by the pancreas and it's function is to regulate the blood sugar levels). There is a high incidence of insulin resistance in these patients. Higher levels of insulin are needed to control the blood sugar levels. ( because of the resistance the insulin is not working properly and more are required). In the long run it can lead to the development of diabetes. There are different methods of treatment and depends on a desire to conceive or not. If a pregnancy is desired, ovulation induction treatment is indicated. (see infertilely for more information). Otherwise ovulation suppression is indicated. The different oral contraceptive pills ( "THE PILL" ) and certain drugs used in the treatment of acne are usually used (Drugs containing cyproterone.) These drug suppress the pituitary by fooling its negative feedback system. The pituitary detects these drugs, regards it as estrogen secreted by the ovary and decreases its production of FSH and LH. ( See Pituitary Gland; FSH ; LH.). At one stage an operation called a wedge resection ( also called bivalving of the ovary) was commonly done but it became less frequently performed over the years. A new technique is now advocated called ovarian drilling. These operations will be discussed in more detail elsewhere. The presence of PCO is frequently masked by the use of oral contraceptives ( either used for their contraceptive effects or in many cases as way of treating the abnormal cycles). PCO is than only discovered later when the contraceptive is discontinued. We recommend that it may be worthwhile to exclude PCO in girls with menstrual abnormalities , before they start taking " the pill ". The necessary testing and treatment can than be started as soon as the desire to become pregnant. Contraceptive pills are a way of treating PCO, but the disease frequently starts again after discontinuation of the pill. There is a third way of treating it. by taking progesterone containing drugs for about 10 -14 days every month. This mimics the normal changes in the endometrium and causes menstruation but it doesn't suppress the pituitary gland. ( See later). The continuous secretion of estrogen without being being opposed by progesterone can over a period of years ( more than ten years) lead to development of cancer of the endometrium. This is an important indication to treat this disease. All the treatment options will prevent endometrial cancer .

	The enlarged ovary with multiple cysts(large follicles) is illustrated. No ovulation occurs (or it occurs very seldom). New follicles develops while the old ones are still present. Some of these cysts can become very large, even the size of tennis balls or larger.
	This illustrates the thick endometrium due to the continuous secretion of estrogen and the absence of progesterone. There is an absence of spiral arteries and the endometrium becomes very thick. ( Compare with " The endometrium in the normal cycle")
	This illustrates what happens after a prolonged period (months) of estrogen only stimulation. Areas of the endometrium became so thick these parts outgrow their blood supply . The endometrium in these areas are shed, the blood vessels are exposed and bleeding begins. This bleeding can continue for prolonged periods ( longer than 7 days) Eventually this unopposed stimulation of the endometrium can lead to the development of abnormal cells and eventually cancer of the endometrium It is called unopposed stimulation because of the absence of progesterone.

PCO is a cause of abnormal menstruations. For further information about abnormal menstruations click here