POLYCYSTIC OVARIAN

SYNDROME

A   32-year-old woman   visits  the gynecologist’s  office  complaining of

vaginal bleeding,   facial  hair    growth, and obesity.    She states  that    she has

noted   the facial  hair    growth  for many    years   and the irregular   bleeding    has

been    progressively   getting worse   during  the past    six months. She has no

other   significant personal    or  family  history,    and on  pelvic  examination she

has slightly    enlarged    bilateral   ovaries.    A   rectovaginal    examination is

confirmatory.

Polycystic ovarian syndrome (PCOS), historically called Stein-Leventhal
syndrome, is a condition of chronic anovulation with resultant infertility. The
patient presents typically with irregular vaginal bleeding. Other symptoms
include obesity and hirsutism.

Chronic anovulation.    Instead of  showing the characteristic  hormone

fluctuation of  the normal  menstrual   cycle,  PCOS    gonadotropins   and sex

steroids    are in  a   steady  state,  resulting   in  anovulation and infertility.    Without

ovulation,  there   is  no  corpus  luteum  to  produce progesterone.   Without

progesterone,   there   is  unopposed   estrogen.   Endometrium,    which   is

chronically stimulated  by  estrogen,   without progesterone    ripening    and cyclic

shedding    becomes hyperplastic    with    irregular   bleeding.   With    time

endometrial hyperplasia can result, which   could   progress    to  endometrial

cancer.

Increased   testosterone.   Increased   LH  levels  cause   increased   ovarian