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Polycystic Ovarian Syndrome: Overview and Risk Factors

Polycystic ovarian syndrome (PCOS) is a disorder involving excessive androgen production by the ovaries and adrenal cortices. It affects approximately 5% of women in the United States. The etiology is unknown. Hypotheses include excess luteinizing hormone or adrenocorticotropic hormone stimulation of the ovaries, and imbalance of regulatory peptides (insulin, insulin–like growth factor, inhibin, follistatin). Increased circulating insulin decreases the concentration of sex hormone–binding globulins, thereby increasing the amount of unbound free testosterone.

The classic presentation is a triad of hirsutism, anovulation, and obesity, with onset during the peripubertal years; however, it has been recognized in recent years that many women with PCOS are not obese and present only with anovulation and androgenizing effects. Affected women generally have multiple ovarian cysts and may be infertile. They often exhibit insulin resistance, hypothalamic–pituitary axis abnormalities, male–pattern baldness, and acne. Adolescents may also present with precocious puberty or acanthosis nigricans.

Although PCOS is not curable, weight loss and symptomatic treatment can usually control most symptoms.

Risk Factors


Epilepsy. Both epilepsy and anti–seizure medications increase the risk of PCOS.1

Family History. Approximately 40% of first–degree relatives are affected.2


Polycystic Ovarian Syndrome: Diagnosis and Treatment >>