New Name for PCOS

polycystic ovaryIn January 2013, an expert panel from the NHI called for PCOS to be renamed.  It needs a new name because PCOS is not an ovarian condition. It is a hormonal condition.  

When women are told that they have Polycystic Ovarian Syndrome, many of them are left to believe that they have abnormal growths on their ovaries. Nothing could be further from the truth. 

Fluid-filled sacs are normal for the ovary. They are the follicles that contain the developing eggs. In other words, ovaries are meant to be cystic. The abnormality with PCOS is not the cysts, but - in a way - the fact that they're not cystic enough. Normally, as the follicles progress to ovulation, one or two of them increase in size and become larger cysts - the dominant follicles - the ones that will release an egg.

In PCOS, the underlying hormonal issues prevent the dominant follicles from forming. The ovary is left with too many small undeveloped follicles - and no ovulation. Too many small follicles, and no big follicles.

Dr. Robert A. Rizza from the Mayo Clinic - and a member of the NHI panel- sums up the name change:

"[The name PCOS]..focuses on a criteria – namely the polycystic ovarian morphology – that is neither necessary nor sufficient to diagnose the syndrome. It is time to assign a name that reflects the complex metabolic, hypothalamic, pituitary, ovarian, and adrenal interactions that characterize PCOS."

Normal women exhibit polycystic ovaries 25% of the time.

If you were to just grab any healthy woman off the street, and do an ultrasound, 25% of the time it would show polycystic ovaries. Test her again a few months later, and it will be normal. Two things to understand: 1) a polycystic appearance to the ovaries means nothing as an isolated finding, and 2) the ovaries are dynamic, with the number and size of follicles constantly changing.

PCOS must be diagnosed by blood test and symptom profile

The consensus is that to diagnose PCOS, at least 2 of the following 3 criteria must be met:

  1. irregular or no ovulation. 
  2. high testosterone on blood test
  3. ovaries have a polycystic appearance on ultrasound.

(in other words, the single finding of polycystic ovaries cannot be used to diagnose the condition)

Once the underlying hormone imbalance is addressed, PCOS reverses

The underlying hormone imbalance is usually insulin resistance but may be thyroid, leptin or other issues. Once that is corrected, and regular ovulation established, then PCOS can revert to normal.

To determine PCOS type, please see the full PCOS article.

Large painful ovarian cysts are a different condition

The word cyst is used to describe many different - unrelated - things that occur with the ovaries. Follicular cysts are large painful enlarged cysts that occur when the follicle grows but doesn't rupture to release the egg. There are also chocolate cysts associated with endometriosis and abnormal growths such as dermoid cysts. 

Perhaps, as relates to ovaries, we need to drop the word cyst entirely. 

 

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