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Polycystic ovaries
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The name of this condition, the Polycystic Ovary Syndrome, derives from the cystic appearance of the ovaries of affected women. In 1935, Stein and Leventhal described the polycystic appearance of the ovaries of women with other symptoms that we now associate with the syndrome of PCOS. For this reason, PCOS has also been referred to as the Stein-Leventhal syndrome. Although this name is no longer used you may encounter it in other literature and should understand that it is simply a different name for PCOS.
Polycystic is a term that simply means ‘many cysts’. Cyst is a term used to refer to ‘fluid-filled sacs’. The polycystic ovary typically contains many small – usually less than 1 centimeter, or less than ½ inch – cysts (fluid-filled sacs). These cysts are usually arranged around the surface of the ovary, just below the surface layer of the ovary. When examined directly, or by ultrasound, these small cysts commonly are said to have a string-of-pearls appearance. The ovaries of affected women can be slightly enlarged when compared to unaffected ovaries. Each small cyst represents a follicle, which contains a single egg or ovum that is attempting to develop to a stage where it will be ready to be released from the ovary, a process known as ovulation. However, because of the complex biochemical situation that exists in ovaries with PCOS, the development of these follicles is stopped too soon resulting in a collection of small follicles and the lack of ovulation. This lack of ovulation is the reason why women with PCOS commonly have difficulty becoming pregnant. We will discuss this later under the heading of infertility.
Not all women with ‘cystic ovaries’ have polycystic ovaries. The definition of polycystic ovaries is relatively strict; for example, current recommendations suggest that at least one ovary must contain 12 or more small cysts measuring 2-9 mm in diameter and/or must have a total volume of greater than 11 cubic milliliters.
Of note, not all women who are found to have polycystic-appearing ovaries on ultrasound have PCOS. Keep in mind, the polycystic ovary is a structural finding of the ovary and this single finding should not be confused with the entire syndrome. In fact, many women who show no other signs or symptoms of PCOS have been found to have polycystic-appearing ovaries on ultrasound. For example, many patients with non-classic adrenal hyperplasia also demonstrate polycystic ovaries.
Many women hear the term “polycystic ovary” and associate this with ovarian cancer. This is not the case! Polycystic ovaries are not cancer, and a diagnosis of PCOS does not mean that you have cancer.