The first clinical description of the pathology of this condition was made by Stein and Leventhal in 1935, hence its first name Stein-Leventhal syndrome, and the authors have distinguished a functional diagnosis of this pathological condition as chronic anovulation or functional hyper-androgyny, and a structural approach placing the diagnosis on an anatomical identification of PCOS. Polycystic ovaries can be identified with an ovarian MRI (Magnetic resonance imaging) test associated with the medical analysis of the clinical symptoms of the endocrine, functional abnormalities.
PCOS is among the most common endocrine reproductive affections in women of childbearing age, characterized by hyperandrogenism and polycystic-ovaries.
As a clinical description, this syndrome is characterized by irregular menstrual cycles, hyperinsulinemia and excessive body and facial hair, condition defined as hyperandrogenism, it is also associated with chronic diseases like diabetes mellitus, dyslipidemias and other cardiovascular affections.
Anovulation or oligo-ovulation presents multiple clinical/biochemical symptoms, the signs of hyperandrogenism can indicate PCOS’s presence, but we must exclude other diseases which also cause this symptom as CAH- congenital adrenal hyperplasia, Cushing syndrome or the existence of androgen secreting tumors.
By polycystic ovaries we understand the presence of over 12 follicles, measuring from 2 up to 9 mm in diameter, in each ovary or elevated ovary volume (higher then 10 m L).
The syndrome of polycystic ovaries develops when the woman’s body produces an excessive amount of masculine sex hormones, androgens, especially testosterone due to excessive insulin or luteinizing hormones released in her blood.
The syndrome acquired its name because it manifests itself on an ultrasound examination as a multitude of ovarian cysts. The cysts are actually immature follicles that haven’t been able to fully develop because of the abnormal ovarian function. The follicles appear on the ultrasound examination in the form of a string of nodules oriented towards the ovarian periphery.
Polycystic ovary syndrome presents a series of symptoms but there cannot be always established the triggering cause for all the patients. However in most cases insulin resistance seems to be the cause of this condition.
For this condition can also be responsible a certain genetic predisposition, and in spite of the fact that hasn’t been discovered the gene responsible for this abnormality it is believed that there is more than one gene responsible, but this theory is still under scientists’ careful examination.
Abnormalities found on the hypothalamic-pituitary-ovarian axis caused by insulin resistance or overweight usually lead to PCOS.
Obesity influences the development of this condition due to the elevated content of Aromatase inside the adipose tissue an enzyme which transforms Androstendion in Estrone and Testosterone in Estradiol and paradoxically elevates both the Androgens and Estrogens parameters leading to FSH -follicle stimulating hormone- negative feed back.
The GnRH- gonadotropine-releasing hormone can be increased by high blood insulin level and also by the dominance of LH-luteinizing hormone over FSH-follicle stimulating hormone; excessive androgen production leads to insufficient follicular maturation and low SHBG-sex hormone-binding globulin and moreover it leads to PCOS development.
Curiously the risk of developing PCOS has been shown to be greater in lesbian women.