Dr. Tabatha Barber explains PCOS as a syndrome where follicles develop but fail to ovulate, causing irregular periods, excess androgens that trigger acne and hair loss, and enlarged ovaries visible on ultrasound. Diagnosis requires two of three features: irregular ovulation, hyperandrogenism, or polycystic ovarian morphology.
Questions this video answers
Polycystic ovarian syndrome.
About 10 to 20 to 30 tiny follicles (small cysts) on an affected ovary.
About nine times per year (oligomenorrhea; cycles >35 days apart).
(1) Oligo-/anovulation (irregular periods), (2) elevated androgens or clinical hyperandrogenism (e.g., testosterone, DHEA; hirsutism, acne), (3) polycystic ovarian morphology on ultrasound. Diagnosis requires two of the three.
Chapters
PCOS stands for polycystic ovarian syndrome. And syndrome means that there are constellation of symptoms that are often seen together in association and lead to a certain situation. And so it gets named a syndrome, as opposed to a disease like diabetes, which is definitely elevated blood sugar with your loss of ability to make enough insulin or respond to insulin appropriately. That's a disease with a cause, a syndrome. They're not sure exactly what the cause is, but they know that this constellation of symptoms goes together and certain effects are seen. You know, back in the 90s when PCOs really came out, it was thought, okay, women who have irregular periods, who have too many androgens, which are more male type hormones of testosterone and dhea, that they're seeing. These symptoms occur with hirsutism, which is like chin hair growth or hair on your abdomen or in your nipples, places it's not supposed to be, essentially. And sometimes hair loss on your head in a male pattern baldness picture. They started seeing women with this constellation of symptoms, and they decided that that was polycystic ovarian syndrome. The name came from the fact that when they did ultrasounds on these women, they were seeing multiple cysts on the ovaries most of the time. The key here is that these were very small cysts. They were follicles, very tiny, in multiples like 10 or 20 or 30 of these tiny little cysts, making the overall size of the ovary larger. Because of all these tiny cysts, essentially what we figured out was that women with this polycystic ovarian syndrome with not ovulating and so their ovaries, every month, when you're going to ovulate, you make a bunch of little follicles. Those are the tiny little cysts that have the egg inside of them that are potentially going to grow and be big enough to rupture open and release an egg. That's ovulation. And so every month you normally get different sized follicles. The biggest one is the winner, and it breaks open and releases the egg for the fallopian tube to grab and take in. And that resulting leftover area, called the corpus luteum, produces progesterone. And so you ovulated, you made progesterone. In polycystic ovarian syndrome, those follicles never get big enough to release an egg. So you don't ovulate, and then you actually don't make progesterone because there's no corpus luteum. And so what they saw was these ovaries had all these multiple cysts on them. Women weren't ovulating, so they weren't having their periods. They maybe had a period three or four times a year. That was the common presentation. They had hirsutism and acne from these elevated androgens. The Rotterdam criteria came out saying you had to have two of those three symptoms to diagnose pcos. So say you're having your period every, you know, few months, more than 35 days apart. The average was like nine times a year. You had elevated testosterone or DHEA, and you had these cysts on your ovaries. So if you had two to three of those, you had pcos.
