HISTORY & TERMINOLOGY

In 1935, Drs. Stein and Leventhal reported three problems associated with larger than normal ovaries containing many small cysts: 

• Excessive male-pattern hair growth (hirsutism),
• Obesity, and
• Menstrual cycle disturbances leading to infertility.

They designated this condition “polycystic ovarian disease,” often since referred to as Stein-Leventhal syndrome. The term “disease” indicates a specific set of symptoms, or constant physical findings. Even in this first report, not all of the patients treated had all three of the above problems. The term disease now has been abandoned in favor of syndrome to reflect a grouping of symptoms, physical and laboratory findings. It must be realized that the term “syndrome” still might be too restrictive and that this condition is broad “spectrum” with a vast difference among patients.

Not all patients are obese. There seems to be a distinct group of thin PCOS patients that may have even more firmly entrenched hormonal and fertility problems. Some patients with abnormal hair growth have been given the diagnosis of idiopathic (no known cause) hirsutism, but on close examination most will have subtle abnormalities of their hormones or polycystic ovaries on ultrasound scan. Some researchers make the distinction between “PCO-appearing” ovaries on ultrasound and PCOS. Not all PCOS patients are infertile or have menstrual cycle abnormalities. With pelvic ultrasound it has been found that approximately 20 to 30 percent of women of the reproductive age range will have polycystic appearing ovaries, some despite proven fertility and lack of other characteristic findings. How all this fits together is really unknown. There may be a central, yet to be found problem that may be the root of PCOS. Alternatively, PCOS can be a symptom of a variety of problems; much like a fever is a consequence of a number of diseases. Despite the designation of PCOS, the ovaries may not be the primary source of the problem, but since the designation of PCOS is well entrenched in the literature and medical practice, no better name has emerged. It is much less important what the disorder is called than that it is appropriately recognized.