Chronic Estrogenized Anovulation

This condition involves a cluster of different health abnormalities which are not exactly the same in every patient who has it. Complicating matters further is that there are several names for this disorder. Each one describes an aspect of the condition, so it is good to be familiar with them all. Most of the names are descriptive and they include: 

Chronic Estrogenized Anovulation (CEA)

Polycystic Ovarian Syndrome, or Disease (PCOS) 

Hyperandrogenism 

Androgen Excess syndrome

Stein Leventhal Syndrome

I prefer the term Chronic Estrogenized Anolvuation ( CEA) and for simplicity will use it in my text which follows. 

The National Institute of Health (NIH)  describes it as follows: 

" Polycystic (pronounced pah-lee-SIS-tik) ovary syndrome, or PCOS, is a set of symptoms related to a hormonal imbalance that occurs in women and girls of reproductive age. PCOS may cause menstrual cycle changes, skin changes such as increased facial and body hair and acne, cysts in the ovaries, and infertility. Often, women with PCOS have problems with their metabolism also. NICHD scientists are currently investigating the causes of PCOS, possible treatments, and ways to manage this problem." 

reference: http://www.nichd.nih.gov/health/topics/PCOS/Pages/default.aspx

The bad news: Even though we deal with CEA all the time in everyday clinical practice, we have an incomplete understanding of its causes. 

The good news: CEA is easy to recognize, and most of the time it is easy to treat. 

Not only is CEA as a cluster of conditions, but it is a cluster of conditions which influence one another. Here are the conditions, and not all appear in every patient: 

problems with ovulation

problems with ovarian cyst formation (see Ultrasound photo) 

androgen (male hormone) excess and related symptoms like acne and excess facial hair

abnormal uterine bleeding (AUB)

abnormal endometrial cells if AUB is untreated

carbohydrate intolerance, also known as insulin resistance (problems with cells using insulin to process sugars properly, leading to fat deposition) 

obesity, usually central

eventually Metabolic Syndrome which confers high blood pressure, diabetes, and elevated cardiovascular risk 

We can use the fact that the various features of the condition influence each other to our advantage. This is why: If we treat one part of the disease, then the other parts of the syndrome get better too.  

In some cases the relationships between various features of the disease are clear. For example it is easy to see why carbohydrate intolerance leads to obesity. In others, not so much. Why, for example, is carbohydrate intolerance connected with faulty ovulation? In the past, it was discovered that certain diabetic medications improved the menstrual regularity of female diabetics. That is why we now treat CEA with certain diabetic medications. Again, it turns out that most of the time if you can treat any one factor the others get better as well. If you treat faulty ovulation, androgen excess gets better. If you treat weight, ovulation gets better, and so on. Therefore our treatment approach to this syndrome is multi-pronged. We approach the problem from as many different angles as possible. 

Patients undergoing workup for this can expect to be evaluated with lab work, ultrasound, charting the cycles over time and possibly an office biopsy of the lining of the uterus (See our endometrial biopsy or EMB information and instruction sheet.) . Treatments should be directed at each aspect of a patient's condition.