Polycystic Ovary Syndrome

What is polycystic ovary syndrome?
PCOS is also known as hyperandrogenic anovulation, a common type of hormonal imbalance in women. Women with PCOS have excessive levels of androgens, male hormones – rather than the fluctuating levels seen in the normal menstrual cycle. This results in abnormal release of the pituitary hormones that normally control menstruation and ovulation – the release of one or more eggs from the ovary.

The majority of women who have PCOS don’t have normal menstrual cycles. Most of the time, they don’t even ovulate. With PCOS, your ovarian follicles – tiny sacs containing immature eggs – develop but often form cysts instead of releasing an egg each month. Eventually, your ovaries become covered with small cysts.

What causes PCOS?
Its cause is unknown. Research suggests a link to insulin, the hormone produced in the pancreas that allows cells to use sugars (glucose), an important energy supply for the body. It’s thought that with PCOS, you produce extra insulin to regulate your blood sugar, which increases male hormone levels. Unfortunately, this puts you at higher risk of type 2 diabetes (formally called adult-onset or noninsulin-dependent diabetes).

How common is PCOS?
About 5 percent to 10 percent of reproductive-age American women have PCOS.

How is PCOS diagnosed?
To diagnose PCOS, there must be evidence of high levels of androgen, menstrual irregularity and the absence of other diseases, such as ovarian tumors or tumors on the adrenal gland. High androgen levels can be determined by the presence of excess body hair (hirsutism) or by a blood test. Similar diseases can be excluded with blood tests.

Is PCOS inherited, and what are its symptoms?
There appears to be a genetic component to PCOS – it’s believed that you may be born with a predisposition to acquiring it in later life. Your mother, sister or other close female relatives may have PCOS or a different form of hormonal imbalance. Women with PCOS usually don’t have any symptoms until puberty or middle age. PCOS is associated with obesity, enlarged ovaries, abnormal uterine bleeding, oily skin and acne.

You may also experience abdominal discomfort with PCOS because bloating and pain can occur with enlarged ovaries. You may have some discharge, a cervical mucus that’s caused by not ovulating. The menstrual irregularity you experience with PCOS may cause the uterine lining (endometrium) to build up putting you at greater risk of uterine cancer. Without ovulation, your uterus doesn’t receive the message it needs to develop and shed its lining, the endometrium. Although there’s little information on it, PCOS probably persists through menopause, but symptoms may diminish.

What are the fertility issues associated with PCOS?
PCOS is a common cause of infertility. Infertility can be treated with medication, surgery or in vitro fertilization – a procedure to implant laboratory-fertilized eggs into the uterus to cause pregnancy. If you have PCOS, you’re probably more likely to develop diabetes during pregnancy. Pregnant women with PCOS are also at increased risk of miscarriage, but it’s difficult to determine why. This may be because high insulin levels interfere with the development of embryos, another reason for careful control of insulin and sugar in pregnancy.

What other health issues are associated with PCOS?
There’s still controversy about the increased risk of heart disease and breast cancer in women with PCOS, and the associated effects are still being studied. Some scientists believe that chances of heart disease are increased because of risk factors – obesity, increased abdominal fat and high lipid levels. – often associated with PCOS. High lipid levels with PCOS mean that you most likely have elevated triglyceride levels (a measure of potentially artery-clogging fatty acids in your blood), a higher total cholesterol and a lower high-density lipoprotein (HDL) cholesterol (the good kind). The high levels of calcification found in the coronary arteries of women with PCOS may be another risk factor for heart disease. One study that involved scanning the coronary arteries of a group of middle-age men and women showed that middle-age women with PCOS had calcification levels similar to those of middle-age men. Middle-age men usually have more calcification in the coronary arteries surrounding the heart than women do.

What new treatments for PCOS are available?
Treatment depends on whether you plan to become pregnant and on your individual profile of lipid levels and sugar metabolism. If your lipid or sugar levels are abnormal, you may want to consider medication, diet or behavior modification – probably a combination. Weight loss and regular exercise are important. When you’re overweight, your body makes more insulin that, in turn, stimulates the production of male hormones. Weight loss and exercise helps your body use insulin more efficiently, resulting in a decrease in male hormone production. Insulin-sensitizing drugs, such as metformin (Glucophage), serve to reduce insulin levels and stabilize weight. Metformin improves ovulation, but it can cause side effects and its long-term effects on PCOS are uncertain. To deal with the abnormal hair growth that comes wit PCOS, many women wax periodically or, for a more permanent solution, have excess hair removed by electrolysis or laser. There are also topical creams, such as eflornithine (Vaniqa), and antiandrogen medications, such as spironolactone (Aldactone), that slow unwanted hair growth. Women who aren’t planning to become pregnant may take birth control pills to regulate menstruation and lower their risk of uterine cancer. For women hoping to become pregnant, there are several medications and special treatments, such as in vitro fertilization, to help achieve this goal.

Is there some controversy about the best diet for women with PCOS (high carbohydrate, high protein)?
Everyone’s thermostat is set a bit differently. When you have PCOS, your body tends to hold on to calories, making it harder for you to lose weight. That’s why exercise and diet are so important. The type of diet, whether high carbohydrate or otherwise, isn’t what’s most important. It depends on total caloric intake. Women with PCOS often have to take an aggressive approach to weight loss, one of restricting calories and increasing activity level rather than following a specific type of diet.

Taken from “Supplement to Mayo Clinic Women’s Healthsource”, November 2002, An Interview with Daniel Dumesic, M.D.