Feb 14 2010

Polycystic Ovary Syndrome (PCOS)

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PCOS is a condition where many small cysts (fluid filled sack) is present in the ovaries. It is one of the most common female endocrine disorders affecting about 10% of women of reproductive age (12-45 years). PCOS can occur at ages as young as 11 YO. PCOS is one of the leading causes of infertility in women.


Normal Ovary and Polycystic Ovary

(Picture: womenshealth.gov)


What Causes PCOS?

Researchers have not been able to find a definitive cause for PCOS. A number of factors have been linked to PCOS.

  • There are some genetic link. Many women with PCOS will have a mother or sister with PCOS
  • Insulin plays a role. Insulin converts sugar, starches and food into energy that is stored in your body. Many women with PCOS have too much insulin in their bodies. An excess of insulin leads to the production of an excess androgen in the ovaries, adrenal gland and fat cells. High levels of androgens can lead to achne, excessive hair growth, weight gain and ovulation problems.


PCOS Symptoms

Most of the symptoms of PCOS stems directly from the excess insulin and androgen hormones. It can include a number of the following symptoms. In order for you to be diagnosed with PCOS you need to have at least 2 of the following symptoms::

  • Abnormal, irregular, very light or infrequent menstrual period. This is the most common characteristic. Examples of menstrual abnormality include menstrual intervals longer than 35 days; fewer than eight menstrual cycles a year; failure to menstruate for four months or longer; and prolonged periods that may be scant or heavy. Absent periods, usually (but not always) after having one or more normal menstrual periods during puberty (secondary amenorrhea)
  • Infertility
  • No ovulation
  • Acne, oily skin, dandruff
  • High cholesterol
  • High blood pressure
  • Pelvic Pain
  • Anxiety or depression because of weight or infertility
  • Decreased breast size
  • Excess facial and body hair, may be in male pattern (face, chest, stomach, back, thumbs, toes) ;
  • Adult acne or severe adolescent acne
  • Male-pattern baldness
  • Enlarged clitoris
  • Pre-diabetes or type 2 diabetes. Many women with PCOS are insulin resistant, which impairs the body’s ability to use insulin effectively to regulate blood sugar. This can result in high blood sugar and type 2 diabetes. Pre-diabetes is also called impaired glucose tolerance.
  • Infertility. Women with polycystic ovary syndrome may have trouble becoming pregnant because they experience infrequent ovulation or a lack of ovulation. PCOS is the most common cause of female infertility
  • Weight gain, or obesity. About half the women with polycystic ovary syndrome are obese. Compared with women of a similar age who don’t have polycystic ovary syndrome, women with PCOS are more likely to be overweight or obese.
  • Acanthosis nigricans. This is the medical term for darkened, velvety skin on the nape of your neck, armpits, inner thighs, vulva or under your breasts. This skin condition is a sign of insulin resistance.
  • Polycystic ovaries. Enlarged ovaries containing numerous small cysts can be detected by ultrasound. Despite the condition’s name, polycystic ovaries alone do not confirm the diagnosis. To be diagnosed with PCOS, you must also have abnormal menstrual cycles or signs of androgen excess. Some women with polycystic ovaries may not have PCOS, while a few women with the condition have ovaries that appear normal. 

The physical signs of androgen excess vary with ethnicity, so depending on your ethnic background you may or may not show signs of excess androgen. For instance, women of Northern European or Asian descent may not be affected.


PCOS Treatment

PCOS cannot be cured. It is treated to prevent symptomatic problems and arrive at the results you want to get: Pregnancy, preventing heart problems or reduce the risk of diabetes. Treatments include:

  • Birth Control Pills – Combination pills will control your menstrual cycle, reduce the male androgen hormone concentration and clear up acne for as long as you take it.
  • Diabetes Medication – Glucophage (Metformin – Diabetes Type 2 drug) is used off label to restart ovulation, slow down hair growth, decrease body mass and cholesterol.
  • Fertility Medications – Clomiphene citrate (Clomid, Serophene). Treatment with clomiphene citrate causes the pituitary gland to produce more FSH. This causes the egg to mature and be released. Sometimes women need stronger fertility drugs to get pregnant. A side effect is the risk of multiple births.
  • Anti-Androgen Medicine – Finasteride (Propecia), Flutamide (Eulexin, Flutamin) or Spironolactone (Aldactone) are often used in combination with birth control pills to normalize hair growth and acne
  • Surgery – A process called “ovarian drilling” is used to temporary control androgens and
  • Lifestyle Modification – Eat healthy, exercise and loose weight. Losing weight (which can be difficult) may help to reduce the high insulin levels in the blood. For women with this condition who are overweight, weight loss can reduce insulin resistance, stimulate ovulation, and improve fertility rates.

PCOS Dangers

  • After menopause, excessive hair growth continues, and male pattern baldness or thinning hair gets worse after menopause. Also, the risks of complications from PCOS, such as heart attack, stroke and diabetes, increase as a woman gets older.
  • For pregnant women: There appears to be higher rates of miscarriage, gestational diabetes, pregnancy-induced high blood pressure (pre-eclampsia), and premature delivery in women with PCOS. Researchers are studying how the diabetes medicine metformin can prevent or reduce the chances of having these problems while pregnant. Metformin also lowers male hormone levels and limits weight gain in women who are obese when they get pregnant.
  • More than 50 percent of women with PCOS will have diabetes or pre-diabetes (impaired glucose tolerance) before the age of 40.
  • Women with PCOS have a four to seven times higher risk of heart attack than women of the same age without PCOS.
  • Women with PCOS are at greater risk of having high blood pressure.
  • Women with PCOS have high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol.
  • The chance of getting endometrial cancer is another concern for women with PCOS. Irregular menstrual periods and the absence of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Progesterone causes the endometrium to shed its lining each month as a menstrual period. Without progesterone, the endometrium becomes thick, which can cause heavy bleeding or irregular bleeding. Over time, this can lead to endometrial hyperplasia, when the lining grows too much, and cancer.

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