NORTH COAST WOMEN’S HEALTH
707-443-3557 Barbara
Marchi, N.P.
Polycystic Ovary Syndrome (PCOS)
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.