What Is Polycystic Ovary Syndrome?
Polycystic
ovary syndrome (PCOS) is one of the most common female endocrine disorders.Polycystic
ovary syndrome is a complex, heterogeneous disorder of uncertain etiology, but there is
strong evidence that it can, to a large degree, be classified as a genetic
disease.
Polycystic
ovary syndrome produces symptoms in approximately 5% to 10% of women of reproductive age
(12–45 years old). It is thought to be one of the leading causes of female
subfertility and the most frequent endocrine problem in women of
reproductive age.
The principal
features are (1) anovulation, resulting in irregular menstruation, amenorrhea,
ovulation-related infertility; (2) excessive amounts or effects of androgenic
(masculinizing) hormones, resulting in acne and hirsutism; and (3) insulin
resistance, often associated with obesity, Type 2 diabetes, and high
cholesterol levels.
Finding that the ovaries appear polycystic on ultrasound is
common, but not an absolute requirement in all definitions of the disorder.
The
symptoms and severity of the syndrome vary greatly among affected women.
What causes Polycystic ovary syndrome?
A. Polycystic
ovary syndrome
develops when the ovaries overproduce androgens (e.g., testosterone). Androgen
overproduction often results from overproduction of LH (luteinizing hormone),
which is produced by the pituitary gland.
Research
also suggests that when insulin levels in the blood are high enough, the ovary
can be stimulated to produce more testosterone. That is, the combination of
having ovaries that are responsive to insulin and high insulin levels in the
blood, can result in the overproduction of testosterone.
Obesity,
which itself can cause insulin levels to rise, may intensify Polycystic
ovary syndrome. Yet, not all
women who are overweight develop Polycystic
ovary syndrome. Thus, there appears to be something
unique about Polycystic
ovary syndrome both in the excessively high insulin production and the
increased sensitivity of the ovaries to the insulin that is produced.
How is Polycystic ovary syndrome diagnosed?
A.
Initially, many of the symptoms of Polycystic
ovary syndrome acne, obesity, excessive hair
growth, and irregular periods -- are viewed as unpleasant but unrelated. Many
women are not diagnosed until the symptoms become advanced, or until they
experience difficulty with fertility.
There is no
single, quick test to identify Polycystic
ovary syndrome. Accurate diagnosis depends on the
experienced skills of the clinician, a detailed medical history, and laboratory
studies. Some clinicians may choose to use some of the following diagnostic
tools:
Ultrasound, to assess whether ovaries are
enlarged and cystic.
Blood tests, to detect elevated levels of
androgens.
Blood test to detect high levels of LH
(luteinizing hormone) or an elevation in the ratio of LH to FSH (follicle
stimulating hormone).
Monitoring of the ovary's response to
either a stimulatory dose of gonadotropin-releasing hormone agonist (such as
leuprolide
This test was developed at the University of Chicago and has been
used worldwide) or a suppressive dose of medications such as dexamethasone.
The physician
will also try to rule out other possible causes of irregular menstruation and
excessive hair growth, such as Cushing's syndrome, congenital adrenal
hyperplasia, or other disorders of the pituitary or adrenal glands.
Diet and Polycystic ovary syndrome
Where Polycystic
ovary syndrome
is associated with overweight or obesity, successful weight loss is the most
effective method of restoring normal ovulation/menstruation, but many women
find it very difficult to achieve and sustain significant weight loss.
A
scientific review in 2013 found similar decreases in weight and body
composition and improvements in pregnancy rate, menstrual regularity,
ovulation, hyperandrogenism, insulin resistance, lipids and quality of life to
occur with weight loss independent of diet composition.
Still, a low GI diet,
in which a significant part of total carbohydrates are obtained from fruit,
vegetables and whole grain sources, has resulted in increased menstrual
regularity than a macronutrient-matched healthy diet. Vitamin D deficiency may
play some role in the development of the metabolic syndrome, so treatment of
any such deficiency is indicated.