Polycystic ovary syndrome, commonly known as PCOS, is one of the most common female endocrine disorders.
A syndrome is a group of signs and symptoms that occur together to characterize a particular condition. The definition of PCOS includes irregular periods, signs of excess androgenic hormones (masculine hormones) such as acne and excess hair growth, and an exclusion of other causes of an elevation of androgens. Although the name indicates the presence of cysts on the ovaries, not all women with PCOS have cysts (and not all women with ovarian cysts have PCOS).
What causes the signs and symptoms?
Research has shown that PCOS is likely genetic. An elevation and/or over-activity of androgenic hormones (such as testosterone) occur(s) due to overstimulation of the ovaries.
The ovaries are stimulated by two hormones from the pituitary gland in the brain—luteinizing hormone (LH) and follicle-stimulating hormone (FSH)—which are responsible for regulating the menstrual cycle. In PCOS, a higher amount of LH is released from the brain, which causes excess testosterone to be released from the ovaries.
Another hormone involved in PCOS is insulin, which is most commonly known for regulating blood sugar. Higher amounts of insulin are present in women with PCOS because the cells are not as sensitive to the stimulation of insulin (so-called insulin resistance). Insulin, just like LH, can also cause overstimulation of the ovaries and cause an increased release of androgenic hormones.
How is PCOS diagnosed?
The first step in evaluating any syndrome is a thorough medical history. Some of the questions your physician may ask you regarding PCOS include:
• Has your menstrual cycle been regular?
• Have you noticed any new hair growth on your face or chest?
• Have you developed acne, or has your acne become worse?
• Have you experienced hair loss?
• Have you had trouble getting pregnant?
• Has your weight fluctuated?
The presence of the signs and symptoms of PCOS is a major component of the diagnosis. A blood test to evaluate for excess androgens (testosterone and DHEA-S) and pituitary hormones (LH and FSH) will provide additional information.
Women with PCOS are predisposed to diabetes, based on the resistance to insulin, as well as high cholesterol. Therefore, these conditions should also be part of the blood-work evaluation.
How is it treated?
Treatment is aimed at trying to address the underlying causes of PCOS symptoms (excess androgen activity and insulin resistance).
Lifestyle Changes – Lifestyle changes are always the preferred treatment, if possible. Being more active throughout the day and minimizing processed foods that are high in sugar are good starts to modifying the hormone levels.
Medications – If lifestyle changes do not improve the symptoms of PCOS, then medications may be helpful.
• Oral contraceptives that have both estrogen and progesterone are helpful in regulating the menstrual cycle and can also be effective in reducing hirsutism (excess body hair) because of their anti-androgen properties.
• Spironolactone also has an anti-androgen effect (blocks testosterone cell receptors) and can be very useful for hirsutism and male-pattern hair loss. While on this medication, it is important to monitor blood pressure, which may be decreased, and have blood tests to evaluate for an elevated potassium level.
• Metformin works primarily by reducing insulin resistance. It can be effective in regulating metabolism, inducing ovulation and maintaining normal blood sugar.
• Clomiphene citrate (clomid) may be prescribed to assist with ovulation in women who are trying to get pregnant. It works by blocking the effect of estrogen on the pituitary gland, which increases FSH and causes the ovarian follicles to mature for ovulation.
An understanding of the various hormones involved in PCOS has enabled clinicians to effectively treat many of its symptoms, which is always rewarding as a physician!
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