POLYCYSTIC OVARIAN SYNDROME (PCOS)
Polycystic Ovarian Syndrome, or PCOS, is a condition which occurs in five to ten percent of women of reproductive age. It is associated with a hormonal imbalance that can cause a variety of symptoms, including but not limited to:
Period problems – ranging from no periods at all to irregular, heavy or painful periods. May be linked to difficulty in becoming pregnant due to irregular ovulation (egg release).
Excessive hair growth on the face and body (hirsutism) and/or thinning of the hair on the head (alopecia).
Dark skin patches (called acanthosis nigricans) on the back of the neck or under the armpits or in skin creases.
Problems with easy weight gain and increased upper or abdominal body fat. However, not all women with PCOS have weight problems.
What are the long-term risks?
Studies show that women with PCOS may have an increased risk of:
Diabetes – either pregnancy related or Type 2 (there is an estimated five to seven times higher risk than usual).
Higher blood pressure
Fatty liver disease
Thickening of the endometrial wall (lining of the uterus) which may increase the risk of cancer if not treated.
Fortunately, with early diagnosis and proper management, these risks can be reduced.
What causes PCOS?
No one is quite sure what causes PCOS. Recent studies indicate that lifestyle, environmental and genetic factors can be involved. Sometimes it occurs in families where there is a history of PCOS, diabetes or heart disease.
How is PCOS diagnosed?
Early diagnosis is important so that your symptoms can be managed. Early diagnosis may also prevent long term health problems.
If PCOS is suspected, your doctor will ask you questions about your family history, and your own medical history, including any problems you might be having with your periods (menstruation) and ovulation. Your doctor will also order blood tests to check your hormone levels and an ultrasound to look at your ovaries.
The doctor will suspect PCOS if two of the following situations apply to you:
an ultrasound picture of your ovaries shows polycystic ovaries (PCO)*
you have a history of menstrual or ovulation problems
there are changes in your hormones (like testosterone) that cause excess facial and body hair or acne.
Your doctor will also look for signs of insulin resistance or metabolic syndrome and will also do tests to exclude or rule out other hormonal conditions.
*PCOS is not the same as polycystic ovaries (PCO). PCO only relates to how the ovaries look on an ultrasound, not the entire syndrome. Many people have the ultrasound findings alone and do not have the syndrome.
Hormonal Changes of PCOS
The ovaries and adrenal glands make androgens. Androgens are the so called ‘male’ sex hormones – such as testosterone – that are present in low levels in all women. In PCOS the ovaries either produce more androgens than normal or the body is more sensitive to these levels of testosterone. This may lead to hair growth, acne and irregular periods. It also affects ovulation (release of the egg from the ovary once a month), which may not occur regularly.
Insulin and insulin resistance
When we eat, insulin is the hormone released from the pancreas that keeps blood glucose (sugar) levels well controlled. It moves glucose from the blood to body cells to be used for energy. PCOS increases the body’s resistance to the action of insulin, so it takes higher than usual levels of insulin to let glucose into cells. This is called hyperinsulinaemia. The higher insulin levels affect your ovaries, and change the production of other hormones, such as testosterone, leading to the hormonal symptoms of PCOS.
Insulin is a growth hormone, which normally increases during times such as adolescence and pregnancy, but constant high levels can lead to too much fat in the upper body. Extra fat tissue can then have the affect of increasing the insulin resistance which will lead to even higher insulin levels, further weight gain and worsening PCOS symptoms. Not all women with PCOS are overweight, but thinner women still can have some insulin resistance.
If you have higher insulin levels it does not mean you have diabetes, as your blood sugar levels are usually still normal. However, if your body is eventually unable to create enough insulin to maintain the higher levels, diabetes can occur.