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Billy Johnson, MD, Ph.D

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Polycystic Ovarian Syndrome (PCOS)
by Billy Johnson, MD, Ph.D   
Rated "G" by the Author.
Last edited: Monday, March 24, 2008
Posted: Monday, March 24, 2008

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Polycystic Ovary Syndrome(PCOS)is an endocrine disorder that affects one in ten women of childbearing age (about five million or more American women). It can occur in girls as young as 11 years old. It's a major cause of obesity and infertility. Approximately 75% of women with PCOS have weight problems because the disorder interrupts their metabolism and causes them to store excessive fat.


Did you Know?
Obesity and uncontrolled weight gain have many causes of genetic and environmental origin. Perhaps, the most common problem among women of reproductive age and beyond is Polycystic Ovary Syndrome (PCOS), which is frequently misdiagnosed.

You can suspect PCOS if you’re overweight or obese, and trouble losing weight despite doing all the right things; having irregular periods; trouble getting pregnant; multiple miscarriages; excessive hair growth on your face, chest, and abdomen; hair loss or thinning head hair; acne and skin blemish; dark skin patches around your inner thighs, armpits or neck; high blood pressure; high cholesterol or triglycerides. If you have two or more of these symptoms, the chance is that you may have PCOS. However, no two women have exactly the same symptoms; therefore, it’s not always easy to diagnose women with PCOS.  Getting early diagnosis could help you reduce toxic inflammatory fat and pounds or save your life from a life threatening illness.
What is PCOS?
Polycystic ovary syndrome is an endocrine disease in which too much of the male hormones (i.e. testosterone) are produced by the female ovaries.  This often happens when insulin levels in the blood are very high, causing the ovaries to produce excessive amounts of the female hormone, estrogen, and the male hormones, androgens. Inflammatory abdominal obesity itself can cause high levels of insulin, which may further intensify PCOS.  The hormonal imbalance suffered by women with PCOS may cause the ovaries to produce many eggs that don't grow to maturity.  As a result, most PCOS sufferers have too many male and female hormones, as well as cysts (fluid- filled sacks) in their ovaries.  The cysts, which are responsible for the typical menstruation pain and discomfort, can be sometimes seen on sonograms.

Who is affected?
PCOS affects about one in ten women of childbearing age (about five million or more American women). It can occur in girls as young as 11 years old. Most often this dangerous metabolic disorder is overlooked, misunderstood and under treated by doctors.  Approximately 75% of women with PCOS have weight problems because the disorder interrupts their metabolism and causes them to store excessive fat. Some women develop the condition in early childhood, forcing them to battle weight problems for most of their lives.  Often, their weight will continue to soar despite diet after diet, even if they are doing all the right things. PCOS affects women of all races and nationalities.  PCOS is believed to be either genetic or acquired.  Women who have a sister with the disorder often have high male hormones, even if they do not develop PCOS. Researchers at the University of Chicago, Hospitals, found that 1 in 3 women with PCOS have an abnormal glucose tolerance test and that 1 in 10 will be diabetic by age 40.  Women with PCOS who have a family history of diabetes appear to have a higher risk of developing type 2 diabetes.

Multiple Ovarian Cysts Causing Painful Irregular Menstruation
Most women with PCOS often have multiple small cysts in their ovaries that can cause the ovaries to be enlarged and painful during menstruation causing frequent visits to the emergency room. PCOS can be life threatening if the ovarian cyst ruptures as was the case involving a 19 year old-college student who was brought to the emergency room in a New England small town hospital in shock.  She was pale and her pulse was weak, and was immediately rushed to the operative room to save her life.
Her belly was filled with blood and blood clots all the way to the rib cage. Both ovaries had ruptured and she was  hemorrhaging profusely losing substantial amount of her blood volume into her abdominal cavity. The cause of the rupture was apparently due to two large ovarian cysts called “endometriomas”. They were the size of large grapefruits that looked just like chocolate, and that’s why it’s called a ‘chocolate cyst”. The symptoms of a ruptured or bleeding ovarian cysts is often confused with a ruptured ectopic pregnancy, which also requires an emergency surgical exploration and treatment.
The monthly release of an egg from an ovary in women is regulated by estrogen, and the process is called ovulation. In women with PCOS excessive amounts of estrogen is produced and the female eggs never really develop to maturity causing irregular ovulation or failure to ovulate, which can lead to irregular bleeding and infertility. Not ovulating (anovulation) can increase your lifetime exposure to estrogen stimulating the endometrial tissue to divide rapidly into cancerous growth. The hormonal imbalance also causes acne, excessive facial hair or thinning hair on the head. Treating obesity and PCOS can help restore the monthly ovulation and hormonal imbalance, menstruation cycle, and decreasing risk of endometrial cancer and infertility.
Insulin Resistance, a Probable Cause
PCOS sufferers are often overlooked, misunderstood and under-treated by doctors who do not suspect the disease since it varies in its presentation, which makes diagnosis more difficult. For example, some women with the disorder may have normal regular periods and normal ovaries, including ideal body fat and weights, while others may have the classic symptoms. Many women with PCOS, however, have insulin resistance, but again, not all of them. To add to the problem is the prejudice against overweight women, which can also contribute to misdiagnosis.
Doctors who are not familiar with the disease may blame women for their excessive weight and body fat. But, women are not to be blamed, because the disease is far more complicated than the lack of physical inactivity and emotional causes. If left untreated, as stated earlier, women with PCOS may develop endometrial cancer (the lining of the uterus) and are also at risk for developing heart disease, high blood pressure and type 2 diabetes due to insulin resistance and low-grade chronic inflammation.
PCOS may cause Resistance to Fat & Weight Reduction
Some women develop the condition in early childhood, forcing them to battle weight problems for most of their lives. Often, their weights will continue to soar despite diet after diet, even if they are doing all the right things. Insulin resistance is the real culprit responsible for causing a PCOS sufferer to store fat and develop heart disease and diabetes and worst of all making it difficult to lose weight or reduce body fat and keep it off permanently.  
Reducing inflammatory abdominal fat can help reduce insulin resistance and inflammation and normalize blood glucose level, male hormones and lipid levels. This will also increase your chance of becoming pregnant in case of infertility. Sometimes, losing a mere 20 to 30 pounds is usually sufficient to decrease body fat enough to cause ovulation to occur even without hormonal therapy.
Diagnosis of PCOS
A program of exercise, low glycemic carbohydrates, and high bulk-fiber foods of vegetables and fruits rich in antioxidants and phytonutrients can help with body fat reduction and weight reduction. Yet paradoxically, women with PCOS have a very difficult time reducing body fat or losing weight because the male hormones and high insulin tend to stimulate appetite and cause overeating. In addition, the high insulin stimulates excessive fat storage. To make a diagnosis, you need a thorough medical history and a high degree of suspicion, physical exam and the following tests:

Sonograms to detect enlarged ovaries or ovarian cysts.
Blood tests to detect high levels of male hormones.
Blood test to detect high levels of the hormones LH and FSH or their ratio LH/FSH.
Blood test to detect high levels of fasting glucose and insulin.
Monitoring the ovaries response to hormone releasing or suppressing compounds.

Health Risks:

-       Left untreated, women with PCOS are at increased risk of developing:
-       Insulin resistance or syndrome X
-       Type 2 Diabetes
-       Lipid abnormalities low HDL (good) and high LDL (bad) cholesterol
-       Hypertension
-       Heart disease
-       Mal-function of the ovaries can cause infertility and abnormal menstrual cycles. Majority of   women will seek medical help for this reason and that's when the diagnosis is usually made.
-       Cancer of the lining of the uterine (endometrial cancer)

Treatment Options:

     Although there is no cure for PCOS, there are a number of treatments for specific symptoms:
-    The diabetic drug (Glucophage) metformin helps lowers insulin resistance, and may promote fat and weight reduction.  It may also protect against heart disease and help women have a normal period and become pregnant.
-    Birth control pills and progesterone can be used to treat irregular periods, acne, and excessive facial and body hair.
Spironolactone is also helpful for acne and excessive hair growth.
-    Infertility drugs, such as Clomid, Pergonal, Metrodin and Fertinex are effective in helping some women conceive by inducing ovulation.
-    Low glycemic carbohydrates may help control glucose and insulin levels causing fat and weight reduction and may even help women ovulate and become pregnant.
-    Exercise may help muscle burn carbohydrates and even help decrease blood sugar, insulin, triglyceride and male hormone levels. A consistent exercise routine of about 30 minutes daily is effective.
-   Stress management or reduction of chronic stress may help to reduce insulin resistance and levels of male hormones, including cortisol, which can break down muscle tissue causing a depressed metabolism ---- a condition that accelerates fat storage.

The management of PCOS is a lifelong endeavor that requires the help of a physician familiar with the disorder. If you suspect you may have PCOS, ask your primary physician or gynecologist to refer you a reproductive endocrinologist or infertility specialist. Many experts think that the number of women developing PCOS is growing, particularly among the teenage population. The disorder is believed to be either genetic or acquired. Women who have a sister with the disorder often have high male hormones, even if they do not develop PCOS. Environmental factors such as extreme stress, sedentary lifestyle and highly refined carbohydrate diets may predispose an individual to develop PCOS.
 PCOS is discussed in my Blog---I like to hear from you.
Selected Reference:
American Association Clinical Endocrinologists
American Society of Reproductive Medicine
Polycystic Ovarian Syndrome Association
The Hormone Foundation
Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome: Treatment with Insulin Lowering Medications





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Reviewed by Cryssa C 4/24/2008
Sounds like my sister...
You are a wealth of information...

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