Polycystic Ovarian Syndrome Explained (PCOS)— The Many Causes, Symptoms, and Treatments
Polycystic Ovarian Syndrome (PCOS), first officially identified in 1935 by Chicago gynecologists, Stein and Leventhal is characterized by irregular menstrual periods in women, facial hair growth, acne, thinning hair, and weight gain around the abdomen. Individuals with the condition often have enlarged ovaries, containing multiple liquid-filled cysts. Recognized as an endocrine disorder affecting the balance of male and female hormones, historically doctors explored ways to treat patients, initially considered infertile.[1] Today, according to the American Society for Reproductive Medicine, as many as 15% to 20% of women suffer with PCOS.[4] About 40% of those women have difficulty with fertility. In fact, PCOS remains the leading cause of infertility in the United States.[2]
What is the cause of PCOS?
Referred to as “polycystic”, meaning “many cysts” PCOS often presents with ovaries containing several small, pearl-sized cysts. These consist of immature eggs and are filled with fluid. The actual cause of polycystic ovarian syndrome (PCOS) is not fully known however. One theory suggests that some women with the condition do not respond well to insulin in the body. This, “insulin resistance” may lead to the overproduction of male hormones known as, “androgens”. These hormones are responsible for the presence of male characteristics such as facial hair growth, and male-pattern baldness. PCOS is thought to be hereditary and the chances of having polycystic ovarian syndrome are much greater if a mother, sister, or biological aunt have the condition.[5]
PCOS Symptoms Overview
Polycystic ovarian syndrome is a collection of symptoms ranging in severity depending on the individual.
PCOS symptoms may include:
- Absence of menstrual periods/irregular menstrual periods
- Infertility
- Facial hair growth or excessive/unwanted hair growth (hirsutism)
- Male-pattern baldness/thinning hair
- Weight gain (especially in the waist)
- Acne
- Darkening of skin in neck creases, under breasts, or in the groin
- Skin tags[3]
Secondary conditions associated with PCOS include:
- High blood sugar levels
- Insulin resistance
- Diabetes
- Issues with heart and blood vessels
- Cancer of the uterus
- Sleep apnea
- Heart disease
- Depression and anxiety
- Liver inflammation
- Gestational diabetes[5]
How is PCOS diagnosed?
Physical exam—A healthcare practitioner may suspect PCOS based on a physical examination whereby excess unwanted hair, acne, belly fat, skin discoloration or thinning scalp hair is visibly detected.
Pelvic exam—A pelvic exam may reveal an enlarged clitoris or swollen/ enlarged ovaries.
Pelvic ultrasound (sonogram)—Sound waves are used to check the ovaries (for cysts) and the uterine lining.
Blood testing—Hormone tests may be conducted to determine the level of androgens (male hormones) in the body. Cholesterol and diabetes tests may also be run. Other hormone testing may be done to rule out other health problems such as thyroid disease.[5]
When does PCOS begin?
Polycystic ovarian syndrome may present during first menstruation, or later after considerable weight gain. PCOS symptoms may also increase in severity with obesity as well.[5]
What PCOS treatments are available?
Treatment for the condition is based on specific PCOS symptoms, age, and a woman’s future plans for pregnancy.
PCOS treatments may include:
- Oral contraceptives to help regulate menstruation
- Laparoscopic ovarian drilling for infertility
- Medications to promote insulin sensitivity
- Inducing ovulation through hormone therapy
- Medication to block androgens
- Medication to prevent hair growth
- Laser hair treatment
- Hair loss treatment
- Skin treatment for acne
- Skin treatment for dark patches
- Skin tag removal
- Nutrition/Weight loss[5]
How does a healthy lifestyle help treat PCOS symptoms?
Because insulin resistance is associated with PCOS it is important to adopt a diet low in refined carbohydrates. Exercise can also be beneficial in helping to regulate blood sugar levels and maintain a healthy weight. In some instances, changes in diet and exercise may be enough to stimulate regular ovulation and menstruation.
Long-term Impact of PCOS
Although there is no cure for PCOS, the condition and many of its symptoms are treatable. In fact, most women who are infertile because of polycystic ovarian syndrome are able to successfully conceive with the help of medical treatment.
Over the course of a lifetime, more than half of women with polycystic ovarian syndrome will get diabetes. They will also be at greater risk for certain cancers and heart disease. Although menstrual cycles may stabilize as women age, the primary hormonal imbalance associated with PCOS will remain. While polycystic ovarian syndrome affects many systems throughout the body, through healthy lifestyle changes and medical intervention, most PCOS symptoms can be successfully managed.
Bibliography
1Layout 1 (2010) Available at: http://medind.nic.in/jaq/t10/i2/jaqt10i2p121.pdf (Accessed: 7 October 2016).
2pmhdev (no date) ‘Polycystic Ovary syndrome – national library of medicine – PubMed health’, .
3Polycystic ovary syndrome (2016) Available at: https://medlineplus.gov/ency/article/000369.htm (Accessed: 7 October 2016).
4Sirmans, S.M. and Pate, K.A. (2013) ‘Epidemiology, diagnosis, and management of polycystic ovary syndrome’, 6.
5Staff, M.C. (2014) ‘Polycystic ovary syndrome (PCOS) definition’, Mayoclinic, .
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CAN PCOS BE CURED COMPLETELY? IF YES, THEN HOW?
One in 10 women of childbearing age lives with the effects of PCOS every day. Classified as a metabolic disorder, the syndrome wreaks havoc on a woman’s hormone production and reproductive cycle with symptoms that include an irregular menstrual cycle, insulin resistance, hirsutism (hair growth), thinning hair, acne and weight gain. The syndrome is responsible for the majority of infertility issues in women, causing small fluid-filled cysts to form in the ovaries that interfere with normal ovarian function and reproduction.
Androgens, Genetics, and Environment—New Hope for a Cure
Researchers at the University of Birmingham may just be one step closer to finding a cure for Polycystic Ovarian Syndrome. While scientists have long since known that excessive androgens (male sex hormones) are responsible for the many symptoms associated with the medical condition, until now only testosterone was thought to be important in the PCOS equation.
Research published in the Journal of Clinical Endocrinology and Metabolism identifies a new class of androgens known as 11-oxygenated C19 steroids that play a major role in polycystic ovarian syndrome. In fact, scientists have found that these androgens make up more than half of the androgens found in PCOS sufferers. The significance of this is staggering as Dr Michael O’Reilly, from the University of Birmingham, and author of research adds ‘This recent paper adds to the puzzle that needs solving: how male hormones increase the risk of metabolic disease in PCOS”. Like other chronic medical conditions, the more researchers can learn what drives certain disease processes, the closer we are to a cure in this area.
Genetic Links
Genetic studies and a found link between pituitary function and PCOS have also furthered progress toward a greater understanding of the disease according to University of Utah endocrinologist, Dr. Corrine Welt. One study of over 2000 women of European dissent helped identify risk factors in Caucasian women. “Until this new study, the pituitary was not thought to be the driver of PCOS, but a passenger in the syndrome,” says Welt. “The increased pituitary hormones were not even considered a critical abnormality in the diagnosis…The study is the first to identify genetic variants, changes in the DNA that make up our genes, that put Caucasian women at risk for PCOS”, reiterates the endocrinologist. “The pituitary gland will probably explain the cause in a subset of women with PCOS,” says Welt. “The study found many other genetic risk variants that will likely explain the cause in other subsets of women with PCOS”.
Environment and PCOS
One controlled, cross-sectional study involving 1854 female participants found definitive links between Polycystic Ovarian Syndrome and environmental exposure to toxins thought to be “endocrine disrupters” (ED’s). The study that measured sex hormone, glucose and insulin in participants aged 12–44 years gathered responses to predesigned questionnaires on medication history, contact with possible ED’s, environment and daily habits.
To further isolate the independent risk factor for PCOS, matched logistic regression analysis was used. Comparisons were made involving one hundred sixty-nine PCOS patients and 338 matched controls. Results indicated that more individuals in the PCOS control group had eaten plastic-packaged food, as well as produce treated with insecticide. More individuals in the group also lived within close proximity of a refuse site as compared to other participants who did not have Polycystic Ovarian Syndrome. While further research is necessary to corroborate the study, the association between PCOS and ED’s was evident.
PCOS Treatment
While the search for a cure for PCOS continues, the U.S. Office on Women’s Health suggests effective management of symptoms through a combination of therapies that address fertility issues, as well as other long-term health consequences such as, diabetes and heart disease.
Treatment includes:
Weight loss—By losing weight PCOS patients may be able to lower blood glucose levels and even change the way in which the body uses insulin. This can lead to a better balance of hormones, relieving many of the symptoms related to the condition. Even a modest 10 percent weight loss can significantly improve menstrual regulation and the possibility of becoming pregnant if previously infertile.
Hair growth removal—Laser hair removal, electrolysis or treatment with a prescription, e ornithine HCl cream may remove or slow growth of hair in unwanted places.
Prescription medicines—Birth control pills, vaginal rings, shots, patches or IUD’s may be prescribed to alter the hormone imbalance that leads to acne or hirsutism. Medications that block androgen production or androgen effects may be used, as well as other drugs that help lower insulin or assist in ovulation.
In vitro fertilization (IVF)—To facilitate pregnancy in PCOS sufferers, IVF may be an effective option. In vitro fertilization implants viable female eggs fertilized with male sperm directly into the uterus.
Surgery—The process of ovarian drilling works by creating holes in the ovarian cortex (outer shell) using a laser or heated needle. This generally restores ovulation for a limited period (six to eight months) to enable conception and pregnancy.
Complementary Therapies
Complementary Therapies—These include those therapies used to supplement other treatments or those that act as an alternative to mainstream conventional therapies. Included are acupuncture, exercise, and the polyphenol, resveratrol. Several studies confirm that these may work to improve metabolic, hormonal or psychological symptoms.
While researchers continue to look for a definitive cure for Polycystic Ovarian Syndrome, no one piece of information appears to hold the key. Instead, a combination of significant factors involving genetics, environment, and behaviors will likely provide the answers.