PCOS

POLYCYSTIC OVARIAN SYNDROME

What is Polycystic Ovarian Syndrome?

Polycystic Ovarian syndrome affects 5-10% of females. This syndrome can also be know as, Stein-Leventhal Syndrome, Polycystic Ovarian Syndrome or Disease (PCOS/D) and Hyperandrogenic Annovulation Syndrome. Most commonly Polycystic Ovarian Syndrome is referred to as PCOS.
Poly meaning many, cystic meaning cysts.

PCOS is an endocrine (hormonal) disorder. It can be a frustrating and unfortunate disorder and affects between 5 and 10% of all women of childbearing age. In most cases symptoms usually present themselves at puberty but also have been found to begin in the early to mid 20s. Some certain symptoms of the disorder are life long, the others will cease to exist at menopause.

What causes PCOS?

When the ovaries overproduce androgens (e.g. testosterone) PCOS develops. The overproduction of the androgen is often a result of the overproduction of another hormone - in most cases LH (or luteinizing hormone). LH is produced by the pituitary gland.

More recent research is suggesting that the possible cause of too much testosterone being produced by the ovaries is due to an inability of the female to effectively process insulin (the hormones that enables glucose to get inside the body's cells). When insulin is too high in the blood, the ovary reacts by producing more testosterone. This is called Insulin Resistance. Unfortunately the inability of the woman to process insulin can cause obesity in many women, yet not all. PCOS can also affect women who are of normal weight and who are underweight. Underweight or normal weighted women can also have their insulin processing impaired.

So what else is going on...?

Most of the hormones affected are FSH (Follicle stimulating hormone) - this becomes low in production, estrogen is too high, there are erratic surges of LH, progesterone is too low and there are elevated male hormones (testosterone).

During a normal menstrual cycle, the various hormones listed go through cycles - rising and falling at certain times. In PCOS however, they tend to remain at a constant level throughout the cycle.

A follicle swells but does not release an egg, so it becomes a cyst. The cells surrounding the cyst release weak levels of testosterone, which the body converts into estrogen. The brain senses the high levels of estrogen present and therefore assumes that the ovaries are functioning normally and a ripe egg is ready to be released. The secretion of FSH is cut back and the LH is sent out. LH usually triggers the ripened egg to break away ready for impregnation, but as there is in fact no egg, the follicle forms a cyst and the process is repeated cycle after cycle and the problem gets worse.

In short - polycystic ovaries are where follicles have matured in the ovaries but are never released due to abnormal hormone balance.

What are the symptoms?

Each woman with PCOS will have varying symptoms and though there is a particular set of dignostic symptoms, each case should be looked at separately.
Some of the symptoms are:

Acne

Irregular or absent periods

Numerous cysts on the ovaries

Hirsutism (excessive hair growth on the chest, face and abdomen)

Obesity

Infertility or reduced fertility

Hair loss (androgenic alopecia - similar to male pattern baldness)

High Blood Pressure

Elevated Insulin levels, diabetes or insulin resistance.

Having polycystic ovaries can be one of the symptoms however they are not present in all sufferers which can sometimes makes the common name of PCOS a little confusing. Furthermore the some females will have the polycystic ovaries but will have no other symptoms at all making it more important to understand the difference between having polycystic ovaries and the syndrome.

How is PCOS diagnosed?

One of the problems with PCOS is that many of the symptoms are considered unrelated by the patient and sometimes also the Doctor. Women will go to the doctor with the complaint of one symptom at a time and then treatment is given accordingly for that one symptom. It is often not until a history of symptoms develop that both the doctor and sufferer discover that the ongoing complaints all point toward PCOS. This is when more adequate treatment can begin for the whole syndrome.
As can be the case with many disorders, prognosis of PCOS is dependant upon how quickly the truth is realised. As there is no single or quick test to identify PCOS, correct diagnosis will also rely on the skill of the Doctor in matching all of the pieces of the puzzle together to form a diagnosis.

There are tests that can be performed to confirm other symptoms or hormonal imbalances. Along with the medical history of the patient, the following tests can be done:

Blood test to detect high levels of luteinizing hormone (LH) This will also decipher an elevation in the ration of LH to Follicle stimulating hormone (FSH)

An Ultrasound can be done to assess whether ovaries are enlarged and cystic.

Blood tests, to detect increased amounts of androgen and higher than normal levels of insulin.

The Dr will also check for other symptoms to do with other disorders. For example Cushings Disease may be responsible for excessive hair growth.

What can you do? What help is out there?

Obviously it is incredibly important to have someone to talk to about the condition and to ensure that it is indeed correctly diagnosed. Once the patient knows what they are dealing with they can seek the right kind of help and guidance. Some women seek assistance from naturopaths and start to use herbs in their diet to help with side-effects and symptoms. Other women try low carbohydrate diets if they are battling with obesity. Some females also try to better improve their exercise regimes to make themselves healthier overall and to feel better about themselves.
The most important thing of all is to get help for a GP and make sure that if counselling is needed - it is sought.
Remember Is treatable, but not curable, by medications and changes in diet and exercise.

FOR MORE INFO:

Polycystic Ovarian Support Australia

Other health risks?

Unfortunately women with PCOS appear to be at an increased risk of forming and developing other health problems throughout their lives. Some of the other things that sufferers can be faced with are:

Cancer of the Endometrium

Because women who have PCOS often have infrequent periods, this can produce abnorml and cancerous cells. Often women with PCOS are advised to take the birth control pill which will bring the regular onset of periods.

Infertility or sub fertility

The most common reason for women realising they have PCOS is because they cannot fall pregnant. Infertility or problems falling pregnant are usually brought on by the hormonal imbalances preventing regular ovulation. Ovulation inducing drugs (fertility pills) may be prescribed.

Insulin Resistance/ Type II Diabetes

The inability of most PCOS sufferers to process insulin tends to get worse with age. By menopause almost half of women with PCOS are diagnosed with Insulin Resistance or Type II Diabetes.
By exercising and controlling this from an early age (or as soon as you are aware something is not quite right) will help prevent this getting out of control.

High Cholesterol Levels/Cardiovascular Disease

As there are higher than usual levels of testosterone present this can cause high levels of LDL which is known as the "bad" cholesterol. Levels of HDL (Good cholesterol) can be decreased. This imbalance can unfortunately increase the chances of cardiovascular disease and coronary risk.


- Michelle Palmer