Polycystic Ovarian Syndrome - General Info About PCOS

General Information About PCOS

What is PCOS? | What's going on in my body? | What causes it?
How is it diagnosed? | Problems and risks associated with PCOS

What is PCOS?

Polycystic ovarian syndrome (also referred to as Stein-Leventhal syndrome, polycystic ovarian disease or hyperandrogenic chronic anovulation) is an endocrine disorder found in 5%-10% women. It can cause a myriad of symptoms that appear, on the surface, to be unrelated, including:

irregular or absent periods
lack of ovulation
weight gain (particularly around the waist - the "apple" shape as opposed to the "pear" or "hourglass" shape which is more typical for women)
hirsutism (excess body hair) which tends to worsen over time
insulin resistance (now thought to be a cause rather than a symptom, more on this later). When insulin resistance is found along with high blood pressure, high triclyceride levels, decreased HDL (good cholesterol) and obesity, it is sometimes termed "Syndrome X".
acne
male-pattern balding
multiple small cysts on the ovaries
acanthosis nigrans (darkening of the skin under the arms and breasts and at the nape of the neck)

What's going on in my body?

In PCOS, a cycle starts wherein the body becomes resistant to insulin, leading to the release of more and more insulin to compensate. This condition is called hyperinsulinemia. The ovaries of PCOS women seem to be particularly sensitive to high blood levels of insulin and respond by overproducing androgens (such as testosterone). This disrupts the "feedback loop" between the ovaries and the pituitary gland, and the pituitary gland produces too much LH (luteinizing hormone), leading to more overproduction of androgens. The immature follicles in the ovaries then fail to convert the excess androgens to estrogen, which inhibits the development of the follicle. Ovulation doesn't take place because the egg couldn't develop properly, and the immature egg, instead of being released from the ovary, becomes a tiny cyst that starts producing its own supply of androgens, which interferes with next month's developing follicle.

What causes it?

In the past it was thought that PCOS was caused entirely by excess androgen production, but recent research has shown that the factor that causes the problem is insulin resistance and hyperinsulinemia, which in turn cause overproduction of androgens. Treatment previously revolved around treating the androgen imbalance, and wasn't necessarily very effective. Newer treatments focus on the insulin problems and are showing great promise. There's an excellent diagram of the process at Polycystic Ovary Syndrome: A New Direction in Treatment. The diagram is about halfway down the page, under the heading "Insulin Resistance in the Polycystic Ovary Syndrome." The whole article is good and gives a great explanation of the process.

How is it diagnosed?

PCOS is often overlooked by doctors, though awareness of it is increasing. It is generally diagnosed through various blood tests and ultrasound. It shouldn't be diagnosed by ultrasound alone, though, because about 20% of women have polycystic-appearing ovaries - it's a symptom of chronic anovulation, which can be caused by other things. Blood tests can be done to test a number of different hormone levels - high androgen levels (particularly free testosterone), high levels of LH or elevated LH to FSH (follicle stimulating hormone) ratio are often the basis for diagnosis.

Problems and risks associated with PCOS

Women with PCOS have an increased risk of developing a number of other health conditions. This does not mean that by having PCOS you are destined to develop any of these problems, just that you have a higher risk than the general population.

Type II (adult-onset) diabetes. By controlling the production of insulin and with changes in diet, this risk can be reduced. If it isn't treated, there is up to a 40% risk of developing diabetes by age 40.
High cholesterol and triglyceride levels
Cardiovascular disease. Again, by controlling the production of insulin, this risk can also be greatly lowered. During treatment cholesterol levels have often been seen to drop down to normal levels as well.
Endometrial cancer (cancer of the uterine lining). This risk comes from lack of menstruation - if you haven't reached menopause and aren't having periods on your own on a semi-regular basis, you need to be treated or you may risk developing endometrial cancer.