Dr Tariq Jagnarine
Family Medicine/ Endocrinology, Diabetes
Polycystic ovary syndrome is caused by an imbalance of androgens. Common symptoms include ovarian cysts, irregular menstrual periods, and hair on the face and body. Treatment options include hormonal birth control and the diabetes drug metformin.
Polycystic ovary syndrome (PCOS) is a condition that affects a woman’s hormone levels. Women with PCOS produce higher-than-normal amounts of male hormones. This hormone imbalance causes their bodies to skip menstrual periods and makes it harder for them to get pregnant. PCOS also causes hair growth on the face and body, and baldness. And it can contribute to long-term health problems like diabetes and heart disease.
Birth control pills and diabetes drugs (which combat insulin resistance, a PCOS symptom) can help fix the hormone imbalance and improve symptoms.
PCOS is a problem with hormones that affect women during their childbearing years (ages 15 to 44). Between 2.2 and 26.7 percent of women in this age group have PCOS. Many women have PCOS but don’t know it. In one study, up to 70 percent of women with PCOS hadn’t been diagnosed.
PCOS affects a woman’s ovaries, the reproductive organs that produce estrogen and progesterone — hormones that regulate the menstrual cycle. The ovaries also produce a small number of male hormones, called androgens.
The ovaries release eggs to be fertilized by a man’s sperm. The release of an egg each month is called ovulation.
Follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are produced in the pituitary gland, control ovulation.
FSH stimulates the ovary to produce a follicle — a sac that contains an egg — and then LH triggers the ovary to release a mature egg.
PCOS is a “syndrome,” or group of symptoms that affect the ovaries and ovulation. Its three main features are:
* Cysts in the ovaries
* High levels of male hormones
* Irregular or skipped periods.
In PCOS, many small fluid-filled sacs grow inside the ovaries. The word “polycystic” means “many cysts.” These sacs are follicles, each one containing an immature egg. The eggs never mature enough to trigger ovulation. The lack of ovulation alters levels of estrogen, progesterone, FSH, and LH. Progesterone levels become lower than usual, while androgen levels become higher than usual. Extra male hormones disrupt the menstrual cycle, so women with PCOS get fewer periods than usual.
CAUSES
Doctors don’t know exactly what causes PCOS. They believe that high levels of male hormones prevent the ovaries from producing hormones and making eggs normally. Genes, insulin resistance, and inflammation have all been linked to excess androgen production.
*Genes
Studies show that PCOS runs in families. It’s likely that many genes — not just one — contribute to the condition.
*Insulin resistance
Up to 70 percent of women with PCOS have insulin resistance, meaning that their cells can’t use insulin properly. Insulin is a hormone the pancreas produces to help the body use sugar from energy foods. When cells can’t use insulin properly, the body’s demand for insulin increases. The pancreas makes more insulin to compensate.
Extra insulin triggers the ovaries to produce more male hormones.
Obesity is a major cause of insulin resistance. Both obesity and insulin resistance can increase your risk for type 2 diabetes.
*Inflammation
Women with PCOS often have increased levels of inflammation in their bodies. Being overweight can also contribute to inflammation. Studies have linked excess inflammation to higher androgen levels.
COMMON SYMPTOMS OF PCOS
Some women start seeing symptoms around the time of their first period. Others discover they have PCOS only after they’ve gained a lot of weight, or they’ve had trouble getting pregnant.
The most common symptoms of PCOS are:
*Irregular periods: A lack of ovulation prevents the uterine lining from shedding every month. Some women with PCOS get fewer than eight periods a year, or none at all.
*Heavy bleeding: The uterine lining builds up for a longer period, so the periods you get can be heavier than normal.
*Hair growth: More than 70 percent of women with this condition grow hair on their face and body — including on their back, belly, and chest. Excess hair growth is called hirsutism.
*Acne: Male hormones can make the skin oilier than usual, and cause breakouts in areas like the face, chest, and upper back.
*Weight gain: Up to 80 percent of women with PCOS are overweight, or have obesity.
*Male pattern baldness:
Hair on the scalp gets thinner, and may fall out.
*Darkening of the skin:
Dark patches of skin can form in body creases like those on the neck, in the groin, and under the breasts.
*Headaches: Hormone changes can trigger headaches in some women.
IMPACT OF PCOS ON THE BODY
Having higher-than-normal androgen levels can affect your fertility and other aspects of health.
*Infertility
To get pregnant, women must ovulate. Women who don’t ovulate regularly don’t release as many eggs to be fertilized. PCOS is one of the leading causes of infertility in women.
*Metabolic syndrome
Up to 80 percent of women with PCOS are overweight or have been. Both obesity and PCOS increase your risk for:
* High blood sugar
* High blood pressure
* Low HDL “good” cholesterol
* High LDL “bad” cholesterol
Together, these factors are called metabolic syndrome, and they increase the risk of: heart disease, diabetes, stroke, sleep apnea.
This condition causes repeated pauses in breathing during the night, which interrupts sleep.
Sleep apnea is more common in women who are overweight — especially if they also have PCOS. The risk for sleep apnea is 5 to 10 times higher in women who have both obesity and PCOS than in those without PCOS.
*Endometrial cancer
During ovulation, the uterine lining is shed. If you don’t ovulate every month, the lining can build up. A thickened uterine lining can increase your risk for endometrial cancer.
Depression
Both hormonal changes and symptoms like unwanted hair growth can negatively affect your emotions. Many women with PCOS eventually experience depression and anxiety.
