What is Polycystic Ovary Syndrome?
Over the past few years, few other conditions in the field of reproductive medicine have been more debated and discussed. I am frequently asked by patients about articles they have read on the web, or some tidbits they heard from a friend.
There’s a good reason for all the media spotlight, however. Polycystic ovary syndrome (PCOS) affects roughly 5 million women in the United States, or about 4% of all reproductive-aged women. While 4 percent doesn’t seem like much, it is the most common hormone disorder in reproductive-aged women and is the leading cause of female infertility. Fortunately, it is also one of the most treatable forms of infertility. This is something many aren’t aware of, though. I’ve seen patients who suffer from PCOS too long because it is unrecognized or mistreated. All of these patients are surprised when they find that there are effective treatments available for virtually every symptom associated with PCOS.
Polycystic ovaries are characterized by the presence of many small cysts, typically 2 – 6 mm in diameter. Before the advent of better technology and techniques, PCOS could only be diagnosed during surgery when the ovaries were visible. Luckily, we have access to machines like an ultrasound, which can reveal the polycystic nature of an ovary without invasive surgery.
Ultrasound technology has improved our understanding of the condition and she light on the fact that polycystic ovaries have been observed in 25% of normal women. This new information means that it is extra important to distinguish between polycystic ovaries that are asymptomatic and PCOS.
Polycystic ovaries are a common in patients with PCOS, but do not define the condition. A runny nose is something you expect to find in someone with a cold, but does not necessarily mean that anyone with a runny nose has a cold. There are lots of other reasons that can make our noses run, such as allergies, sniffing pepper, crying, etc. Similarly, women with PCOS also present with a variety of symptoms, with polycystic ovaries comprising one feature of many symptoms of polycystic ovary syndrome.
What Are the Symptoms of PCOS?
PCOS is determined by irregular ovulation and signs of excessive androgen (male-type hormones) effect. The diagnosis cannot be established by a single symptom or clinical test alone. In fact, that’s why it’s called a syndrome–because it’s grouping of symptoms.
Often times, all kind of different individuals may exhibit an extreme variety of symptoms, ranging from a thin woman with occasionally missed menses to an overweight woman with no menses who suffers from hirsutism acne, diabetes, balding, skin pigmentation and the inability to lose weight no matter how many diets she follows.
What Causes PCOS?
To put it simply, PCOS is the result of a hormone disorder that disrupts normal ovarian function. This hormone imbalance affects the ovary’s ability to mature and release an egg. Under normal circumstances, a woman’s pituitary gland, located in the center of the brain, releases follicle stimulating hormone (FSH) which stimulates the ovaries, prompting them to mature or “grow” an egg. This normally triggers the production of an egg.
Once the egg has matured, the follicle sends a signal to the brain indicating it is ready for ovulation. The pituitary gland then sends out a pulse of luteinizing hormone (LH), telling the ovary to release or ovulate the egg. The follicle ruptures (i.e., the cyst pops) releasing the egg to the surface of the ovary where the fallopian tube should pick it up.
PCOS occurs when the hormonal signals are not carried through to the ovaries. Thus, follicles do not grow and release the egg, but instead stay small (2 – 6 mm in diameter) each month. Over time, these small follicles build up resulting in an ovary packed with multiple small cysts.
We still don’t fully understand why the ovaries fail to respond to FSH. One common theory suggests that there are elevated “resistance factors” that keep the ovaries from functioning normally. Some of these resistance factors include androgens and insulin-like growth factors. Hormones like these raise the threshold at which the ovary will respond to FSH. If the FSH does not reach the necessary levels, the follicles don’t respond and remain in the early phase of their development.
These resistance factors are manifested in other unpleasant ways throughout other parts of the body. Androgens may cause hirsutism or male-type distribution of hair growth on the face, chest and abdomen, as well as increased activity in the oil gland of the hair follicle, which may result in oily skin and acne.
Nearly 70% of patients with PCOS have some degree of insulin resistance, which means it takes more insulin than normal to regulate blood sugar levels. The reason for this insulin resistance is an intense area of research, as the exact cause is still unknown. Currently, leading theories suggest the cause seems to be related to a defect within the cells signaling mechanism, which allow glucose to come into the cell. Due to the cellular resistance, PCOS patients have elevated levels of insulin and/or insulin-like growth factors. Furthermore, insulin promotes growth or body mass/weight retention, which means PCOS patients have a very difficult time losing weight regardless of how much they exercise and diet.
Excess body weight and obesity are commonly known stimulants to both elevated androgen levels and insulin resistance, meaning women with PCOS often become trapped in a vicious cycle. The more weight they gain, the worse the condition becomes. All the symptoms of PCOS, including hirsutism, anovulation and difficulty losing weight become more difficult to reverse. Consequently, excess weight can exacerbate PCOS and in some individuals can even be the sole cause of the condition.
The treatment of PCOS begins with the symptom the individual wishes to treat first. Because it is a multifaceted disorder, several different treatments are available depending on the symptom you wish to improve. The medicinal treatments for PCOS can be directed at a specific symptom or combined to treat several complaints. But first, the patient and physician must decide on what the therapeutic goals should be.
Almost every patient with PCOS can be treated effectively. The symptoms are so diverse and many, so no single treatment fits all conditions. But we’re committed to working with our patients to develop an individual plan for their treatment.