Polycystic Ovarian Syndrome (PCOS)

For patients looking for additional information about Polycystic Ovarian Syndrome (PCOS), Dr. Pellegrini and Dr. Minassian have compiled the Polycystic Ovarian Syndrome Resource Guide. Please click here to download the booklet.

Polycystic Ovarian Syndrome is a hormonal disorder. Research suggests that PCOS affects between 5 and 10% of all women of childbearing age regardless of race or nationality.

In the case of PCOS, the ovaries are filled with tiny cysts. Using an ultrasound, they look like black rasin sized dots on the ovaries. The term "string of pearls" has been used to describe this ultrasound appearance. These cysts contain eggs that have failed to properly mature and release from the ovaries.

PCOS symptoms usually present during puberty but may also begin in the early to mid 20s. Certain symptoms are life-long, others will cease at menopause.

Polycystic Ovarian Syndrome is caused by an overproduction of hormones in women during their reproductive years. The severity of symptoms varies from woman to woman, and the disease can only be accurately diagnosed with blood tests. Many of the symptoms can be eradicated with medication.

The following is a list of some of the possible symptoms of PCOS:

• Irregular menstrual periods
• Excessive hair growth, such as on the face, chest, back or abdomen
• Obesity
• Infertility, as seen in 80% of the women with PCOS
• Multiple tiny cysts on the ovaries often seen on ultrasound
• Male pattern baldness and hair thinning
• Dark, pigmented skin on the neck

In addition, women with PCOS appear to be at increased risk of developing the following health problems during their lives:

• Insulin resistance or pre Diabetes
• Diabetes
• Lipid abnormalities
• Cardiovascular disease such as heart disease, heart attacks and stroke
• Endometrial cancer

Although multicystic or polycystic ovaries on ultrasound can be one of the findings, this isn't present in all sufferers, making the most common name of the syndrome confusing. In addition, many women without PCOS have polycystic ovaries on ultrasound but none of the other features and therefore it is important to understand the difference between the syndrome and having only polycystic ovaries.

PCOS is sometimes called "hyperandrogen anovulation syndrome" which describes its hormonal imbalance and associated problems with ovulation better. However the term Polycystic Ovarian Syndrome has been used by the medical profession since the early 1930s and is almost too entrenched in medical literature to change to a more appropriate term.

PCOS develops when the ovaries overproduce androgens – male hormones, like Testosterone. The overproduction of androgens usually triggers overproduction of Lutenizing Hormone (LH), which is produced by the pituitary gland in the brain. This then interferes with ovulation and the menstrual cycle becomes irregular.

Research suggests the cause of the overproduction of Testosterone by the ovaries is due to the woman's geneticially controlled ability to handle her blood sugar by Insulin released by the Pancreas. A "blockode" is present making it difficult for her Insulin to process sugar. This leads to higher and higher levels of Insulin needed to keep the blood sugar under control. This situation is called Insulin Resistance or Hyperinsulinemia, as pre Diabetic condition.

Over years of this excessive Insulin production, the Pancreas gets progressively more exhausted releasing high levels of Insulin and it cells begin to die out. As this occurs, the Insilin level falls and the blood sugar is no longer able to be controlled and Type II Diabetes sets in. All people, male and female, who end up with Type II Diabetes have gone through this process of Insulin Resistance. It turns out that Insuln directly stimulates the ovaries to produce Testosterone. When Insulin levels are too high, the ovaries react by producing excessive amounts of testerone. This leads to a vicious cycle of not ovulating and producing too much Testerone, all driven by too much Insulin. A cascading effect of other conditions is also triggered, including excessive hair growth, acne and head hair loss.

The inability of the woman to process this excess insulin can also lead to obesity. But not all PCOS are obese – even though in the past being excessively overweight was considered a diagnostic symptom. Research over the past number of years has found that PCOS can affect women who are underweight and of normal weight. These so called "thin" sufferers can also have impaired insulin processing.

• What Every woman and Her Doctor Should Know About Polycystic Ovary Syndrome as Written by AACE

• Facts About Polycystic Ovary Syndrome from The Hormone Foundation