Polycystic Ovarian Syndrome (PCOS): A Hormonal Imbalance
03/21/2012 | 04:25 PM
Polycystic Ovarian Syndrome: Summary and Overview
Polycystic ovarian syndrome (PCOS) is condition that affects between one in 10 and one in 20 women. It caused by an imbalance of the female sex hormone and higher levels of male hormones called androgens. It is also called Stein-Leventhal syndrome, Sclerocystic Ovarian Disease, and Chronic Anovulatory Syndrome.
Polycystic Ovarian Syndrome: Causes
The exact cause of PCOS is unknown but it likely comes from the interplay of genetic and environmental factors. PCOS seems to run in familes and research is on-going to find out if there’s an identifiable gene for the condition.
A main underlying problem with PCOS is a hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. Androgens are male hormones that females also make. Scientists aren’t sure why some people make too much of them, although it could be triggered by the pancreas secreting too much insulin, excessive exposure to male hormones in fetal life, or eating certain foods for people who are predisposed. High levels of these hormones affect the development and release of eggs during ovulation.
Studies also suggest that excess insulin production is related to polycystic ovarian syndrome. Insulin is the hormone needed to control the change of sugars and starches into energy. Many women with PCOS often have elevated levels of insulin in the blood and insulin resistance because their bodies have problems utilizing it. Elevated levels of insulin appear to augment the production and release of androgen. Elevated levels of androgen can cause acne, excess growth of hair, weight gain, and ovulation problems.
The syndrome acquired its most widely used name due to the common sign on ultrasound examination of multiple (poly) ovarian cysts. They are sometimes said to look like a pearl necklace. These "cysts" are actually immature follicles, not cysts.
Polycystic Ovarian Syndrome: Symptoms
Polycystic ovarian syndrome can impact a number of different bodily functionings. Most women who have the condition have small cysts (or immature hair follicles) in the ovaries. However, women may have cysts in the ovaries for other reasons too, and so it is the characteristic constellation of symptoms, rather than the presence of the cysts themselves, that is important in establishing the diagnosis of PCOS.
The principal signs and symptoms of PCOS are related to menstrual disturbances and elevated levels of male hormones (androgens). Symptoms related to elevated androgen levels include acne, excess hair growth on the body (hirsutism), and male-pattern hair loss.
Other signs include:
- obesity and weight gain
- missed or irregular periods
- elevated insulin levels and insulin resistance
- oily skin,
- skin discolorations,
- high cholesterol levels,
- elevated blood pressure,
Women with PCOS are at a higher risk for a number of illnesses, including high blood pressure, diabetes, heart disease, and cancer of the uterus (endometrial cancer).
Polycystic Ovarian Syndrome: Diagnostic Tests
The principal signs and symptoms of PCOS are related to menstrual disturbances and elevated levels of male hormones (androgens). Diagnosing the condition is a matter of discussing your symptoms and taking other tests for the right diagnosis. Your doctor will also check for increased hair growth, enlarged clitoris, swollen ovaries. Elevated blood pressure, increased cholesterol levels, and diabetes are also common symptoms of the condition.
Obesity is linked to PCOS, and for that reason your doctor will take your height and weight measurements during your physical examination. However, it’s still being debated whether obesity causes PCOS to emerge or whether those with PCOS have higher weight because the condition triggers weight gain. It is known that obesity, sometimes even beginning early in life, is present in about 60 % of persons with PCOS.
- Blood tests and hormone tests may be ordered to identify the levels of the different hormones such as estrogen, follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone and androgen (male hormones), and 17-ketosteroids. They may also test for levels of lipids, pregnancy test or serum HCG, thyroid function tests, and prolactin levels. Your doctor will want to rule out possible causes of menstrual abnormalities or androgen excess that mimic PCOS.
- Pelvic ultrasound. A pelvic ultrasound can show the appearance of your ovaries and the thickness of the lining of your uterus (endometrium). The endometrium thickens when menstruation is irregular. During the pelvic ultrasound, you lie on a bed or examining table while a wand-like device (transducer) is placed in your vagina (transvaginal ultrasound). Inaudible sound waves travel through the human body to create an image of the organs and look for the pearl necklace of polycystic ovaries. The ultrasound is not routinely done for the diagnosing of PCOS as the presence of ovarian cysts can be from a cause other than polycystic ovarian syndrome.
Polycystic Ovarian Syndrome: Treatment Options
Treatment of PCOS depends partially on the woman's stage of life. For younger women who do not immediately want children, the birth control pill may be a first line of treatment as it causes regular periods and prevents the risk of uterine cancer. Another option is intermittent therapy with the hormone progesterone. Progesterone therapy will induce menstrual periods and reduce the risk of uterine cancer, but will not provide contraceptive protection.
Weight loss is often recommended for those with PCOS, which will also help manage some of the associated conditions, including elevated blood pressure, diabetes, and high cholesterol level. In addition, weight loss can normalize menstrual cycles and often increases the possibility of pregnancy in women with PCOS.
For acne or excess hair growth, a water pill (diuretic) called spironolactone (Aldactone) may be prescribed to help reverse these problems. The use of spironolactone requires occasional monitoring of blood tests because of its potential effect on the blood potassium levels and kidney function. Eflornithine (Vaniqa) is a cream medication that can be used to slow facial hair growth in women. Electrolysis and over-the-counter depilatory creams are other options for controlling excess hair growth.
Women with PCOS who want to have children may consider fertility medications.. The first line of treatment is usually Clomiphene (Clomid), which stimulates egg production. More aggressive treatments include metformin together with clomiphene, and gonadotropins or IVF.
There are also a number of natural medications and treatments that may be used to complement traditional medicine for women with PCOS. Nutritional management, kinesiology, herbalism homeopathy, and acupressure are all possiblities to help you manage its symptoms and return your body to balance. Speak to a registered naturopath or homeopath about a course of treatment that is right for you. The American Association of Naturopathic Physicians or the North American Society of Homeopaths can recommend someone in your area.
Polycystic Ovarian Syndrome: Prevention
Polycystic ovary syndrome or PCOS has no guaranteed prevention measures. However, early detection and treatment can help in preventing long-term complications like obesity, diabetes, infertility, cardiovascular diseases and metabolic syndrome. Keeping a healthy body weight will also significantly lower your chances of PCOS or manage its symptoms if you already have it. Studies have linked smoking to higher androgen levels, so it’s a good idea to consider quitting as this will not only help lessen the symptoms, but improve your over-all health.
Polycystic Ovarian Syndrome: Conclusion
Polycystic ovarian syndrome is a hormonal imbalance affecting women that is primarily characterized by excess androgens, or male hormones. It can cause several symptoms including missing or irregular periods, infertility, obesity, excessive hair growth, and acne. If left unmanaged, PCOS may lead to complications such as diabetes, cardiac diseases, as well as obesity and elevated blood pressure. If you are over-weight, your doctor may recommend a weight loss program to help you manage its symptoms. Weight loss for women with PCOS can also help normalize menstrual cycles and increase the possibility of pregnancy. There are a number of natural medications and treatments specifically for managing the symptoms of PCOS that have also proven effective.