Pregnancy & Baby Index: Infertility: Polycystic Ovarian Syndrome: A debilitating disease that's often overlooked
Polycystic Ovarian Syndrome: A debilitating disease that's often overlooked
Michael Swanson, MD
Today, obesity and infertility both rank among top health concerns for women. However, many women don't realize there is a disease that can lead to both these conditions. It is called Polycystic Ovarian Syndrome (PCOS), and it affects up to 10 percent of reproductive-age women.
With such high numbers of women impacted, learning more about PCOS is becoming a top priority for researchers and physicians nationwide. In fact, the National Institutes of Health recently bestowed a $5.5 million grant to researchers at the University of Virginia to study the subject.
Currently, there are two theories on what causes the disease. The first is that it is caused by an abnormality in a part of the brain -- the hypothalamus -- that tells the ovaries to produce too much testosterone. The second theory is that there is something wrong with the ovaries, making them produce too many androgens (male hormones). The end result of both theories is the same -- the follicles in the ovaries don't mature and consistent ovulation does not occur.
In addition to learning about the sources of the hormones, the medical community is learning more about why this hormonal imbalance occurs. Recent studies have shown that PCOS is a result of insulin resistance. Insulin carries glucose into the cells. As the cells become more resistant to insulin, sugar levels increase in the blood, eventually causing glucose intolerance, along with many of the problems commonly seen in adult-onset diabetes. It is the excess insulin that is responsible for directly stimulating the ovaries to produce an excess of male hormones, throwing the entire system out of balance, research says.
Symptoms and diagnosis
Symptoms of PCOS often begin at puberty but, because these signs can occur in any combination, women do not always see them as an indicator of a larger issue and don't visit a doctor until they have had the disease for several years. Unfortunately, this delay can make things worse, as the more advanced the disease, the harder it is to treat and the more likely it is that a woman will suffer from infertility.
Upon visiting physicians, the chief complaint of women with PCOS is irregular menses. Other indicators of the condition include obesity, high blood pressure, hirsutism (excessive hair growth), acne and large ovaries with multiple small cysts.
The disease can often be very difficult to diagnose, as it manifests itself
through a group of symptoms, rather than having one known cause. In fact, most women visit an average of four doctors before they are accurately diagnosed.
A number of factors contribute to an accurate diagnosis. First, the physician must take a full medical history and conduct a physical exam including a variety of blood tests which detect the level of androgens in the body. Lastly, an ultrasound is used to give physicians an internal view of the ovaries and pelvic organs, confirming that the ovaries are cystic.
Proper diagnosis often means a visit to a specialist -- a reproductive endocrinologist -- with particular training in infertility and endocrine disorders. Only one in three women meet the classic criteria for the disease -- hair growth, obesity and irregular periods, according to published research.
If not properly diagnosed, PCOS can lead to serious long-term health effects. Seventy percent of patients with PCOS suffer abnormalities of their cholesterol/triglycerides and 10 times the risk of heart attack and stroke. What's more, women with PCOS have an increased risk of endometrial cancer, miscarriage and Type 2 diabetes (65 percent of patients have diabetes by age 50).
Treatments
While the disease can be difficult to diagnose, once recognized, it can be successfully treated through a combination of drug therapies and lifestyle adjustments.
In the past, PCOS was treated with birth control pills that suppressed the excess androgens. However, now that the medical community has a better understanding of the causes of the disorder, insulin-sensitizing drugs such as metformin (also known as Glucophage) is the preferred course of treatment.
Lifestyle changes can also have a dramatic impact on women with PCOS. Because of the role fat cells play in the chemical reactions with hormones, losing weight can greatly improve a patient's situation, according to reports. What's more, a low-carbohydrate diet improves insulin sensitivity and can help regulate periods. Many women have seen the symptoms greatly reduced through proper diet and exercise.
Lastly, women wanting to have a family -- 55 to 75 percent of PCOS patients suffer from infertility -- are given hope in the form of assisted reproductive therapies (ARTs) such as in vitro fertilization.
Patient support
As hundreds of thousands of women are impacted by PCOS every day, support groups and educational seminars have been sprouting up around the country. (Visit our PCOS message board for women trying to conceive.)
While PCOS is a serious disease with serious consequences, treatments are available to help women alleviate the symptoms and lead normal lives.
