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From Washington University Physicians, written by Mary Jo Blackwood, RN, MPH, posted May 9, 2012

Polycystic ovary syndrome (PCOS)  gets its name from characteristic multiple cysts in the  the ovaries. The condition is an imbalance of a woman's female and male sex hormones.

Two principal physical features include irregular or no ovulation, which can cause irregular menstruation and infertility,  and the production of excessive amounts of male hormones, which can result in acne and male-patterned hair growth.

Valerie Ratts, MD, professor of OB/Gyn, reproductive endocrinology and infertility at Washington University School of Medicine, says PCOS affects 4 to 6 percent of reproductive-age women, and seems to run in families.

The symptoms and their severity vary widely among affected women, beginning in young girls starting their periods and extending through menopause.

Normally each month a follicle in the ovary creates and releases an egg, which can either be fertilized and grow into a baby or dissolves, hormonally triggered by a male hormone  to create a menstrual period. In PCOS, no egg is released  and instead produce very small cysts in the ovary. But the ovaries continue to produce abnormal levels of male hormones. 

Insulin Resistance

Importantly, most women with PCOS  have evidence of insulin resistance, a physiological condition in which the insulin system becomes less effective at lowering blood sugar. This creates high blood glucose levels that can lead to type II diabetes, heart disease, hypertension and high cholesterol.

Insulin resistance also interferes with the normal signals to the ovary, and making it produce more androgens (male hormones) and ovulate less often. Normally, says Ratts, women in their reproductive years ovulate 12 times a year; but patients with PCOS may only ovulate 2 to 3 times a year.

Besides affecting fertility, that abnormal hormone signaling can cause weight gain,  which in turn increases insulin resistance, in a vicious cycle. Since PCOS cannot be diagnosed with a specific test, and symptoms vary from woman to woman, it often goes undiagnosed for years.

Treatment Options

Says Ratts, “Treating the PCOS patient focuses on the goal for that woman’s point in life. For the teenager, the goal may be to treat the cosmetic issues. Irregular periods, acne, facial hair growth and weight gain can have profound emotional impact.

For these patients, I prescribe medications like oral contraceptives that regulate the periods and treat the acne and hair growth by suppressing the male hormone produced by the ovaries.”

For the older girl or one with a family history of chronic disease, treatment might be more focused on  helping her regain ovulation in order to have children or to prevent other complications. . Medications like Clomid can induce the pituitary gland to release more FSH and LH hormones, stimulating the growth of an ovarian follicle containing an egg.

Ratts can’t overemphasize the importance of good health habits in reversing and controlling this condition. PCOS itself can cause excess weight, so women with PCOS need to be especially vigilant to control their diets so as not to add stress to the  already taxed insulin system.

She advises choosing small portion size, avoiding simple sugars, concentrating on protein and complex carbohydrates. Also weight management and general physical health is helped by  regular exercise and should be a permanent commitment.

There are data that demonstrate that obese patients who have bariatric surgery or lose significant weight with diet and exercise often find that the symptoms of PCOS go away, and periods become more regular, enabling pregnancy.

PCOS can also occur in women of normal-weight. Thin PCOS patients typically have irregular periods, acne and male facial hair. They still need to maintain a diet low in simple carbohydrates and to stay thin because of their greater than normal  risk for type II diabetes.

All of the patients with PCOS managed by Dr Ratts are monitored closely for development of diabetes, high blood pressure, high cholesterol and other symptoms of heart disease

Dr Ratts' message to women is clear: early diagnosis, lifestyle change, and proper education and treatment can help them lower their risk factors and live a normal life.
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