The most common endocrine syndrome that affects women of reproductive
age, puberty to menopause, is known as Polycystic Ovary Syndrome
(PCOS). It affects approximately 10 percent of women in the reproductive
age group. For years, many people automatically assumed PCOS was
purely an ovarian syndrome, due to its given term; however, it is
now recognized as a systematic endocrine and metabolic disorder,
as multiple risk factors are at work.
PCOS can be described as a total body endocrine syndrome. In fact,
the abnormalities in the ovary are actually more the result of a
bigger problem, rather than the cause. And although there is no
set definition for PCOS, most endocrinologists would agree on a
set of criteria necessary to make the diagnosis:
- The complete or almost complete lack of ovulation
- Increased androgen (male hormone) production, either facial
hair and/or acne
- Obesity
- Hyperinsulinemia (insulin resistance with elevated serum insulin
levels)
While it is clear PCOS is a complicated syndrome with many interactions
combining to produce the clinical picture, it is also evident these
interactions play off one another, creating a vicious cycle.
The PCOS Cycle
Any hormone problem that interferes with normal ovulation results
in what is known as a "polycystic" ovary, which, regardless
of the cause, will produce increased amounts of androgen. Conversely,
increased androgen production interferes with normal ovulation.
Evidence has also pointed to obesity as part of the androgen excess
syndrome; overweight women produce increased androgens even if they
have no underlying abnormality in the adrenal gland. It is not known
for certain whether obesity is a cause or an effect or simply a
part of PCOS.
Moreover, increased insulin found in women with PCOS stimulates
ovarian androgen production; increased androgen production contributes
to insulin resistance. Yet increased androgen production also leads
to an increased body weight (obesity), which in turn contributes
to insulin resistance. Women with PCOS who are not overweight also
frequently have insulin resistance.
PCOS is an inherited, autosomal dominant trait, meaning if a woman
has PCOS, it should be looked for in her mother, sisters and daughters.
And, since it is autosomal dominant, male relatives can also carry
the gene and can transfer the problem to their daughters. Having
PCOS puts women at an increased risk of developing diabetes, coronary
artery syndrome, lipid disorders (such as elevated cholesterol and
high blood pressure) and possibly breast cancer.
Suggested Methods of Preventing PCOS Development
- Weight Loss
- Drugs (such as the anti-diabetic drug Metformin)
- Suppress ovarian function with oral contraceptives or other
drugs
- Making an early diagnosis, which will prevent the development
of a full-blown diagnosis
InfertilityPhysician.com
February 4, 2005
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