HORMONAL DISORDERS
POLYCYSTIC OVARIAN SYNDROME
Polycystic Ovarian Syndrome (PCOS) describes a cluster of symptoms resulting from an imbalance of reproductive hormones, and specifically an excess of androgens (male reproductive hormones, such as the steroid hormone testosterone). Healthy women possess small amounts of androgens in their system, which are produced in the ovaries and mostly converted into estrogen. If the levels of androgens in the female body are too elevated, this can cause the symptoms associated with Polycystic Ovarian Syndrome, including ovarian cysts, hirsutism (excessive facial and body hair growth), irregular menstrual periods, pain and infertility. Diagnosis of Polycystic Ovarian Syndrome is usually made after a physical exam, blood tests (screening for abnormally high androgen levels), and imaging (ultrasound). With a prevalence of 10-15%, Polycystic Ovarian Syndrome is very common among women of reproductive age, and one of the leading causes of infertility.
Risk Factors
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High BMI (obesity)
- Type 2 diabetes (insulin resistance)
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Family history of PCOS (genetic factors)
Causes
Polycystic Ovarian Syndrome is caused by elevated androgen levels in the female body. There are different reasons for such an increase in androgen levels. One possible explanation is an inability of the ovaries to ovulate regularly with each menstrual cycle (for instance because there is an imbalance of the female reproductive hormones GnRH, LH, FSH, estrogen and progesterone). Such a failure to ovulate can lead to cysts and chronic low-grade inflammation, which in turn produce higher levels of androgens.
Another reason for the elevated androgen levels in PCOS patients may be elevated insulin levels. In patients who suffer from obesity, diabetes type 2 or are pre-diabetic, metabolic cells can become resistant to insulin, the hormone responsible for processing glucose (sugar) and eliminating it from the blood stream. The higher levels of blood glucose in such patients due to insulin resistance cause even higher amounts of insulin being secreted from the pancreas. Such excess free insulin in turn may be responsible for increased androgen production.
Symptoms
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Infertility
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Abnormal uterine bleeding
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Premature termination of pregnancy (miscarriage)
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Lighter, shorter or less frequent menstrual periods
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Hirsutism (excessive facial and/or body hair growth)
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Metabolic disorders, including diabetes, elevated blood glucose, cholesterol and triglyceride levels
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Hair thinning (balding) on the head
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Skin flaps and discolorations
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Weight gain (obesity)
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Acne (skin issues)
Treatments
Treatment of Polycystic Ovarian Syndrome usually includes hormone therapy.
Hormonal birth control (IUDs, implants, or oral contraceptives) that contain either progesterone and/or estrogen can help rebalance hormone levels and restore normal patterns of ovulation. Androgen antagonists can further reduce the amounts of androgens active in the body, thereby alleviating the symptoms of PCOS. Insulin-sensitizing medications, such as Metformin, can also help reduce androgen levels, especially in diabetic or pre-diabetic patients where the hormonal imbalance is caused by excess free insulin in the blood stream. If a pregnancy is desired, ovulation-inducing medication can also be prescribed.
Rarely, if medical treatment is unsuccessful, surgical intervention (most often minimally invasive, i.e. laparoscopic) may be required to remove excess tissue from the ovaries, which can help induce normal ovulation.