Polycystic ovarian syndrome (PCOS) is one of the most common hormonal disorder among women of reproductive age. It is an endocrine disorder caused by an imbalance of female and male hormones. It is a leading cause of inability to become pregnant, infertility. It occurs in women of all races and nationalities.
How is PCOS Recognized?
The most common symptom is irregular ovulation, and irregular or absent menstrual periods. Any owmen have difficulty getting pregnant should be elevated for PCOS. Characteristically there are imbalances in estrogen, progesterone and the male hormone, testosterone levels. The excessive amount or hence affect of male hormones is often associated with increased hair growth in male hair growth pattern, face, truck, arms and legs. The degree of symptoms and the severity of the syndrome may vary greatly from women to woman. While the exact cause or causes are still unknown, it has been recognized that insulin resistance (often leading to obesity) is heavily associated with PCOS.
Other symptoms associated with PCOS are: acne, obesity (but not always), difficulty losing weight, male pattern baldness and/or thinning hair on the scalp, hair growth on the face, back, or chest. Many women with PCOS are also noted to have elevated blood sugar levels, hyperglycemia.
Nearly half of the women with PCOS have high insulin and blood sugar levels a condition called, insulin resistance. When an individual is not using insulin well, blood sugar tends to reach higher than normal levels. If this problem is not treated, it can lead to the onset of type 2 diabetes. Elevated blood cholesterol levels are also common in women with PCOS.
Women with PCOS often develop multiple cysts within their ovaries. These ovarian cysts are generally small, undeveloped follicles, that have had their growth and development stunted. These cysts, as well as the connective tissues around them produce male hormones called androgens, the most common of which is testosterone. These androgens are released into the blood stream and alter the feedback mechanism within the hypothalamic-pituitary-ovarian axis (HPO axis). The ovary responds to this by increasing the amount of estrogen it makes, so estrogen levels rise. This then increases in relation to progesterone causing an increase in testosterone and Luteinizing hormone (LH).
Diagnosing PCOS
- Possibly the most important factor in diagnosing PCOS is the medical history and physical examination.
- The history usually determines the following symptoms: The symptom pattern whether including infertility or not is often the greatest clue. A relatively young women with increased hair growth on the face and body, and/or acne, irregular or absent menstrual periods, weight gain or difficulty losing weight, thinning hair on the scalp (male pattern balding), and some level of depression, with or without anxiety.
- The physical exam demonstrates the above findings consistent with the patient’s symptoms. Blood pressure may be elevated. A pelvic and pap smear should always be done.
- An ultrasound to evaluate the ovaries for cysts will be necessary.
Lab Testing that May Help
FSH/LH Ratio: Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) are produced by the pituitary gland to stimulate the ovaries. FSH stimulates the growth of an egg follicle within the ovary, while LH triggers the release of the egg during ovulation. The diagnoses PCOS isnot dependant on the FSH/LH ration, however if the LH:FSH ratio of greater then 3:1. This is not diagnostic but can suggest PCOS if other symptoms are present. A low LH or a high FSH level indicate decreased ovarian reserve, aging or onset of menopause, as a reason for infertility.
DHEA/Testosterone: Dehydroepiandrosterone (DHEA) and testosterone are two androgens, or male hormones. They are partially responsible for many of the male secondary sex characteristics like abnormal hair growth or loss and acne, which explains the symptoms that PCOS sufferers experience. They may also cause menstrual irregularities in women. Elevation of testosterone is typical in women with PCOS. A high DHEA level would indicate an adrenal cause, such as congenital adrenal hyperplasia or an adrenocortical tumor as part of the reason for the patient’s symptoms.
- Estrogen and progesterone, FSH, LH, and sex-binding globulins
- Testosterone and DHEA
- Blood sugar, electrolytes, cholesterol and triglycerides
- Conditions such as Pituitary tumors (prolactin) or thyroid disorders (a thyroid panel), must be ruled out as a possible reason for the woman’s symptoms.
- Ultrasound to evaluate ovaries
- Computed tomography (CT scan) and magnetic resonance imaging (MRI) if needed also to evaluate ovaries
Women with PCOS are at risk for a number of medical problems which must be prevented:
- Endometrial hyperplasia and cancer of the uterine lining are possible, caused by overstimulation of uterine cells by estrogen
- Insulin resistance/Type II diabetes
- High blood pressure
- Depression with or without Anxiety
- Elevated cholesterol and triglycerides which increase the risk of atherosclerosis, cardiovascular disease, and stroke
- Weight gain and/or obesity
- Miscarriage
- Acanthosis nigricans. patches of darkened skin under the arms, in the groin area, on the back of the neck
- Autoimmune thyroid inflammation
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