P.C.O.S. : POLYCYSTIC OVARY SYNDROME
Neal Rouzier, M.D.
Most women associate hormones with menopause. However, most women are unaware that premenopausal women might need hormones too. Over 20% of all premenopausal women have a hormonal disorder termed “Polycystic Ovary Syndrome (PCOS)”. The name is misleading because the defect does not lie in the ovaries. In fact, the ovaries are not to blame for this syndrome in spite of the name.
► At least 50% of women with PCOS will have ovarian cysts – therefore the name PCOS.
►However 50% of women with PCOS do not have ovarian cysts.
►And not all women with ovarian cysts have PCOS.
Ovarian cysts can be the result of PCOS but the cysts are not the cause. PCOS is actually an endocrine disorder and not a gynecological disorder. The syndrome is genetic and due to insulin resistance. Treating the insulin resistance is the key to controlling the symptoms of PCOS as well as all of the possible serious complications of PCOS that are related to insulin resistance.
Common signs of PCOS are irregular periods, heavy periods, difficulty getting pregnant, weight gain, difficulty losing weight. Most women with PCOS do not have all the signs of PCOS. In fact, many women will have normal periods and conceive normally. Many women with PCOS are overweight, yet 50% will be of normal weight. Therefore making the diagnosis of PCOS is elusive to both doctors and patients. This is precisely why PCOS is often missed. In addition, many doctors are not aware of PCOS, don’t know how to diagnosis or treat it, and often dismiss women’s complaints as normal.
Other common symptoms of PCOS include acne, hirsutism (unwanted hair growth), sugar craving, severe PMS. The ovarian cysts can be painful or asymptomatic. Some women might have trouble with fertility. Any women with any of the symptoms should be evaluated. And if they have PCOS they should be treated to improve symptoms as well as to preserve health and wellness. Simple blood tests will determine the diagnosis and the severity will determine the treatment.
It is of utmost importance to diagnosis and treat PCOS. It can contribute to heart disease, diabetes, breast cancer and early mortality, all of which can and should be prevented with early diagnosis and aggressive treatment.
The cause of PCOS is genetic and related to insulin resistance. Insulin resistance results in alterations of the pituitary hormones FSH and LH. These hormones can be the cause of the ovarian cysts and menstrual irregularities. Insulin resistance also causes loss of sex hormone binding globulin (SHBG) which results in less binding of testosterone with the resultant increase in free testosterone. This higher level of free testosterone results in the skin and aesthetic changes such as acne and excessive hair growth, such as facial hair. The insulin resistance increases the risk of diabetes, heart disease and cancer. The importance of early diagnosis and treatment of PCOS is clear, particularly in light of the varied signs and symptoms which makes the disorder confusing and difficult to diagnosis. It is a prevalent hormone disorder in premenopausal young women and physicians often miss the diagnosis, especially in “normal” premenopausal women.
Once the diagnosis is considered and confirmed, the treatment is straightforward and simple. Insulin sensitizers are medicines that decrease insulin and insulin resistance. The treatment of the insulin resistance reverses menstrual and fertility abnormalities. Although testosterone is extremely important in both premenopausal and post menopausal women, too much can adversely affect the skin. Therefore, medicines that prevent the skin sensitivity of PCOS are also recommended. The potential harm of future diabetes and heart disease is eliminated by lowering the adrenal hormone known as aldosterone which increases systemic inflammation of blood vessels that eventually lead to heart disease and strokes. Obviously it is imperative to decrease the insulin resistance with diet, exercise and medication and lower the systemic inflammation that causes plaque formation. Most young women just want their symptoms and skin changes to improve and don’t appreciate the long term health risks from PCOS. Unfortunately many physicians don’t either.
A recent study demonstrated that women with PCOS have a five-fold increased risk of breast cancer due to loss of progesterone. Prescribing natural progesterone is very beneficial in the treatment of PMS and heavy bleeding, however it is of upmost importance in protecting against breast cancer. The medical literature very adequately demonstrates progesterone’s protective effect against breast cancer and most women with PCOS lack adequate progesterone which puts them at risk for breast cancer.
Inadequate production of progesterone, due to anovulation or failure to release an egg from the ovary, also puts one at risk for uterine cancer. Women that demonstrate irregular periods and anovulation will also experience fertility difficulty. Progesterone maintains pregnancy as it is pro-gestational or the hormone of pregnancy. Women with PCOS have a 50% miscarriage rate due to loss of progesterone thereby making it imperative that women with PCOS take natural progesterone throughout their pregnancy to prevent miscarriages.
Finally, most women with PCOS are thyroid resistant. Optimization of thyroid function improves metabolism and fatigue associated with PCOS as well as assisting in weight loss. Thyroid should be optimized by supplementing with natural thyroid hormone. Diet, exercise and weight loss are emphasized to further lower insulin resistance, which along with thyroid administration increases success in lowering insulin resistance.
Appropriate treatment of PCOS :
►Treat the insulin resistance
►Treat acne and hirsutism (extreme hair growth usually on the face, neck and underarms)
Early diagnosis and adequate treatment of PCOS is of utmost importance for health and well-being. Unfortunately, PCOS is tremendously under-recognized, undiagnosed and untreated. Increased patient awareness and understanding will hopefully lead to better diagnosis and treatment strategies, less health risks and better quality of life for those 20% of women that have this endocrine (not gynecological) disorder. Also, I am amazed at the number of women that I diagnose with PCOS that don’t have the “classic” PCOS symptoms. Any premenopausal women that complain of menstrual irregularity, PMS, heavy bleeding, mood disorder or sugar craving should be screened and treated for PCOS. With the advent of the internet, many women present to us having self-diagnosed themselves with PCOS from what they have researchedt. Oftentimes the signs and symptoms go unrecognized or ignored by physicians. Recognizing and treating PCOS is imperative for long-term health and well-being.
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