Polycystic Ovary Syndrome

February 2, 2017

Polycystic (pah-lee-SIS-tik) ovary syndrome (PCOS) is a health problem that can affect a woman’s menstrual cycle, ability to have children, hormones, heart blood vessels and appearance. Women with PCOS typically have high levels of androgens, also known as male hormones which may become the reason for the body to stop ovulating, reason for getting acne, and grow extra facial and body hair. They also have higher levels of insulin production that can result in excess weight gain and increases your chance of getting diabetes. They may have enlarged ovaries that contain small collections of fluid called follicles located in each ovary as seen during an ultrasound exam.

The term “polycystic ovaries” refers to the many tiny cysts, or bumps, in the ovaries. These cysts themselves are not harmful and do not need to be removed. Most women with PCOS grow many small cysts camera.gif on their ovaries. That is why it is called polycystic ovary syndrome. PCOS is also known as ‘Stein-Leventhal syndrome’.

Hormones are chemical messengers that trigger many different processes, including growth and energy production. Often, the job of one hormone is to signal the release of another hormone. For reasons that are not well understood, in PCOS the hormones get out of balance. One hormone change triggers another, which changes another.

Between 1 in 10 and 1 in 20 women of childbearing age has PCOS. As many as 5 million women in the United States may be affected. It can occur in girls as young as 11 years old.

Causes

Although the exact cause is unknown, it is known that PCOS is a result of a hormone imbalance in the brain and ovaries. Also, many women with PCOS have too much insulin, a hormone that turns food into energy. Having too much insulin may cause the body to make too much testosterone. This high testosterone level would account for some of the symptoms, like excess body hair or irregular periods.

Resistance to insulin – Insulin is a hormone produced by the pancreas to control the amount of sugar in the blood. It helps to move glucose from blood into cells, where it’s broken down to produce energy. Insulin resistance means the body’s tissues are resistant to the effects of insulin. The body therefore has to produce extra insulin to compensate. High levels of insulin cause the ovaries to produce too much testosterone, which interferes with the development of the follicles (the sacs in the ovaries where eggs develop) and prevents normal ovulation. It can also lead to weight gain, hence making the symptoms worse.
Hormone Imbalance – This includes:
- Raised levels of testosterone– a hormone often thought of as a male hormone, although all women usually produce small amounts of it
- Raised levels of luteinising hormone (LH)– this stimulates ovulation, but may have an abnormal effect on the ovaries if levels are too high
- Low levels of sex hormone-binding globulin (SHBG) –a protein in the blood, which binds to testosterone and reduces the effect of testosterone
- Raised levels of prolactin(only in some women with PCOS) – hormone that stimulates the breast glands to produce milk in pregnancy

Genetics – PCOS sometimes runs in families. If any relatives, such as your mother, sister or aunt, have PCOS, then the risk of you developing it is often increased. This suggests there may be a genetic link to PCOS, although specific genes associated with the condition haven’t yet been identified.
Low-grade Inflammation – It has also been found that women with PCOS have low-grade inflammation, which may be a cause for insulin resistance. White blood cells produce substances to fight infection, this is known as inflammatory response. In some predisposed people eating certain foods, or exposure to certain environmental factors may trigger an inflammatory response. When inflammatory response is triggered, white blood cells produce substances that may contribute to insulin resistance and atherosclerosis.

Symptoms

The symptoms of PCOS can vary from woman to woman. Some of the symptoms

of PCOS include:

Infertility (not able to get pregnant) because of not ovulating. In fact, PCOS is the most common cause of female infertility.
Infrequent, absent, and/or irregular menstrual periods.
Hirsutis— increased hair growth on the face, chest, stomach, back, thumbs, or toes.
Cysts on the ovaries
Acne, oily skin, or dandruff.
Weight gain or obesity, usually with extra weight around the waist.
Male-pattern baldness or thinning hair.
Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black.
Skin tags —excess flaps of skin in the armpits or neck area.
Pelvic pain
Anxiety or depression.
Sleep apnea – when breathing stops for short periods of time while asleep.

While not symptoms of the disease, many women with PCOS have other concurrent health problems, such as diabetes, hypertension, and high cholesterol. These are linked to the weight gain typical in PCOS patients.

PCOS and Menopause

PCOS affects many systems in the body. So, many symptoms may persist even though ovarian function and hormone levels change as a woman nears menopause. For instance, excessive hair growth continues, and male pattern baldness or thinning hair gets worse after menopause. Also, the risks of complications (health problems) from PCOS, such as heart attack, stroke, and diabetes, increase as a woman gets older.

Women with PCOS appear to have higher rates of:

Miscarriage
Gestational diabetes
Pregnancy-induced high blood pressure (preeclampsia)
Premature delivery

Babies born to women with PCOS have a higher risk of spending time in a neonatal intensive care unit or of dying before, during, or shortly after birth. Most of the time, these problems occur in multiple-birth babies (twins, triplets).

Treatment

Treatment goals are based on the symptoms, whether or not a woman want to become pregnant, and lowering the chances of getting heart disease and diabetes. Many women will need a combination of treatments to meet these goals. Some treatments for PCOS include:

Lifestyle modification – Women with PCOS are generally over- weight or obese, that may result in health problems. This modification may include –
- Limiting processed foods and foods with added sugars
- Adding more whole-grain products, fruits, vegetables, and lean meats to your diet

This helps to lower blood glucose (sugar) levels, improve the body’s use of insulin, and normalize hormone levels in your body. Even a 10 percent loss in body weight can restore a normal period and make your cycle more regular.

Birth Control Pills – For women who don’t want to get pregnant, birth control pills can:
- Control menstrual cycles
- Reduce male hormone levels
- Help to clear acne

Since the menstrual cycle will become abnormal again if the pill is stopped, women may also think about taking a pill that only has progesterone like Provera, to control the menstrual cycle and reduce the risk of endometrial cancer.

Diabetes Medication – The medicine metformin (Glucophage) is used to treat type 2 diabetes. It has also been found to help with PCOS symptoms. Metformin affects the way insulin controls blood glucose (sugar) and lowers testosterone production. It slows the growth of abnormal hair and, after a few months of use, may help ovulation to return. Recent research has shown metformin to have other positive effects, such as decreased body mass and improved cholesterol levels. Metformin will not cause a person to become diabetic.
Fertility medications – Lack of ovulation is usually the reason for fertility problems in women with PCOS. Several medications that stimulate ovulation can help women with PCOS become pregnant. Even so, other reasons for infertility in both the woman and man should be ruled out before fertility medications are used. Also, some fertility medications increase the risk for multiple births (twins, triplets). Treatment options include:
- Clomiphene (Clomid, Serophene) — the first choice therapy to stimulate ovulation for most patients.
- Metformin taken with clomiphene — may be tried if clomiphene alone fails. The combination may help women with PCOS ovulate on lower doses of medication.
- Gonadotropins — given as shots, but are more expensive and raise the risk of multiple births compared to clomiphene.
- Another option is IVFe. vitro fertilization.
Surgeries – Ovarian drilling is a surgery may increase the chance of ovulation.

Alternative Treatment

Many of the conventional treatments being utilized are not specific for PCOS but have been used because the mechanisms of action indicate a potential benefit. There are a number of natural products which may have potential benefit without the possible side effects of abnormal uterine bleeding, weight gain, and liver failure seen with some of the conventional approaches.

Dietary Fiber – The health benefits of dietary fiber in reducing the risk of chronic disease have been well-established. Several characteristics of dietary fiber have been established, including the bulking effect that increases fecal volume, limits caloric intake, slows stomach emptying, and dilutes the content of urine. Dietary fiber also has the capacity to bind and eliminate organic compounds, which could reduce the interaction of potentially carcinogenic compounds within the intestinal mucosa. Several lines of evidence also suggest that dietary fiber may play a key role in the regulation of circulating insulin levels. Fiber reduces insulin secretion by slowing the rate of nutrient absorption following a meal. Studies show that insulin sensitivity increases and body weight decreases in people on high fiber diets.
Flaxseed – Flaxseed is one of the most significant sources of plant lignans, one of the main classes of estrogenic compounds called phytoestrogens. Phytoestrogens represent a family of plant compounds that have been shown to have both estrogenic and antiestrogenic properties. Flaxseed and its isolated lignans have been shown to have numerous chemoprotective effects both in vitro and in vivo. Many of the chemoprotective effects may be mediated through their influence on endogenous sex hormone production, metabolism, and biological activity.
Fish Oil – Adjusting the quality of food eaten – specifically fats – appears to be an important component of treatment of PCOS. The fatty acid components of dietary lipids not only influence hormonal signaling events by modifying membrane lipid composition, but fatty acids may directly influence molecular events that govern gene expression. It is thought that this regulation of gene expression by dietary fats has the greatest impact on the development of obesity and insulin resistance. Fish oils, which are comprised of the essential fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), fall into a larger category of fats called polyunsaturated fatty acids (PUFAs).
D-chiro-inositol – Studies suggest that women with PCOS may have insulin resistance and hyperinsulinemia due to a D-chiroinositol deficiency. D-chiro-inositol is a component of a phosphoglycan that has been shown to mediate the action of insulin.
Chromium – Chromium is one of the most widely studied nutritional interventions in the treatment of glucose- and insulin-related irregularities. While research shows a clear link between chromium and glucose metabolism, evidence for its interaction in insulin resistant states is a bit more ambiguous. Chromium picolinate is the form of chromium which has been used in a number of studies on insulin resistance.
Amino acid glutamine – Is reputed to improve blood sugar control.
Evening Primerose Oil – Evening Primrose Oil helps to increase cervical mucous and metabolic function.
Calcium and Vitamin D – Both calcium and vitamin D play significant roles in the health of many parts of the body. Where PCOS is concerned, calcium protects cardiovascular health. Vitamin D plays a role in glucose metabolism. Studies have shown that people with type 2 diabetes are often deficient in vit. D. Calcium can be found in kale, turnips, collards, mustard greens, kelp and wakame seaweed.
Herbs – These include –
- Licorice Root – Helps the body to maintain proper hormone production and release. Licorice also supports healthy insulin levels and liver health which is important for women with PCOS.
- Maca – Maca works to balance estrogen and progesterone in the body which may help to encourage a healthy menstrual cycle. Maca is an adaptogen and an incredible fertility superfood. It helps to balance the hormones, but does not contain any hormones itself. It is able to do this by nourishing the endocrine system.
- Vitex – Helps encourage regular ovulation in infertile women when used prior to ovulation. This herb has been found to be wonderful in aiding women with menstrual irregularities, improving the timing of the entire menstrual cycle.
- White Peony – Helps in relaxing muscles, reducing painful menstruation, as well as lowering serum and free testosterone levels in women with PCOS.

PCOS is a complex female health issue. It consists of many different health concerns and risks. If alternative treatment options are implemented, these risks and health issues may become obsolete.

Reference –

http://www.healthline.com/health/polycystic-ovary-disease#Overview1

http://www.eijppr.com/may_jun_2012/15.pdf

http://www.nhs.uk/Conditions/Polycystic-ovarian-syndrome/Pages/Treatment.aspx

http://www.medicinenet.com/polycystic_ovary/article.htm

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