Introduction to Polycystic Ovarian Syndrome
What is Polycystic Ovary Syndrome (PCOS)?
PCOS occurs when a woman doesn't ovulate, which causes a disruption in the normal, cyclical interrelationship among her hormones, brain and ovaries. Normally, the hypothalamus, a regulatory centre in the brain, monitors the hormone output of the ovaries and synchronizes the normal menstrual cycle. When monthly bleeding ends, the hypothalamus secretes gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland in the brain to release follicle stimulating hormone (FSH) and luteinizing hormone (LH). These hormones direct an ovary to start making estrogen (mostly estradiol), and stimulate the maturation of eggs in about 120 follicles.
The first follicle that ovulates, releasing its egg into the fallopian tube for a journey to the uterus, quickly changes into the corpus luteum, which is a factory for making progesterone, and raises progesterone's concentrations to 200 to 300 times higher than that of estradiol. This huge surge of progesterone simultaneously puts the uterine lining in its secretory or ripening phase, and turns off further ovulation by either ovary.
If fertilization does not occur, the ovary stops its elevated production of both estrogen and progesterone. The sudden fall in the concentrations of these hormones causes shedding of the blood-rich uterine lining and bleeding (menstruation). Then, in response to low hormone levels, there is a rise in GnRH and the cycle starts all over again.
But what happens to this cycle if, for some reason, ovulation is unsuccessful? For example, if the follicle migrates to the outside of the ovary, but does not "pop" the egg and release it, the follicle becomes a cyst, and the normal progesterone surge does not occur. The lack of progesterone is detected by the hypothalamus, which continues to try to stimulate the ovary by increasing its production of GnRH, which increases the pituitary production of FSH and LH. This stimulates the ovary to make more estrogen and androgens, which stimulates more follicles toward ovulation. If these additional follicles are also unable to produce a matured ovum or make progesterone, the menstrual cycle is dominated by increased estrogen and androgen production without progesterone. This is the fundamental abnormality that creates PCOS.
What are the symptoms of PCOS?
The symptoms of PCOS can include, but are not limited to the following:
infrequent periods (oligomenorrhea);
no periods at all (amenorrhea);
excessive bleeding during your period (polymenorrhea);
multiple ovarian cysts in a typical “pearl necklace pattern”.
skin tags
skin discolouration known as acanthosis nigricans;
thinning hair;
hirsutism (excess hair on the face and body);
acne;
weight gain and obesity, difficulty losing weight;
infertility.
pain in the lower abdomen and pelvis
high blood pressure
high Cholesterol levels and
depression
What causes PCOS?
PCOS is characterized by a complex set of symptoms, and the cause cannot be determined for all patients. However, research to date suggests that insulin resistance could be a leading cause. PCOS may also have a genetic predisposition, and further research into this possibility is taking place. No specific gene has been identified, and it is thought that many genes could contribute to the development of PCOS. PCOS also seems to run in families.
How is PCOS diagnosed?
A doctor will perform a physical examination and ask about your medical history. She will ask questions about your family history as well as your period and its regularity. She will check your weight and look for physical symptoms, like acne, hair growth and darkened skin. She might also ask for blood tests to measure insulin and other hormone levels. These tests may be used to diagnose PCOS or to rule out other conditions like thyroid or other ovarian problems.
Another test, called an ultrasound, is used to look at the ovaries and to see if you have cysts.
What are the possible health problems associated with PCOS?
Cardiovascular disease (heart attack, high blood pressure, stroke)
Type II DiabetesWomen with PCOS are 3 to 6 times more likely than other women to develop Type II Diabetes in middle age.
Cancer Prolonged exposure to elevated levels of estrogen increases the risk of breast, uterine and ovarian cancers
Hyperandrogenism Elevated levels of androgen can cause hirsutism (excessive body hair), acne and alopecia (hair loss)
Infertility
Increased risk of miscarriage
Increased risk of gestational diabetes
Sleep apnea