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Polycystic Ovary Syndrome (PCOS)

PCOS is by far the most common cause of infertility in women, and the number of women with diagnosed and undiagnosed PCOS is best described as “vast.” Experts estimate that as many as 10% of women of childbearing age may have the disorder.

When I was in med school, PCOS was quite uncommon. Now you see articles in women’s magazines and experts on daytime talk shows teaching the public about PCOS. At least there’s hope for affected women, who find themselves becoming overweight without any change in eating habits. Adding the other PCOS symptoms–acne, dark facial hair, and sometimes male pattern baldness—is like rubbing salt in a wound.

The average woman sees five doctors before being diagnosed with PCOS. (Most don’t actually make it to five, giving themselves up to fate, and millions more go undiagnosed because they have no access to the health care system).

This diagnostic delay is a good example of a major flaw in the specialized education of doctors. Ovaries, infertility, and irregular periods are considered the turf of obstetrician-gynecologists. On the other hand, obesity, excess facial hair, metabolic syndrome, and cholesterol are buzzwords belonging to internists. PCOS requires that an OB-GYN think like an internist…and vice-versa. Plus, it’s only been recently that the two groups of physicians sat down and started discussing what seems to be a near epidemic of PCOS.

What causes PCOS?
The situation is further complicated by the absence of straightforward tests to clinch the diagnosis, not helped by the fact that doctors are uncertain what triggers PCOS in the first place. There appears to be a genetic predisposition–PCOS is common in sisters and mothers, and brothers of PCOS patients have high levels of pre-testosterone DHEA, though it’s harmless to them.

Some researchers attribute the PCOS epidemic to endocrine (hormone) disruption caused by the massive amounts of toxic chemicals in our environment, which then trigger PCOS in a genetically susceptible woman.

The underlying problem in PCOS begins when the ovaries develop fluid-filled sacs called cysts and begin to secrete an excessive amount of the male hormone testosterone. This in turn disrupts menstrual regularity and ovulation and leads to infertility. It’s the testosterone that also causes excessive facial hair and acne.

To complicate matters, woman with PCOS develop resistance to the blood sugar-lowering hormone insulin, a situation similar to adult-onset (Type 2) diabetes that leads to high levels of glucose in the blood, weight gain, high cholesterol, and even more testosterone production. To compensate for insulin resistance and high glucose, the body produces even more insulin, which in turn produces even more male hormone, like a snowball rolling downhill out of control. After years of elevated glucose and cholesterol levels, women with untreated PCOS become susceptible to heart disease and high blood pressure.

I’d recommend that every woman with a combination of irregular periods (with or without infertility), unexplained weight gain, and/or new facial hair ask her doctor about PCOS. I assure you there are helpful treatments, both conventional and alternative.

The standard diagnostic tests for PCOS are:
• Blood tests that check for evidence of elevated male hormones (testosterone and androstenedione).
• Tests to check for insulin resistance (blood glucose and insulin levels).
• Vaginal ultrasound to look for cysts.
• Tests for levels of other hormones (estrogen, progesterone, thyroid, adrenal) and cholesterol.

It’s essential for women with PCOS to begin major lifestyle changes, primarily nutritional counseling with weight reduction and exercise.

Next week: Treating PCOS.

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One comment on “Polycystic Ovary Syndrome (PCOS)
  1. mery says:

    Dr. Edelberg:
    I enjoy your columns and read them religiously, although I am not what most people would describe as a “religious person.” Anyway, many if not most of your columns deal with life-threatening health issues, where you tell us, with depressing regularity, how bad everything is and how our good health is nothing but an illusion. You have introduced me to diseases and breakdowns that I had never considered before. So my question is, why do you end each of your provocative columns with “be well?”
    Isn’t that a major inconsistency? And wouldn’t it make more sense to close your columns with something on the order of ; “bite the bullet?” or maybe, “you are going to die; the only questions is, of what!”

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