Polycystic ovarian Syndrome

Polycystic ovarian syndrome is a common disorder affecting 5-10% of women. It is only in the past decade that an understanding of both the cause and multiple manifestations of this disorder were widely known amongst women qnd their physicians. PCOS affects the reproductive, cardiovascular, endocrine and respiratory system.

The criteria for diagnosing PCOS has changed throughout the years. The name actually comes from ultrasound findings of multiple small cysts on the ovaries. However women with PCOS may have normal appearing ovaries and women without PCOS may have multiple cysts on their ovaries. To be diagnosed with PCOS women must have 2 of the following 3 criteria: Absent or infrequent menstrual periods; signs of elevated androgems such as increased body hair growth, acne, alopecia (loss of hair on the head) or elevted blood levels of testosterone; polycystic ovaries on ultrasound. Other endocrine disorders also need to be excluded to comp[lete the diagnostic criteria.

The underlyng cause of PCOS is unknown. The disorder is characterized by excessive androgen production by the ovaries. Androgens are hormones, such as testosterone, that are responsible for the increased hair growth, alopecia and acne that occur in women with PCOS. The level of insulin, the hormone that regulates glucose metabolism, is also elevated in PCOS. However resistance to the actions of insulin is thought to be a causative factor in developing PCOS. Increased levels of insulin also increase testosterone levels. The abnormal hormone;la mileui in the ovary can result in inhibition of ovulation and the resulting lack of regular menstrual periods. Hypertension, diabetes, cardiovascular disease, sleep apnea and certain cancers are more prevelant in women with PCOS.

The "metabolic syndrome" occurs in both men and women. People with this disorder are obese, hypertensive, have elevated blood lipid levels, increasedrisks of diabetes and cardiovascular diseas. It is thought that resistance to insulin may be the underlying cause of metsabloic syndrome. Thus some authorities believe PCOS is a sex-specific form of metabolic syndrome.

Obesity is present in 30-75% 0of women with PCOS. American women with PCOS tend to have a higher body weight than European women. Weigth loss can ameliorate some of the metabolic derangements in women with PCOS but not completelt reverese them. Prevention of obesity in young women diagnosed with PCOS should help decrease the chance they will develop some of the long term health risks associated with PCOS and the metaboilic syndrome.

Treatment of women with PCOS is directed at ameliorating clinical complaints such as infertility or excessive hair growth and reducing risks to long term health. Decreasing androgen levels is the goal of medical therapy of acne and hirsutism . Oral contraceptive pills are genetrally the first line of treatment. Anti-androgens such as the diutretic spitonolactone are also used alone and in combiunation eith oral contraceptive pills. Ovulation induction agents are used to achieve pregnancy in women who are not ovulating.

To combat the insulin resistance seen in women with PCOS a combination of weight loss and thje use of me4dications is advocated. No particular weight loss regimen has been shown to be superior in women with PCOS but many advocsate limiting carbohydratesin a diet regiomen. Of course exercise is critia]\cal in improving overall health and contributing to weight loss. The most comm. Drug used to ameliorate insulin resistance is glucophage (metformin). This works by decreasing the livers production of glucose thus lowering insulin levels. Lowered insulijn also helps decrease androgen production in the ovaries. Metformin has been shown to decrease lipid levels and blood presusure, elevated lebels of both have been assocoaieted withn increased risk of cardiovascu;ar disease. Metformin has also been shown to increae rates of ovulation and can be used with or without ovulation indicing drugs in women eoith PCOS who desire pregnancy.

PCOS is a common endocrine disorder affecting many aspects of health. Both androgen excess and insulin resistance account for its effects on metabolism, reproductive function and cardiovascular health. Recognition that multiple, seemingly unrelated, complaints are part of this syndrome will help affected women obtain the treatment they need.