Polycystic Ovary Syndrome Part I: The Science Behind It

Polycystic Ovary Syndrome Part I: The Science Behind It

  August 01, 2020    AVisenMD

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Polycystic ovary syndrome is a very common disorder that affects 5-10% of women around the globe in their reproductive years.

Many women believe that PCOS only means reduced fertility or that it is merely a cosmetic issue (changes in physical features). However, women with PCOS are at a higher risk of developing metabolic disturbances like heart disease, type 2 diabetes, high cholesterol, obesity and cancer.

Coming up in this article:

• How PCOS is diagnosed

• The role of hormones in PCOS

• Common medical conditions linked with PCOS

• Some obvious signs and symptoms of PCOS

• Which class of medication are prescribed for treatment

• Definition of 'Metabolic Syndrome'
  

How Do You Identify PCOS?

There are three very classic features of PCOS and clinically, two of these need to exist for a formal diagnosis:

1. Hyperandrogenism (excess androgen): hormones responsible for the development of male reproductive activity and male traits like voice change, facial and body hair growth
2. Ovulation difficulties:
1. Anovulation: ovaries do not release an egg during a menstrual cycle
2. Oligoovulation: irregular/infrequent ovulation
3. Polycystic ovaries: ovaries contain numerous harmless follicles or cysts that can be up to 8mm in size.

Story of the Hormones in PCOS:

                                                           

**Hypothalamus and Pituitary gland are parts of the brain. Hypothalamus releases GnRH into the pituitary. In response, pituitary then releases LH and FSH hormones. These hormones then influence the male and female reproductive system, which finally release testosterone or estrogen and progesterone, respectively.**

1. Gonadotropin-releasing hormone (GnRH): In PCOS, there is an increased GnRH activity, which causes and increase in the LH and FSH secretion (more of LH than FSH).
   
2. Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH): At the beginning of the menstrual cycle (beginning from menstruation), levels of both are in 1:1 ratio. An LH spike occurs 24 hours before ovulation and then comes back to normal levels. In PCOS, women have constantly increased levels of LH and FSH with the ratio of 3:1. There is no LH spike in PCOS, which means there is no ovulation.
   
3. Testosterone: Women with PCOS have abnormally high levels of testosterone that naturally suppresses ovulation and menstruation.
4. Estrogen: Uterus is where the androgens (described above) are converted into estrogen by FSH. In PCOS, where FSH is lower in ratio than LH, these androgens are not converted into estrogen. Thus, resulting in excess androgens and male traits. 

Some Health Issues Linked with PCOS:

• Infertility with other pregnancy issues: miscarriage, gestational diabetes, preterm labour
  
• Obesity/weight gain
• Heart disease
• Type 2 Diabetes
  
• Dementia
• Cancers caused by hormonal fluctuations (breast, ovarian, endometrial)
• Non-alcoholic fatty liver disease (Read here to learn more about fatty liver)
• Poor joint and bone health

What are Some Signs and Symptoms of PCOS?

• Fatigue and poor sleep
• Weight gain that is challenging to manage
• Hair growth on face, arms, chest, back, abdomen, thumbs and toes
• Hair loss, especially at the front (male-pattern hair loss)
• Infertility
• Acne, skin tags, dark patches of skin on neck
• Depression & anxiety
• Pelvic pain with heavy bleeding or very scanty bleeding

What Kind of Medications are Prescribed?

• Metformin: one of the first medicines prescribed; given for insulin and glucose moderation to control the risk of development of type 2 diabetes.
• Oral contraceptive pills (OCPs): helps regulate the menstrual cycle.
• Anti-androgen medications: to control excess androgen; usually given to men for regulating prostate health; used to prevent testosterone surge and its effects to manage excess hair, voice changes and acne.
• Ovulating medicines: to induce successful ovulation.

Metabolic Syndrome and PCOS:

Metabolic syndrome is a cluster of conditions listed below that are very closed associated with PCOS and require medical attention (approximately 30-75% of women with PCOS have metabolic syndrome)

• Central obesity (belly fat): BMI more than 30
• Abnormal cholesterol and triglyceride levels: HDL (good cholesterol) <35mg/dL and triglyceride >150mg/dL
• High blood pressure: >140/>90 mmHg
  
• Insulin resistance
  

This is a general representation in simplified terms of the pathophysiology and biology behind PCOS. Stay tuned for Part 2 of this article that will discuss lifestyle changes, dietary modifications, powerful antioxidants and natural plants/ingredients that help manage PCOS.

Leave your questions and comments below and connect with me.

Reference: Dr. Nina Bailey, Igennus Healthcare Nutrition