Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, affecting 10% or more of premenopausal women, depending on the diagnostic criteria used. It is a cluster of symptoms that often include irregular menstrual periods, acne, weight gain, excess hair growth, thinning scalp hair, difficulty becoming pregnant, and blood sugar dysregulation, among other possibilities. “Polycystic” refers to a large number of normal follicles or eggs in the ovary, not to large painful cysts, so the word is confusing. The ovaries can grow up to three times the size of normal ones and are covered with cysts (sacs) containing immature eggs. These cysts produce an excess amount of androgen hormones -considered “male” hormones such as testosterone- that interrupt the normal menstrual cycle and prevent normal ovulation. The pancreas, brain, liver, blood vessels, muscle and fat tissues may all be affected. Indications of PCOS can start as early as the teen years. An estimated three out to four women with PCOS may not know they have it. Since physical symptoms and lab test results can strongly resemble other conditions, even Cushing’s syndrome or congenital adrenal hyperplasia, women typically see several doctors before getting the proper diagnosis.

PCOS is not a disease since it’s not a specific and constant set of symptoms and physical characteristics. It is a syndrome,  a cluster of various possible symptoms, physical indications and biochemical irregularities. There are two consistent aspects: high levels of androgen hormones and a lack or infrequent occupation. Androgens such as testosterone produce or stimulate the development of male characteristics. Women normally have androgens but in far less amounts than men. Common in PCOS are: a lack of or infrequent ovulation usually resulting in an absence of menstruation (amenorrhea) or scanty or infrequent menstrual flow (oligomenorrhea); excess hair growth or hair in unusual places (hirsutism); acne; multiple ovarian cysts; infertility; and obesity. More than 95% of women who have three classic signs -obesity, hirsutism and irregular menses- have PCOS. Still, some women have the syndrome but don’t have all three of these classic signs. More than 50% of women with PCOS are overweight or obese; the general increase in obesity incidence is linked to the increase in PCOS prevalence. But not all women with PCOS are overweight or obese. Some are of normal weight or even underweight, have not excess hair growth on the face, chest or legs, and may even have semi-regular menses. Obese women with PCOS have much higher average levels of testosterone and androsterone than non-obese women with PCOS. Obesity may contribute to hormone imbalances. High androgen levels can manifest, not only by excess hair growth, but also by hair thinning. Not all women with PCOS are infertile as there may be random unpredictable ovulation.

It can be difficult to come up with a definitive diagnosis as there are so many variables in this syndrome. Yet it is probably the most common cause of a lack of ovulation, leading to abnormal menstrual cycles and infertility. There have been some variations in the stipulations for diagnosis since the first mention of this condition in 1935. The current diagnosis criteria are that at least two of the following three features must exist (and other causes of the high androgen hormones and/or lack of or infrequent menses must be excluded):

– scanty or infrequent flow (oligomenorrhea) or absence of menstruation (amenorrhea),

– elevated androgen hormone levels evident in clinical presentation (hirsutism and/or other signs of masculinization) or from laboratory findings,

-polycystic ovaries (12 or more follicles measuring 2 to 9 mm in diameter or volume of more than 10 ml).

Nutrition News and Views, May/June 2015, Vol. 19, No. 3
by Judith A. DeCava, CNC, LNC