Polycystic ovary syndrome: The big picture

Do you have irregular periods, acne breakouts, excessive weight gain and male-pattern hair growth? If you do, you may be struggling with the hormonal disorder polycystic ovary syndrome (PCOS).

In PCOS, the ovaries which regulate the menstrual cycle are often riddled with cysts (fluid-filled sacs) and produce an excessive amount of male sex hormones (androgens). PCOS commonly affects women of reproductive age, between 15 and 44 years, and is one of the leading causes of female infertility. It can also strike girls as young as 11 or 12 years old when they have their first period. It is estimated that one in every 10 women will be affected by PCOS during their lifetime. Unfortunately, more than half of those affected by PCOS don’t know they have it. This makes public awareness of PCOS necessary.

In the normal menstrual cycle, the brain sends hormones to your ovaries to regulate the maturation of follicles (sacs in the ovaries, where eggs develop). The ovaries then produce a small amount of androgens and increased amounts of the female hormone oestrogen so that the most mature egg can be released in a process called ovulation. This results in either pregnancy if the egg is fertilised by the male sperm, or a breakdown of the uterine wall in the form of your monthly period. This process is dysregulated in PCOS, as excess androgens are produced which disrupts ovulation by preventing the follicles from maturing. As such, the ovaries become enlarged with multiple immature fluid sacs and ovulation ceases, leading to fewer-than-normal periods. This makes it difficult for women with PCOS to get pregnant.

NO KNOWN CAUSES

It is not known what causes the imbalance of hormones in PCOS. However, scores of studies have highlighted that genetic factors and weight gain may both increase the likelihood of developing PCOS. Your risk is increased if your mother, sister or aunt has PCOS. Weight gain may drive insulin resistance, in which the body’s cells cannot uptake sugar for energy. This causes a spike in the blood glucose levels and the body responds by producing higher levels of insulin to compensate. Since insulin is one of the regulators of ovarian function, excessive amounts may trigger the ovaries to produce androgens, which interferes with ovulation.

Some of the telltale signs that you have PCOS include irregular periods; alopecia; excess hair on the face, back and chest (hirsutism); deeper voice; rapid weight gain and acne breakouts. These symptoms are usually attributed to the excess androgens. Additionally, some women may notice a thickening and darkening of the skin due to excess insulin blood levels.

PCOS is often diagnosed if at least two of the following three criteria are met:

I. Excessive male hormones in the blood (hyperandrogenism) – This is responsible for symptoms such as excess body hair, deep voice, acne and male-pattern alopecia.

II. Multiple cysts developing around the edge of the ovaries.

III. Failure to ovulate, leading to absent or irregular periods – Some women experience abnormally heavy periods due to missing periods frequently.

A confirmatory diagnosis usually involves an ultrasound scan to examine the ovaries and uterine lining, and blood tests to determine hormone levels.

PCOS is more than just a reproductive issue since it is associated with other health implications. Up to 70 per cent of women with PCOS are insulin-resistant, which will lead to elevated blood glucose levels. As such, up to 35 per cent of women with PCOS have prediabetes (blood sugar level is higher than normal, but not high enough to be diagnosed as diabetes), and more than 50 per cent of women with PCOS will develop type 2 diabetes by age 40.

Excessive insulin levels can also cause rapid weight gain, particularly in the abdomen. Abdominal fat can lead to raised levels of bad cholesterol (LDL) and low levels of good cholesterol (HDL) which are risk factors for coronary artery disease. The high levels of bad cholesterol can cause plaques to block blood vessels, leading to cardiovascular events such as heart attack and stroke. Studies have shown that PCOS women are twice as likely to develop a heart attack or stroke.

If you are having trouble getting pregnant or struggle with PCOS symptoms, please see your healthcare provider for an assessment. The diagnosis of PCOS can be daunting as there is no cure, but you can be treated by your healthcare provider to manage the symptoms and reduce your risk of developing further complications. Additionally, if you wish to become pregnant, speak to your healthcare provider about fertility treatments. Adopting a healthy lifestyle is important, which includes exercising and maintaining a healthy diet. This will help you to maintain a healthy weight and help your body utilise insulin more efficiently.

Melisa Anderson Cross is a clinical chemistry lecturer in the College of Health Sciences at the University of Technology, Jamaica.