POLYCYSTIC OVARY SYNDROME (PCOS)

  Polycystic ovary syndrome....... what actually it is, what are some of the causes of the syndrome.

10 out of 3 women experience with multiple cysts in their ovaries, and doctor can actually see them on an ultrasound of a patient's ovaries. It actually look like black little holes.

SYMPTOMS:

Menstrual irregularity and this irregularity can happen as soon as the patient actually enters puberty. So a lot of times, these patients will have a delayed onset of menarche, or a delayed onset of their first period. So they have their first period a little bit later or a little bit older than average. They also can have oligomenorrhea, which is having less than nine menstrual periods per year. So they have less menstrual periods, and during their adulthood, sometimes they can even have amenorrhea, which is no menstrual periods at all - so they just go through their life without having any periods whatsoever. But interestingly enough, they can have a regularization after the age of 40. 

And another main characteristic of polycystic ovary syndrome is hyperandrogenism, and kind of one of the big characteristics that cause a lot of the visible symptoms that you see with these patients.

The first one is acne - acne is very common in patients with polycystic ovary syndrome because of the high levels of androgens. Another one is hirsutism - now hirsutism is actually just a growth of hair, so these patients oftentimes will grow or have more terminal hair growth so you get this kind of darker hair growing particularly on their face or on other parts of their body. And another one is actually hair loss - so it's almost a kind of a male pattern hair loss due to high levels of androgens. 

ALARMING SIGNS:

Well first off approximately 40 to 85% of women with polycystic ovary syndrome are overweight or obese so there's oftentimes a connection between BMI and polycystic ovary syndrome & women with PCOS typically have an increased risk of type 2 diabetes again this follows in line with glucose intolerance and insulin resistance. 

They are also at risk for dyslipidemia -- which again follows insulin resistance and because they are at a higher risk of being overweight or obese, they have a higher risk of having obstructive sleep apnea (OSA). 

Another condition that's associated with insulin resistance in obesity is non-alcoholic fatty liver disease 

 Again, a lot of these women also suffer from depression and anxiety. anovulatory infertility, so they actually don't ovulate properly and they become infertile as a result. 

Another one is endometrial hyperplasia - now endometrial hyperplasia is just an overgrowth or excessive growth of the endometrium within the uterus and now this also leads to an increased risk of endometrial cancer because of the hyperplasia. 

As mentioned before those that are insulin resistant are at a higher risk of polycystic ovary syndrome. Type 1 and type 2 gestational diabetic moms are also at a higher risk for polycystic ovary syndrome. Another one is premature adrenarche. Now adrenarche is the start or the commencement of the adrenal glands to produce androgens. So during childhood people typically produce some amounts of androgens very low amounts, but individuals that have a premature adrenarche seem to be at a higher risk of polycystic ovary syndrome. 

Also people with first-degree relatives that have polycystic ovary syndrome are at a higher risk of getting it themselves and now this lends credence to possible genetic influences. So a lot of these may be the cause of polycystic ovary syndrome or maybe the result - it's still not known for sure, but again the first-degree relatives seem to show that there are some genetic influences with regards to polycystic ovary syndrome. Some studies have shown that perhaps there are certain genes on chromosome 2 or chromosome 9 - here's a handful of different genes or proteins that may be involved in polycystic ovary syndrome. One is luteinizing hormone receptor. Another one is human chorionic gonadotropin receptor. The other one is called FATA. Another one is androgen receptor, another one is sex hormone binding globulin. Another one is DENN/MADD domain-containing protein 1a and the last one again is insulin. So there still could be some issue with insulin or insulin signaling that's predisposing individuals for polycystic ovary syndrome. 

TREATMENT:

 First things we like to focus on are some lifestyle changes, because as I mentioned before a large amount of patients with PCOS are overweight or obese, so we like to try to change some of those parameters. So we like to get them on a diet or exercise just to try to reduce their BMI try to reduce their weight and to try to normalize their insulin, insulin tolerance, and glucose tolerance. There's also some pharmacologic treatments as well and this is particularly important for stabilizing the menstrual irregularity, But always consult with your gynecologist before taking any medication.