PCOS Basics & Blood Sugar Video

I often come across girls that are just trying to get around PCOS to try and achieve pregnancy.  It worries me because though PCOS can affect your ability to get pregnant and carry to term,  more importantly it is a medical conditional that will lead to much more serious health risks if permanent lifestyle changes are not made.  Please see the educational video at the end of this blog on how our bodies process blood sugar.  Remember, Knowledge is Power

What causes PCOS?

While it's not certain if women are born with this condition, PCOS seems to run in families. This means that something that induces the condition is inheritable, and therefore influenced by one or more genes.
Ongoing research is trying to clarify whether there's a clearly identifiable gene for PCOS. Several different genes have been implicated in the condition – none have been definitely implicated as being the prime cause. Perhaps this role of several genes, and not one in particular, is what lies behind the way in which the condition is expressed so differently in people.
We know that PCOS has some genetic basis, but it's unlikely that all women with one or more of these genes will develop the condition. It's more likely to develop, if there's a family history of diabetes (especially Type 2, the less severe type usually controlled by tablets) or if there's early baldness in the men in the family.
When the genetic tendency for PCOS is passed down through the man's side of the family, the men are not infertile – but they do have a tendency to become bald early in life, before the age of 30.
A number of marker proteins have also been identified in the blood of women with PCOS, further supporting the view that this is a genetically determined disorder.
Women are also more at risk if they're overweight. Maintaining weight or body mass index (BMI) below a critical threshold is probably important to determine whether some women develop the symptoms and physical features of the condition. Just how much weight (or what level of BMI) is difficult to say because it will be different for each individual.
Certainly, for patients who are considered overweight (BMI 25 to 30) or obese (with BMI greater than 30), weight loss improves the hormonal abnormalities and improves the likelihood of ovulation and therefore pregnancy.

Can PCOS be prevented?

Not being certain of the exact cause makes it difficult to answer this question fully.
If there's a genetic influence, some people are more likely to get PCOS than others. But it seems likely that you cannot alter your predisposition to PCOS.
There's no current proof of any benefit of preventative weight loss. But the best advice for overall health is to maintain a normal weight or BMI, particularly if you have strong indicators that PCOS could affect you.
These indicators include:

• a tendency in the family towards Type 2 diabetes (non-insulin dependent diabetes)
• the knowledge that a close relative already has PCOS
• a tendency towards early baldness in the men in the family (before 30 years of age).

 

What are the symptoms?

The ways that PCOS shows itself include:

• absent or infrequent periods (oligomenorrhoea): a common symptom of PCOS. Periods can be as frequent as every five to six weeks, but might only occur once or twice a year, if at all
• increased facial and body hair (hirsutism): usually found under the chin, on the upper lip, forearms, lower legs and on the abdomen (usually a vertical line of hair up to the umbilicus)
• acne: usually found only on the face
• infertility: infrequent or absent periods are linked with very occasional ovulation, which significantly reduces the likelihood of conceiving
• overweight and obesity: a common finding in women with PCOS because their body cells are resistant to the sugar-control hormone insulin. This insulin resistance prevents cells using sugar in the blood normally and the sugar is stored as fat instead
• miscarriage (sometimes recurrent): one of the hormonal abnormalities in PCOS, a raised level of luteinising hormone (LH - a hormone produced by the brain that affects ovary function), seems to be linked with miscarriage. Women with raised LH have a higher miscarriage rate (65 per cent of pregnancies end in miscarriage) compared with those who have normal LH values (around 12 per cent miscarriage rate).

These symptoms are related to several internal changes, some of which can be relatively easier understood in the light of the hormone abnormalities that are frequently found.
These include:

• raised luteinising hormone (LH) in the early part of the menstrual cycle
• raised androgens (male hormones usually found in women in tiny amounts)
• lower amounts of the blood protein that carries all sex hormones (sex-hormone-binding globulin)
• a small increase in the amount of insulin and cellular resistance to its actions
• raised levels of anti-Mullerian hormone, when compared with women with normal regular cycles (this may become a more useful and accurate test than checking LH or the LH to FSH ratio).

Most women with PCOS will have the ultrasound findings, whereas the menstrual cycle abnormalities are found in around 66 per cent of women and obesity is found in 40 per cent. The increase in hair and acne are found in up to 70 per cent, whereas the hormone abnormalities are found in up to 50 per cent of women with PCOS.

 

What can you do for PCOS?

There are several things that an individual can do if they have a tendency towards developing some or all of the elements of PCOS. Much of this involves lifestyle changes to ensure that your weight is kept within normal limits (BMI between 19 and 25).
In addition, because there is a likelihood of developing diabetes in later life and a slightly higher risk of heart disease, low-fat and low-sugar options should be considered when making choices about what to eat or to drink.
Weight loss, or maintaining weight below a certain level, will have the short-term benefit of increasing the likelihood of successful treatment and the long-term benefits of reducing the risk of diabetes and heart disease.
Weight loss is effective in reducing male hormone levels, increasing the likelihood of ovulation and getting pregnant.
Using medications to lose weight may be effective, and orlistat is probably the most effective of these. Metformin on the other hand is probably not effective in helping to lose weight though evidence on this is conflicting.
It's interesting that despite all the research into PCOS, the exact relationship between the condition and weight gain (or loss) is unclear. But being overweight, and especially increased abdominal fat, seems to be a strong predictor of having other hormonal problems – such as raised male hormones and tendencies to having diabetes.

 

Adverse effects of having PCOS

It's likely that there are different stages of the disease throughout life.
Younger women tend to have difficulties with their periods, whereas older women have other problems – such as diabetes and hypertension (high blood pressure), though their period patterns tend to become more regular.
Women with PCOS have an increased risk of strokes and heart attacks – although the likelihood of dying because of these conditions isn't increased.
Women with PCOS have an increased risk of cancer of the uterus, particularly if they have infrequent or absent periods (up to three times). They also appear to have a increased risk of cancer of the ovaries (up to two times).
The increased risk of cancer of the uterus is thought to be due to certain hormonal abnormalities that result in continuous stimulation of the lining of the womb by oestrogen. However, the mild increase in insulin found in these women may also have negative effects.
There appears to be no increased risk of breast cancer in women with PCOS. The consensus is that it's sensible to advise women with PCOS and absent or very infrequent periods to take occasional progesterone therapy to 'oppose' the oestrogen and minimise the risk of cancer of the uterus.

 

Non-drug treatments

Ovarian diathermy (surgery that uses heat to alter ovarian function) is thought to reduce the amount of androgen secreting tissue in the ovaries, leading to resumption of ovulation in up to 80 per cent of women.
The risks include those of having a laparoscopy and a theoretical risk of ovarian damage from the diathermy. The benefits include resumption of ovulation in a simple manner, with effects lasting six to nine months.

 

What is the outlook?

Living with PCOS means different things for different women. This is because women experience the condition in different ways and have more or less severe symptoms depending on their situation.
In addition, as women get older, some symptoms change with age: hirsutism become less as hair distribution patterns change with advancing age and as the male hormones in the blood revert to more normal levels.
Women with PCOS are more prone to some serious conditions. These include an increase in the likelihood of developing diabetes (usually Type 2 diabetes (non-insulin dependent diabetes) and of developing cancer of the womb lining (endometrial cancer).
They also are more at risk of hypertension (high blood pressure) and high cholesterol, though if weight is controlled, high blood pressure is less likely to occur. Therefore, it makes sense to watch for symptoms suggestive of these conditions and to see your doctor should any suspicious symptoms be present.
For cancer of the uterus, these include irregular spotting or bleeding in the 40 to 50 year age group or any bleeding after the menopause. For diabetes, these include unusual thirst requiring large amounts of fluids, tiredness, and passage of increased amounts of urine, particularly at night.



References

Atiomo W, Khalid S, Parameshweran S, Houda M, Layfield R. (2009) Proteomic biomarkers for the diagnosis and risk stratification of polycystic ovary syndrome: a systematic review. BJOG 116: 137–143.
Cahill D (2009) PCOS. Clin Evid (Online). Jan 15; pii: 1408.
Chittenden BG, Fullerton G, Maheshwari A, Bhattacharya S. (2009) Polycystic ovary syndrome and the risk of gynaecological cancer: a systematic review. Reprod Biomed Online. 19(3):398-405.
Eckmann KR, Kockler DR (2009) Aromatase inhibitors for ovulation and pregnancy in polycystic ovary syndrome. Ann Pharmacother. 43:1338-1346
Farquhar C, Lilford RJ, Marjoribanks J, Vandekerckhove P. (2007) Laparoscopic 'drilling' by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev. Jul 18;(3):CD001122.
Galtier-Dereure F, Pujol P et al (1997). (1997) Choice of stimulation in polycystic ovarian syndrome: the influence of obesity. Hum Reprod 12 (Suppl 1): 88-96.
Goodarzi M. (2008) Looking for polycystic ovary syndrome genes: rational and best strategy. Semin Reprod Med 26:5–13.
Homberg R (1998). Adverse effects of luteinizing hormone on fertility. London: Balliere Tindall.
Hughes E, Brown J, Collins JJ, Vanderkerchove P. (2000) Clomiphene citrate for unexplained subfertility in women. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD000057. DOI: 10.1002/14651858.CD000057.
Mathur R, Alexander CJ, Yano J, Trivax B, Azziz R. (2008) Use of metformin in polycystic ovary syndrome. Am J Obstet Gynecol. 199(6):596-609.
Norman RJ, Davies MJ, Lord J, Moran LJ. (2002) The lifestyle modification in polycystic ovary syndrome. Trends Endocrinol Met 13:251-257.
Nugent D, Vandekerckhove P, Hughes E, Arnot M, Lilford R. (2000) Gonadotrophin therapy for ovulation induction in subfertility associated with polycystic ovary syndrome. Cochrane Database Syst Rev. (4):CD000410.
Piltonen T, Morin-Papunen L, Koivunen R, Perheentupa A, Ruokonen A Tapanainen J. (2005) Serum anti-Mullerian hormone levels remain high until late reproductive age and decrease during metformin therapy in women with polycystic ovary syndrome. Human Reproduction 20,1820–1826
Pirwany IR, Yates RW et al (1999). Effects of the insulin sensitizing drug metformin on ovarian function, follicular growth and ovulation rate in obese women with oligomenorrhoea. Hum Reprod ; 142963-68.
Tan S, Hahn S, Benson S, et al. (2007) Metformin improves polycystic ovary syndrome symptoms irrespective of pre-treatment insulin resistance. Eur J Endocrinol 157:669-76.
Tso LO, Costello MF, Albuquerque LE, Andriolo RB, Freitas V. (2009) Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome. Cochrane Database Syst Rev. Apr 15;(2):CD006105
Wild S, Pierpoint T et al (2000). Long-term consequences of polycystic ovary syndrome: results of a 31 year follow-up study. Human Fertility 3: 101-05.
Wild S, Pierpoint T et al (2000). Cardiovascular disease in women with polycystic ovary syndrome at long-term follow-up: a retrospective cohort study. Clin Endocrinol (Oxf) 2000; 52: 595-600.
Winters SJ, Talbott E et al (2000). Serum testosterone levels decrease in middle age in women with the polycystic ovary syndrome. Fertil Steril 73: 724-29.

Pin It