What disease affects 8-20% of reproductive-age women worldwide? This same disease is diagnosed in most women when they are in their twenties, but can affect girls as young as age 11.
The answer is polycystic ovary syndrome and, if both the prevalence and the lifelong health consequences of the ovarian disease go undiagnosed, it demands that we raise awareness.
The cause of polycystic ovary syndrome, or PCOS, still remains unknown, but it is thought that it is due to many different factors. The primary factor in PCOS is insulin resistance, meaning that the insulin receptors in our body are unresponsive to insulin. This is related to weight gain and is harmful in two ways. The first, is that since glucose cannot enter our cells, it is stored, instead, and leads to further weight gain. Secondly, the increased insulin levels lead to increased production of androgens, which leads to symptoms of excess facial or body hair, and moderate-to-severe acne.
Another characteristic of PCOS is the interference with the process of ovulation, where our ovaries release an egg every month. This involves an intricate balance between two hormones: FSH and LH. In PCOS, the LH levels are elevated, which leads not only to exacerbation of the hyperandrogenic state, but also cycles of chronic anovulation (when the ovaries do not release an egg, or oocyte, during the menstrual cycle), leading to a high estrogen state. This leads to irregular menstrual cycles, can result in infertility, as well as increase one’s risk of endometrial cancer.
The diagnosis of PCOS is made when women fit two out of the following three criteria:
- Hyperandrogenism (increased levels of LH, excess facial and body hair acne)
- Anovulation (ovaries do not release an egg during menstrual cycle)
- Polycystic ovaries (found by vaginal ultrasound)
Unfortunately, the detrimental effects on our women’s health due to PCOS extend far beyond what we have just talked about. Women with PCOS are more likely to suffer from depression and anxiety. The insulin resistance can lead to Type II diabetes, which is especially exacerbated when the person is obese. The prevalence of metabolic syndrome, which encompasses abdominal obesity, high blood pressure, high blood sugar, high triglycerides and low HDL levels, is at least two times higher in women with PCOS. The sum of all of these may predispose women with PCOS to coronary heart disease.
Fortunately, not all hope is lost, as PCOS can be successfully treated and managed with medications, and far more importantly, lifestyle changes.
Dr. Bhatia is board-certified gynecologists trained in women’s health, gynecological diseases, gynecology surgery, metabolic treatment, and hormone replacement therapy. If you believe that you may be experiencing symptoms of PCOS or would like to schedule a well-woman exam, contact our office today at (210) 222-2694.5