Polycystic Ovary Syndrome
Polycystic ovary syndrome (PCOS) refers to a condition where the ovaries make too many eggs that turn into cysts. The cysts are like little balloons filled with liquid. Hormone imbalance is the underlying cause of PCOS, and it can be diagnosed without finding cysts on the ovaries.
Women with PCOS have irregular menstrual periods. After a while, some women stop having any periods. Women with PCOS may have trouble getting pregnant.
About 70 percent of women with PCOS have extra hair growing in the sideburn area of their face and on their chin, upper lip, nipple area, chest, lower abdomen and thighs. They may get acne.
About half with PCOS are obese. Some women with PCOS have no signs of it.
Endocrine abnormalities in women with PCOS include elevated levels of androgens (dehydroepiandrosterone, testosterone, and androstenedione), hyperinsulinemia (which results from insulin resistance), impaired glucose tolerance, hyperlipidemia, and a tendency to thrombosis.
Polycystic ovary syndrome is a heterogeneous syndrome. Although the underlying defect remains unknown, there is growing consensus that key features include insulin resistance, androgen excess and abnormal gonadotropin secretion.
Recent evidence suggests that the principal underlying disorder is one of insulin resistance, with resulting hyperinsulinemia stimulating excess ovarian androgen production. PCOS has much in common with metabolic syndrome X (insulin resistance, dyslipidemia, abdominal obesity and high blood pressure). Hypothyroidism may also be present.
One theory suggests that there may be low levels of dopamine in the brain. Because of complex feedback loops in the brain, low dopamine levels result in higher than normal levels of the hormones Luteinizing Hormone (LH), Prolactin (PRL), Thyroid Stimulating Hormone (TSH) and Gonadotrophin Releasing Hormone (GnRH). The increase in GnRH causes a chronic increase in LH and suppression of FSH. The high LH:FSH ratio gives rise to the lack of follicular maturation which is commonly seen with PCOS and which leads to chronic anovulation. The chronically elevated LH levels stimulate the follicular thecal cells and leads to androgen excess. The excess androgens are converted to estrogens (estrone and estradiol), but androgen levels remain high because FSH, which normally promotes this conversion, is low. As estrogen levels rise, this feeds back and further suppresses FSH levels. This pattern of elevated hormones is commonly seen with PCOS.
Key diagnostic indicators of PCOS include:
Testosterone > 70
LH/FSH ratio > 2:1
Elevated fasting insulin > 9
Elevated DG EA-S
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