POLYCYSTIC OVARIAN SYNDROME
This is a condition that is probably alot more common than is currently known. Surprisingly few women know of the condition; and even doctors have a difficult time agreeing on the causes and treatment of it. Unfortunately, there is no cure for polycystic ovarian syndrome.
Each month, a pre-menopausal woman forms an egg on one of her ovaries. Normally, it is released and travels down one of the fallopian tubes to the uterus. But in polycystic ovarian syndrome (heretofore referred to as PCOS), the egg does not get released. Instead, it stays on the outside of the ovary, and a cyst forms around it. Month after month these cysts form, making the ovaries "bumpy" and enlarged. Occasionally, these cysts can rupture, causing severe lower abdominal pain on the affected side.
SYMPTOMS OF PCOS:
irregular menstrual periods (either prolonged ones, very frequent ones, very scant ones or going long periods of time between them, and sometimes, complete cessation of the menses)
elevated testosterone levels (male hormone)
aberrant body and facial hair growth (on the face, chest, back, abdomen; due to high testosterone)
adult acne (also due to the high testosterone levels)
acanthosis nigricans (a grayish-brown velvety "coating" on the skin on the back of the neck, underarms, and inner thighs)
infertility (because of the lack of egg release and the high testosterone levels)
elevated blood insulin levels (cause unknown)
development of insulin resistance (due to the high insulin levels)
weight gain (because of carbohydrate craving due to the high insulin levels)
obesity-related conditions (such as high blood pressure, cardiovascular disease, diabetes mellitus, poor circulation and consequent leg swelling)
Usually the first symptom is the erratic menstrual periods, often starting within a few years after the onset of the menses. Then, a woman may experience infertility problems, which may be the first time she seeks a doctor's advice. If her doctor suspects PCOS, he will draw blood testosterone and prolactin levels, and order a 24-hour urine collection for urinary 17-ketosteroids. If these levels are abnormal, he may order a blood insulin level, or an insulin tolerance test to check for insulin resistance. If all of these tests come back with abnormal results, and the patient has many of the physical signs and symptoms, he will likely arrive at a diagnosis of PCOS.
If a woman is not wanting to get pregnant at the time of diagnosis, doctors often place their patients on birth control pills to cause menstrual periods to occur, and thus prevent build up of estrogen in the uterus that could ultimately lead to the development of uterine or cervical cancer. If she is wanting to attempt pregnancy, he can try one of the fertility drugs (Clomid or Pergonal).
DEVELOPMENT OF PCOS
The sequence of events in the development of PCOS is currently unknown. Many older doctors still operate on the assumption that obesity CAUSES PCOS, and will tell their patients that losing weight will solve all their problems. But newer studies seem to indicate that in fact, the condition CAUSES the obesity because of the food cravings brought on by the elevated insulin levels. What is not known, however, is whether the ovarian cysts start the process in motion, or if the elevated insulin levels and insulin resistance causes the problems with the ovaries. It is thought now that the condition may began to develop at menarche (onset of menstrual periods).
TREATMENT MODALITIES
As mentioned before, there is NO CURE for PCOS at this time. But there are treatments available that may help some women overcome some of the problems associated with it.
Glucophage (Metformin) - a drug that is used to treat the insulin resistance, thus eventually lowering the blood insulin level, and allowing return of the menstrual periods and normal ovulation. This drug is usually taken in 500 mg doses three times a day. The most common side effect is diarrhea, which usually subsides within a few days of starting the drug. It may also have a mild anorexic effect, lowering the carbohydrate cravings. In some people, it may have detrimental effects on the liver; but that is very rare. (NOTE: If you are taking Glucophage, and have to undergo any testing that involves iodinated dyes, such as MRIs, CT scans or cardiac cath procedures, you must stop this drug before having the test, and not resume it for at least 48 hours afterwards due to the potential for kidney failure with the combination of medications.)
Aldactone (Spironolactone) - a drug that is classified as a diuretic and anti-hypertensive (to get rid of excess fluid and lower blood pressure) that has mild anti-androgenic effects - this medication may be helpful in reducing the masculinizing effects of the elevated testosterone levels (the facial and body hair growth, and the acne)
Birth Control Pills - to regulate the menses and change the hormonal balance in the body - recommended lower dosage pills, with a combination of estrogen and progesterone
Occasionally, doctors may recommend laparoscopic surgery to remove or destroy some of the cysts and ovarian tissue. But removal of the ovaries is not a suggested therapy for this condition, even in women who do not wish to get pregnant.
If you think you may have PCOS, see your gynecologist. There may be help for you. And for more information and support, click here to visit the Polycystic Ovarian Syndrome website, or you may get to it from the links on the main page.
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