Identifying Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) is responsible for abnormal menstrual function in 5 to 8 percent or more of women during their reproductive years. It tends to run in families. Women with this condition have trouble conceiving a child, and they have increased hair on their faces, arms, legs, and areas of the body that are not usually hairy in women. In addition, they experience acne and obesity.

The surprise finding in PCOS is that these women are also resistant to insulin and have increased blood levels of insulin even when they are not obese. The greater the degree of obesity, however, the more frequent that the metabolic syndrome is present (see Chapter 5). In fact, women with PCOS who do get pregnant have a prevalence of gestational diabetes that is 2 to 3 times that of those women without PCOS.

Another feature that women with PCOS have in common with metabolic syndrome is obstructive sleep apnea. This sleep apnea results in daytime sleepiness and high blood pressure.

The name of the syndrome derives from the fact that early cases of PCOS were associated with multiple ovarian cysts. More recently, the presence of ovarian cysts has not been a prominent feature of the condition, but the name has stuck.

Women with PCOS have increased levels of male-associated hormones called androgens. Studies have shown that androgens cause decreased insulin sensitivity when they are given to women who don't have PCOS.

The major health risks for someone with PCOS, besides infertility, are the occurrence of impaired glucose tolerance and type 2 diabetes, as well as ges-tational diabetes. In addition, just like patients with the metabolic syndrome (see Chapter 5), these women are at greater risk for high blood pressure, abnormal blood fats, and cardiovascular disease.

The most effective treatment for PCOS is lifestyle change. Weight loss and exercise often reverse the condition and prevent the development of diabetes. In very obese women with PCOS, weight loss surgery will reverse PCOS. Oral contraceptives have been used in the past when more treatment is needed, but these don't restore fertility, which is often the main purpose of treatment. They can still be used to control the other symptoms, such as acne and increased hair. Insulin sensitizing drugs, including metformin, and pioglitazone (see Chapter 10), have been very effective for treating all features of the syndrome. In a study reported in The Journal of Clinical Endocrinology and Metabolism in April 2005, six months of metformin was much more effective than a drug called clomiphene, a well known inducer of ovulation, in restoring fertility.

Other than oral contraceptives, any treatment that is successful for reducing the acne, hairiness, and decreased insulin sensitivity in PCOS also makes the woman much more liable to get pregnant. If she doesn't want to become pregnant, she and her partner need to take the necessary precautions.

Gaining Weight 101

Gaining Weight 101

Find out why long exhausting workouts may do more harm than good. Most of the body-building workout and diet regimens out there are designed for the guys that gain muscle and fat easily. They focus on eating less and working out more in order to cut the excess fat from their bodies while adding needed muscle tone.

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