The Discovery of Polycystic Ovarian Syndrome: PCOS

PCOS: The Syndrome of Hormones, Hair and Havoc of menstrual cycles
Polycystic Ovarian Syndrome (PCOS)

The doctors Stein and Leventhatal in 1935 discovered why some women had big cysts on their ovaries, extra hair growth and troubles getting pregnant. Their original series of patients had 7 cases, ,they performed their now abandoned practice of ovarian wedge resection (their thought was to help eggs ovulate by allowing them to get to the surface of the ovary) on all 7. Out of these 7 women, all began to have regular cycles and 2 did become pregnant from the treatment. And though we recognize their work as the beginning, their name long left the condition of Polycystic Ovaries. After it was called Stein and Leventhal's disease this has been called a disease, a condition and now a syndrome. The definition has been changed so that almost 1/10 women can meet the definition and in fact many women with perfectly regular menstrual periods are surprised to learn upon visiting their gynos that they are now diagnosed with an important condition that can have fertility and  life long health consequences. If you’ve got to shave your chin regularly, you may just have that sort of genetics, and on the other hand your ovaries may be producing too much testosterone, or one of the other boy hormones that emanate from the ovary or the adrenal gland. The most common symptom of PCOS is hyperandrogenism (too much boy hormone), chronic anovulation (skipped periods due to not popping an ovarian egg), many are overweight (7 out of 10) and finally either diabetic or pre-diabetic (again 7 out of 10), insulin resistance (you have it but it won’t work like it’s supposed to with your metabolism) and compensatory hperinsulinemia (the pancreas cranks out extra) are also features. For those with the worse insulin resistance they may develop hypertension and hyperlipidemia (elevated cholesterol). And many have ovaries with a “string of pearls” look…little cysts all lined up around the edge as seen when looking with the ultrasound. But this is not really a helpful criteria as about 30% of all women will have ovaries that appear this way on ultrasound.

The insulin is probably a big part of the extra hair. The insulin stimulates the cells of the ovary to produce more male hormones. These extra male hormones right in the ovary mess up ovulation. Insulin can also suppress the liver substance SHBG (sex hormone binding globulin) which is supposed to bind male hormones and keep them inactive and there for in check. So the more deranged your metabolism is, the heavier you get, the worse your PCOS gets.

So how to fix: well to some extent there is no fix, it’s in your genes, but it can be controlled. Control anything and everything diet: lower bad LDL cholesterol, lower the blood fat triglyceride, improve the production of free fatty acids, and other parameters of your blood fats like the types of particles you carry your cholesterol around in, exercise and increase good HDL cholesterol and reduce the blood vessel wall inflammation that leads to plaque and contributes to complications of higher blood pressure, slim by even 5%, control the sugar and use diabetic drugs like metformin if you need to. But watch for side effects of the medications used to control insulin and blood sugar. Metformin can have its negative side, it can lower vitamin B12 levels (side effects of low B12 levels might include numbness, other odd neurologic symptoms such as memory loss and behavior changes). Controlling your cycles, preserving your fertility, controlling unwanted hair growth and improving how you metabolize your sugars is what your gyno wants to improve. Fe medications do this as well as the birth control pills Oral contraceptives can suppress the boy hormones of the ovary, so that’s a good bet that it will be recommended as a possible solution by your gyno. For those who have struggled with the right pill choice, call Women's Health Practice to be seen to discuss what might the right pill be at 217-356-3736.