WHAT IS PCOS and HOW IS IT DIAGNOSED?

What is Polycystic Ovary Syndrome?

Polycystic ovary syndrome (PCOS) is a complex hormonal condition in women, affecting many aspects of their health, particularly the reproductive system.
It may present with a menu of symptoms including:

  • Polycystic ovaries(surface of ovaries covered in many follicles)
  • Irregular or absent periods
  • Infertility
  • Recurrent miscarriage
  • Acne
  • Hair loss
  • Weight gain
  • Excess body hair
  • Skin tags
  • Acanthosis Nigrican
  • Diabetes
  • Hypertension
  • Fatigue
  • Mood swings

The symptoms can be mild or severe and vary from women to woman.
These symptoms are due to abnormalities in some of the hormones
that control a women’s menstrual cycle. To understand how
these imbalances affect this cycle lets see what happens in a ‘normal’ cycle.

The Normal Menstrual Cycle

In a normal menstrual cycle, the first half, called the follicular
phase, starts on the first day of a period and lasts for about 14 days, in this phase the
pituitary gland in the brain, releases the hormone, follicle stimulating
hormone (FSH). This stimulates the follicles (tiny cyst containing
immature eggs) in the ovary to grow. As the eggs mature they produce another hormone oestrogen, which causes the lining of the womb to start to thicken in preparation
for pregnancy. When the levels of oestrogen are high enough, the pituitary gland release Luteinzing
hormone (LH) and the dominant matured follicle in the ovary releases its
egg in to the fallopian tubes in a process called Ovulation.

After ovulation the Luteal phase starts, here the cells from the ruptured follicle form a cyst, called Corpus Luteum. This produces the hormone Progesterone, which cause the thickened lining of the womb to secrete nutrients ready for the fertilised egg. If the egg is fertilized it will implant and the corpus luteum will continue to produce progesterone to support the pregnancy. If it is not fertilized
the corpus luteum stops producing progesterone. Progesterone and oestrogen levels
fall and the lining of womb breaks down and is shed as a period.

What happens in PCOS?

In PCOS there is an imbalance with the hormones that mature the follicles FSH and the hormone that triggers ovulation, LH, which means that periods are irregular or absent, which makes it difficult to become pregnant. Also because there
is no ovulation there is not an increase in progesterone to balance the hormone oestrogen in the second half of the cycle and you get symptoms such as fatigue, hot flushes, mood swings,
depression and no periods.

Because the body’s hormones system is interconnected, an imbalance in one hormone can affect the balance of others. PCOS affects the hormone Insulin, which is produced by the pancreas
to regulate the levels of glucose in the blood. Many women can become insulin resistant,  this means the body produce more insulin to push the glucose into the cells. Insulin also encourages the body to store sugar as fat.  This causes weight gain, difficulty in losing weight and often
development of type 2 diabetes.

The high levels of insulin, signals the ovaries to secrete testosterone and inhibit hepatic sex-hormone binding globulin (SHBG) production, which leads to an increased level of circulating testosterone. This is why many women with PCOS experience acne, facial hair growth and male pattern baldness (hirsutism). Excess insulin in the bloodstream also signals the ovaries to release more oestrogen, which can suppress ovulation.

PCOS women also suffer with low grade inflammation .

What causes PCOS?

Doctors do not yet fully understand what cause these hormonal abnormalities. It is thought that there is a hereditary link, whereby some women inherit a greater chance of having PCOS, but whether or not these women develop PCOS depends on a number of additional factors such as diet and lifestyle.

How is PCOS diagnosed?

The diagnosis is based on a patient’s symptoms and physical appearance and confirmed by ultrasound scan of the ovaries and blood test to check the levels of different hormones, these would include:

Pituitary and Ovarian Hormone serum levels:

  • Luteinizing Hormone (LH)
  • Follicle Stimulating Hormone (FSH)
  • Estradiol
  • Progesterone
  • Prolactin

Circulating Androgens:

  • Free testosterone
  • Free androgen index (FAI): 17-hydroxyprogesterone
  • Sex hormone binding globulin (SHBG): 24 hr. urinary free cortisol
  • Dehydroepiandrosterone sulfate (DHEA-S)
  • Some practitioners may include the following tests:

Glucose Tolerance Test
Thyroid Panel
Blood Lipid Profile

To be diagnosed with PCOS you will have to met 2 out of 3 criteria, known as the Rotterdam Criteria:

  1. Delayed ovulation or menstrual cycles (anovulation)
  2. Hyperandrogenism ( high androgenic hormone like testosterone/ signs of)
  3. Polycystic ovaries on ultra sound

 

As you can see PCOS is a complex endocrine condition, exhibiting itself differently in each women!

 

Next article: Conventional and Natural Treatment for PCOS