What is PCOS?
Polycystic Ovarian Syndrome (PCOS) is a common female medical condition affecting the ovaries characterized by abnormal functioning of the ovaries which can lead to difficulty getting pregnant and other symptoms that result from increased levels of male hormones. It affects 5-10% of the general population.
What Causes PCOS?
The exact cause of PCOS is not known. Genetic and environmental factors can lead to the development of PCOS.
Some experts believe that the production of an excess amount of androgens, a group of male sex hormones, contribute to the development of PCOS. Although all women produce some androgens, too much of this type of hormone prevents ovulation. Excess androgens also disrupt the normal menstrual cycle. They may cause infertility, acne and abnormal hair growth, such as excess facial hair or male pattern baldness. Excess insulin (the hormone that allows cells to use sugar) may be a factor in developing PCOS. Excess insulin leads to insulin resistance, which in turn decreases your ability to use insulin effectively and the excess insulin is thought to additionally boost androgen production by the ovaries. Low-grade inflammation is another potential factor leading to PCOS. Women whose sister or mother has PCOS may have a greater chance of having PCOS. Exposure to excess male hormones in fetal life (when baby is still in the womb) can increase the risk for developing PCOS.
What are the Signs and Symptoms of PCOS?
People with PCOS might have menstrual irregularities, difficulty getting pregnant, male-pattern distribution of body hair, male-pattern baldness, and acne. PCOS is associated with increased risk for the development of impaired glucose tolerance, type 2 diabetes, hypertension, dyslipidemia (high lipid levels), non-alcoholic fatty liver disease, heart disease, Obesity, and obstructive sleep apnea (OSA).
Can PCOS cause Obesity and can Obesity cause PCOS?
The relationship between PCOS and Obesity is complicated. It is possible that Obesity can lead to PCOS and PCOS can contribute to the development of obesity. About 38-88% of people with PCOS are either overweight or obesity (1). Hormonal irregularities and insulin resistance are thought to contribute to weight gain and obesity in women with PCOS. The majority of women with PCOS (50%-90%) are insulin resistant (2). It is also thought that the abnormal levels of metabolic hormones found in women with obesity can contribute to some of the symptoms of PCOS (3). It is known that women with Obesity have a higher risk for developing PCOS and women with PCOS have a greater risk for obesity. Treating obesity can improve the symptoms of PCOS.
Can PCOS increase my risk for Obstructive Sleep Apnea?
Obstructive Sleep Apnea (OSA) is a breathing disorder where the upper airway repeatedly collapses, blocking the flow of air during sleep and disrupting your sleep. Some symptoms of OSA include snoring, pauses in breathing during sleep, fatigue, daytime sleepiness, and lack of concentration. Women with PCOS have a 2.26 higher risk of developing OSA compared with women without PCOS, irrespective of their BMI or age. It is also known that excess weight increases the risk for obstructive sleep apnea. PCOS may increase the risk of OSA through effects on the sex hormones progesterone and testosterone which can affect respiratory muscles and breathing (4). Losing weight can help improve the symptoms of both OSA and PCOS.
How is PCOS diagnosed?
Your medical provider will obtain a medical history, assess your symptoms, do a physical exam, check hormone levels and a pelvic exam and pelvic ultrasound may also be required.
Why is early Diagnosis and Treatment of PCOS important?
Early diagnosis and treatment can help improve symptoms, quality of life and prevent medical complications. PCOS is associated with increased risk for high blood pressure, type 2 diabetes, sleep apnea, abnormal uterine bleeding, cholesterol abnormalities, metabolic syndrome, heart disease, cancer of the uterus and complicated pregnancies. With early diagnosis and treatment of PCOS, doctors can reduce risk of these long-term complications.
What Treatments can help with PCOS?
There is no simple cure for PCOS. Fortunately, treatment can help improve symptoms and decrease the risk of long-term complications.
Treatment may include lifestyle changes, weight loss, regular physical exercise, avoiding tobacco and excess use of alcohol, use of hormones to counteract the effect of excess androgens (male hormones), use of medication for insulin resistance such as Metformin, and in some cases target treatment for skin and hair issues.
Modest weight-loss of about 5% often results in clinically meaningful improvements in the menstrual abnormalities, fertility, glucose and lipid control, hair and skin abnormalities (5).
About the Author: Dr. Pascal Ngongmon, MD, MHA.
Dr. Ngongmon is board-certified in Obesity, Sleep and Internal Medicine and owner of Optimal Sleep And Weight Loss Clinic. He specializes in Sleep medicine, Medical weight loss and also treats male and female hormone replacement and PCOS.
Reference:
1. Legro RS. The genetics of obesity. Lessons for polycystic ovary syndrome. Ann N Y Acad Sci. 2000;900:193-202
2. Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes. 1989;38:1165-1174
3. Barber TM, Franks S. Adipocyte biology in polycystic ovary syndrome. Mol Cell Endocrinol. 2013;373:68-76.
(4) Balachandran K, Sumilo D, O’Reilly MW, et al. Increased risk of obstructive sleep apnoea in women with polycystic ovary syndrome: a population-based cohort study [published online ahead of print February 1, 2019]. Eur J Endocrinol. doi: 10.1530/EJE-18-0693
5. Kiddy DS, Hamilton-Fairley D, Bush A, et al. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf). 1992;36:105-111