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Obesity? Polycystic Ovary Syndrome Dr. Sqouras Christal Alfonso Burhan Sadiq In this research paper I will attempt to discuss the causes, symptoms and signs of Polycystic Ovarian Syndrome, as well as how it is diagnosed and treated. As someone who is suffering from this disease, I found my research to be very informative and educational, raising awareness for my own understanding, and it is my intention to ensure that this same awareness is translated in my research paper. What is Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome also known as Stein-Leventhal Syndrome, occurs in 5% to 10% of women and is one of the causes of infertility. PCOS is observed by ultrasound as a number of small cysts on a woman’s ovary, and it’s characterized by a constellation of symptoms, and it is with these symptoms can a physician diagnose this disease. The Symptoms of PCOS is generally seen in young adolescent teens with irregular periods, it can also be diagnosed later on in a woman’s life as infertility may be seen.
PCOS is not sensitive to one particular ethnicity, as women with all ethnic backgrounds are affected. Some signs and symptoms of PCOS may include menstrual disturbances, elevations of the male androgen hormone, delay of normal menstruation, absence of the menstruation cycle for more than three months. All of these symptoms are related to the absence of ovulation. Other symptoms such as, weight gain, insulin resistance, oily skin, dandruff, skin discoloration, high cholesterol levels, elevated blood pressures may be present in patients who were diagnosed with PCOS.
Due to the high levels of androgen hormone, such as testosterone, DHEA’s and androstenedione in the blood that are normally present in men and in women, but in greater amounts in men, patients may have a tendency to become obese, develop greater amounts of fat in the waist, hiristism, acne, and male pattern hair loss. Epidemiology and Mechanism of Polycystic Ovarian Syndrome What causes polycystic Ovarian Syndrome? While some geneticists are examining if genetics and gene mutation has some role in the development of PCOS, several studies have shown that PCOS is likely to be the result of both inherited and environmental factors.
Woman who are diagnosed with PCOS would have a family history of a mother, sister, grandmother, or aunt with this condition. What happens to the cells, that cause them to become (poly) cystic? The eggs within the ovary are surrounded by millions of hormone producing cells. These cells along with the egg is considered a follicle. These cells within the ovary is responsible for producing estrogen and progesterone, two important hormone, used in ovulation.
However, as the egg matures, because of the absence of these hormones, fluid accumulated within the follicle and can be visualized as a small cyst via a transvaginal ultrasound. These cells, under ultrasound, appears enlarged with several tiny follicles filled with androgens. For a woman to ovulate naturally, the cells in the follicle wall must be producing estrogen which is made from androgen by surrounding cells of the follicle. A normal egg within the follicle will yield the cells of the follicle wall to produce estrogen.
Unfortunately, if the cells surrounding the follicle beginning to produce androgen, it will interfere with the normal ovulation cycle and the ovary will then stop producing normal amounts of estrogen required for ovulation, instead it will increase production of androgen. Other known causes of PCOS is due to the body’s defects in elevated blood insulin levels (insulin resistance). Insulin plays a key role in ovulation, it stimulates the ovary to produce androgen. Also excessive levels of LH which is released from the pituitary gland in the brain, prevents stimulation of the ovaries to ovulate.
Insulin is a hormone that helps your body regulate blood sugar levels. When a patient is insulin resistant in order for you to keep your blood sugar levels in normal limits your pancreas has to keep making insulin to satisfy your body requirements. If your pancreas is not able to keep up with your body’s demand, your sugar level rises and you can become diabetic. If the pancreas can manage with your body’s high demand for insulin your blood sugar levels will remain normal and you would not become a diabetic. Because diabetes and PCOS is closely related it is monitored closely.
It is shown that women with PCOS is in much greater risk in developing diabetes. Research has shown that once the pancreatic islet cells have become exhausted and depleted in the over production of insulin to satisfy the body requirements, your pancreas stop making insulin and your blood sugar becomes elevated. When that happens the patient becomes diabetic. Besides diabetes a woman with PCOS is more likely to develop uterine cancer and heart disease. Patients are also advised not to smoke while diagnosed with PCOS because it increases the risk for heart disease. Diagnosis of PCOS
If a patient complains with the signs and symptoms previously described along with abdominal pain, amenorrhea, or difficulty to conceive, a physician will take these necessary measures to diagnosing PCOS. During a physical examination, lab work will be ordered such as a fasting lipid profile, a glucose test, hormone levels, and an insulin test. The results will give detail information on hormone levels such as prolactin and thyroid levels, FSH to LH ratio and androgen levels. A transvaginal ultrasound will also be recommended and administered to indicate a pearl-necklace pattern of cysts on some woman’s ovaries.
An evaluation of the cyst to see if any of them have ruptured if the woman complains of pain in and around the ovaries and thereby followed on a regular basis. Other lab test that may be included to help diagnose PCOS are: 1. Triglyceride and Cholesterol levels. 2. Chemistry screen to determine the kidney and liver function and their glucose levels. 3. Levels of DHEA’s in the adrenal gland. 4. TSH levels. 5. SHBG A 2 hr glucose tolerance test is administered orally to measure the patient’s glucose levels in a fasting state and after consumption of the drink ontaining 75 grams of glucose. This is a precursor test for diabetes and pre diabetes to help reduce the risk of developing diabetes in pre diabetics. Some doctors may also want to perform an endometrial biopsy to look for signs of precancer or cancer cells. ? Treatment options for PCOS How is PCOS treated? A Physician may prescribe Metformin which is an anti diabetic drug to help lower insulin levels. Evidence now show that women who were prescribed Metformin as a treatment for PCOS over a period of time, their PCOS may be reversed.
Other drugs such as Actos and Avandia have been show to have a dramatic decrease in insulin levels. Actos is prescribed for people who are already diabetic with PCOS. This is especially good news for young teens who were diagnosed early in the stage of PCOS. These medications has shown to prevent the syndrome from developing further and have minimize the consequences of PCOS. Weight loss is a critical and important part of controlling and treating PCOS. Studies have shown that if a women loses 7% of her body weight, her PCOS is controlled and will allow for the resumption of her normal menstrual cycle.
Along with a low glycemic diet and weight loss, oral contraceptives have been proven to be a significant option for patients with PCOS. Oral contraceptives, suppresses androgen, and in most cases a patient will experience ovulation immediately after discontinuing the pill. Using oral contraceptive will also help the endometrial lining from becoming too thick, therefore leading to further complications such as cancer. If you are planning on conceiving, your doctor will prescribe for you clomid which lowers your insulin levels and enables stimulations of ovulation.
However, there are some consequences in using fertility medications which is multiple births. Other medication that can help with hair loss and acne, are androgen lowering medications such as spironolactone which may help to reduce hair loss, acne and male hair growth. Someone people prefer to approach a holistic treatment to PCOS. Because it’s a chronic illness some patients believe that using oral contraceptive does not contribute to insulin resistance and will not control or treat it. In my research, I found several books on nutrition available for patients that suffer from PCOS.
They are, “The Schwartzbein Principle” by Diana Schwartzbein, “The Diet Cure” by Julia Ross and “ The PCOS diet Book” by Colette Harris. These books focus on weight loss for women with PCOS along with a diet comprised of proteins, such as fish and meat, which contains excellent sources of Omega 3 fatty acids and has clinically proven to be viable for women suffering from PCOS. Equally important are nuts, vegetables, whole grains, seeds, small amounts of beans and fruits, excluding soy based products. In fact there are several health risks that were found due to the consumption of soy products, such as milk, cheese etc.
Along with the soy based products refined carbs such as white flour, sugars and caffeine should be eliminated from the diet. Besides diet, exercise is equally as important. Activities such as swimming, weight training, Yoga, Pilates are shown to not only build muscle but increase your body’s insulin sensitivity. According to the book, studies have shown that women with PCOS should avoid all cardiovascular exercise because it’s shown to raise adrenaline and cortisol levels which contributes to increase insulin levels. According to Dr. Nelson Soucasaux, a gynecologist and the author of Menstruation and Women Health.
Herbs helps greatly because they are much more gentle, coats your stomach, have fewer side effects, and last longer than synthetic drugs. Herbs that are common in the treatment of PCOS are: 1. Agnus Castus: This herb has shown to have a direct effect on the pituitary gland, which helps to increase the levels of LH. 2. Black Cohosh: This herb exhibits estrogenic effect which is excellent for treating irregular menstruation and Amenorrhea. 3. Evening Primrose: This herb contains G. L. A and Linolenic acid which have been shown to be an essential source of fatty acids.
It is one of the most common herb used in women who has PCOS and fibrocystic breast diseases, and it has also proven to help with acne and improving skin quality. 4. Donq Quai: This is a Phytoestrogenic herb, that is used to nourish liver and endocrine system promoting the treatment of irregular menstruation, PMS and pain caused by PMS and menopause. It is very popular in Western health stores and it is known as a Chinese herb. Along with diet, exercise and herbs, supplements that are rich in B complex, fish oil, GTF chromium are recommended to women who are suffering from PCOS.
Metformin is generally recommended along with an oral contraceptive for women suffering from PCOS, it has proven to be more effective, than just masking the problem by using a contraceptive alone.