PCOS, i.e. PolyCystic Ovarian Syndrome – key information – part I

PCOS is the most frequent hormonal disorder and the most common reason of fertility disorders, which concerns women with child-bearing potential. What's interesting, the PCOS diagnosis has been stated quite often nowadays, but only two decades ago there weren't many people who knew about it. It's good to take a closer look at the etiology and methods of diagnosing this complicated syndrome and pay attention to the nutritional aspects of therapeutic procedures.

You should definitely read:

Fitness shape and menstrual disorders – part I

PCOS, i.e. PolyCystic Ovarian Syndrome – key information – part II

What is PCOS and how often does it appear?

We often use the abbreviation PCOS, which means PolyCystic Ovary Syndrome. It is a set of endocrine disorders, which concerns about 10-15% of women with child-bearing potential. This ailment is also the most common reason of female infertility.

PCOS is nowadays recognized quite often, but some time ago efficient diagnosis was a rarity. What's interesting, prime information about PCOS come from the year 1935, when two American doctors – Irving Stein and Michael Leventhal described the characteristic for this syndrome anomalies. Despite that, even less than twenty years ago doctors were not able to precisely diagnose PCOS for their patients.

Diagnostics

Recognizing PCOS is not easy. The problem is, that in order to confirm this ailment, the doctors have to do a lot of tests and analyse the symptoms at the beginning. In 2003 it was agreed that the patient suffers from PCOS, if there are at least two criteria from the following list:

  • rare ovulations, or lack of it,

  • symptoms of excess amount of androgens (clinical or biochemical),

  • polycystic ovaries (there have to be at least 12 enlarged follicles in the ovary or the diameter of the ovaries is larger than 10cm3, or if other reason for PCOS are excluded).

According to the list above, the recognition of PCOS is possible for women without excess amount of androgens, which is criticised. Before, the findings assumed that excess amount of androgens is necessary to recognize this illness. Anyway, it should be assumed that the clinical approach in case of women with or without excess amount of androgens should be different.

Women with PCOS are also often diagnosed with metabolic disorders, such as the pathological result of glucose tolerance test, overweight or obesity, or sometimes metabolic syndrome. It's also important that the recognition of PCOS has to be preceded with excluding other possible reasons of ovulation disorders and hyperandrogenism, such as:

  • hyperprolactinemia,

  • hypothyroidism,

  • adrenal glands functions disorder (doctors have to be cautious here, because during PCOS higher level of adrenal glands hormones is sometimes observed).

Where does PCOS come from?

The etiology of PCOS is not well known, however, many factors are distinguished, which I will mention later in this article, that may foster formation of this ailment. For sure, the following hormonal factors are of key importance in this matter:

  • excessive secretion of testosterone,

  • excessive production of luteotropin,

  • excessive amount of insulin.

The hormones mentioned above influence the ovaries, what causes the disorder of their structure and functions. For example, excessive production of androgens causes ovulation disorder and creation of endometrial cystic changes. However, there's no certainty whether this process results from the disorder of gonadotropines secretion disorder, or it is the consequence of steroidogenesis disorder in the ovaries and in adrenal glands. The fact is, that for about 70-75% of women with PCOS, there is excessive secretion of LH (to be precise, the frequency of pulsatory secretion of LH is higher, and its strength is bigger). The production of FSH, in opposite, stays on constant level for the whole menstruation cycle. In other words, the LH/FSH ratio disorder is observed.

Results of hormonal disorders

In order to understand the circumstances mentioned above, it's good to remember that LH stimulates the theca interna to produce androstenedione and testosterone. In PCOS increased activity of insulin-like growth factors is also observed. This ailment is very often accompanied with insulin resistance, too. It is a rule for obese women, and in case of proper body mass, it occurs in every other or in one in three cases. The consequence of insulin resistance is further gaining weight and... stronger symptoms of PCOS. Insulin resistance usually occurs with hyperinsulinemia, which contributes to strengthening the androgens synthesis in the ovaries increasing the activity of 17α-hydroxylaze, the enzyme, which conditions convertion of progesteron into 17-OH progesterone, and then in androstenedione.

Additionally, in case of PCOS, because of the hormonal conditioning mentioned above, the decrease of estradiol occurs. Estradiol influences the activity of sex hormone-binding globulin (SHGB). Low level of eastradiol causes that the activity of SHGB is lower, which also results in higher level of free radicals. And also in this matter the phenomenon of vicious circle can be observed, where the results of hormonal disorders make them even worse.

Another issue in case of PCOS are fertility disorders. Their etiology is simpler: lower level of FSH with higher level of free testosterone blocks the process of growth of graafian follicles, what leads to suspension of ovulation. As a result, getting pregnant is very hard, or even impossible. Unfortunately, majority of women with PCOS also have FOH (Functional Ovarian Hyperandrogenism), and almost half of them have FAH (Functional Adrenal Hyperandrogenism). Both disorders influence the course of this disease, its diagnostics and treatment.

Hereditary conditioning

If you want to refer to the etiopathogenesis of PCOS, you have to take under consideration the hereditary conditioning. It is believed that the tendency of having such syndrome may be inherited. However, there is no compliance of which genes lead to developing PCOS. So far, a group of genes responsible for controlling steroidogenesis is blamed for that, as well as genes connected with producing insulin and growth factors. PCOS sometimes occurs within other hormonal disorders, like in hyperprolactinemia. These aspects should also be taken under consideration.

Can I have PCOS?

As I mentioned before, diagnosing PCOS is based on the interview and detailed tests, which are commissioned and analysed by a doctor. However, there are some symptoms, which should be alarming and cause asking for the doctor's advice.

It's worth knowing that PCOS may show itself with many various symptoms in different periods of life:

  • in childhood it is one of the most common reasons of premature adolescence,

  • in adolescence it contributes to the deregulation of menstrual cycle and hirsutism,

  • in adulthood it causes menstrual disorders, as well as infertility, hirsutism, overweight, obesity,

  • in old age it increases the risk of developing diabetes and cardiovascular diseases.

Some of the disorders mentioned above may be treated as the symptoms of PCOS. They are not the base of diagnosing this ailment, but it's good to use them as the indication to medical consultation. In other words, the potential symptoms, which may point at the existence of PCOS are most of all:

  • premature adolescence in childhood,

  • hirsutism in adolescence and adulthood,

  • irregular menstruation and lack of it in adolescence and adulthood,

  • additionally, in adolescence the indication to extend the diagnostics is purulent acne resistant to dermatological treatment,

  • problems with getting pregnant despite trying should also be the indication to tests directed at excluding PCOS,

  • obesity, dyslipidaemia, high blood pressure, incorrect glycemia on empty stomach and the disorder of glucose tolerance may also indicate the existance of PCOS (but, of course, such disorders are often the result of the unhygienic lifestyle).

And here is the end of the first part of the article concerning PCOS. In the next parts I will describe the matter of pharmaceutical procedures (informatively, because medicines are prescribed by doctors), I will also focus on nutrition and supplements.

PCOS, i.e. PolyCystic Ovarian Syndrome – key information – part II