What is PCOS?Polycystic Ovary Syndrome (abbreviated PCOS or PCO), also known clinically as Stein-Leventhal syndrome, is an endocrine disorder that affects approximately one in ten women. PCOS affects all races and nationalities and is the most common hormonal disorder among women of reproductive age.
The principal features of PCOS are lack of regular ovulation and/or menstruation, weight gain and excessive amounts or the effects of androgenic hormones. While the causes are unknown, insulin resistance, obesity and diabetes are all strongly correlated with PCOS. There is also a strong genetic component. One of the main clinical signs of PCOS is the observation of numerous follicles in the periphery ovaries, often referred to as having the appearance of a “string of pearls”. Interestingly polycystic women ovulate much more frequently when they are underweight which might be an evolutionary trick to keep the population going in times of famine.
Symptoms of Typical PCOS:
- Oligomenorrhea (irregular menstruation), amenorrhea (no menstruation)
- Hirsutism (excessive body hair)
- Dyspareunia-pain during intercourse
- Dark patches of skin
- LH: FSH ratio 2:1 instead of 1:1
- Insulin resistance
- Prolonged PMS
How Typical Ovulation Works:At about cycle day three Follicle Stimulating Hormone (FSH) is released from the brain that sends a message to the ovaries to grow an egg. Many eggs “hear” the message and grow in response to the hormone. As the eggs grow they secrete estrogen. The bigger the egg, the more estrogen it secretes. Once one egg gets large enough and secretes a high enough level of estrogen it turns off the FSH. This prevents the body from releasing too many eggs in one cycle. At this point Lutenizing Hormone (LH) is secreted and the egg ruptures from the follicle causing ovulation. The corpus luteum that surrounds the egg begins to secrete progesterone and more estrogen.
PCOS and Anovulation:Women with PCOS usually have a cluster of cysts in the ovaries as detected by transvaginal ultrasound in addition to a set of symptoms. This little cluster of eggs secretes enough estrogen to tell the body to turn off the follicle stimulating hormone but they are not large enough to ovulate. This creates a stalemate between the ovaries and the brain and no ovulation occurs. In this situation there is an abundance of estrogen and testosterone floating around the system but very low levels of progesterone.
“New PCOS”Lately I have seen a rise in women diagnosed with PCOS as determined by cysts on their ovaries but they do not have the aforementioned symptoms. Interestingly this group presents entirely differently from the original PCOS group that I have both studied and treated extensively. This “new” group appears entirely different. These women tend to be very thin (not anorexic thin, as low leptin and fat levels can also inhibit ovulation), just typical “New York thin” if you will. Another remarkable factor is long-term birth control pill usage. I usually discover that the women had regular cycles before going on the birth control pill but after taking the pill for 10-18 years consecutively they are having difficulty ovulating after stopping the pill.
Commonly observed new PCOS:
- Observable cysts on the ovaries
- Long term birth control pill usage
- Prolonged PMS
- Digestive complaints like reflux, IBS
- Post-nasal drip
- Light or no flow on the BCP
- Poor sleep