POLYCYSTIC OVARIAN SYNDROME (PCOS)

4. Hormone changes in PCOD and their impact on woman's health

What is Polycystic ovarian Disease?
What causes PCOS?
What are some symptoms of PCOS?
What are the hormone changes in PCOS and their implications to the woman’s health?
How is PCOS diagnosed? What tests are done?
When should I become alert about myself or someone I care for, about PCOS?
How is PCOS treated?
Will PCOS affect pregnancy?
Does PCOS put women at risk for other health problems?
What can I do to prevent complications?
Emotional aspects of PCOS

What are some hormone changes and their implications to the woman’s health?

Three important groups of hormones produced in the ovary are : Estrogens, Androgens & Progesterone. These in turn are regulated by two hormones released by the pituitary gland, present at the base of the brain. They are Follicle stimulating Hormone (FSH) and Luteinizing Hormone (LH). These two hormones influence the development of the follicle and the time of ovulation. The cause of polycystic ovaries is believed to be the alteration in the FSH-LH ratio.

The pituitary gland senses that the ovaries are not working normally and in turn release high amounts of LH. Certain cells (called theca cells) in the ovary receive more stimulation from LH and respond by producing more androgens. Because of a decreased level of follicle-stimulating hormone (FSH) relative to LH, the androgens cannot be converted into estrogens in adequate amounts, thus leading to estrogen deficiency and consequent anovulation.

Hirsutism
The increased concentration of androgens over years lead to masculine characteristics such as hair on the upper lip, chin, around the nipples, chest hair, abdominal hair, and occasionally enlargement of the clitoris, deepening of voice and male pattern baldness etc.

Obesity
Obesity, characterized by a waist circumference of greater than 35 in (>88 cm), is common in women with PCOS (in approx. 50% of cases).

Forty to 45% of patients with PCOS have characteristics of metabolic syndrome. The metabolic syndrome is characterized by abdominal obesity (waist circumference >35 in), dyslipidemia (triglyceride level greater then 150 mg/dL, high-density lipoprotein cholesterol [HDL-C] level < 50 mg/dL), elevated blood pressure, and other symptoms.

Diabetes
Approximately 10% of women with PCOS have type 2 diabetes mellitus, and 30-40% of women with PCOS have impaired glucose tolerance by age 40 years
Women with PCOS have increased prevalence of coronary artery calcification and mild narrowing of the vessels.

Another consequence of this hormone imbalance is that lack of ovulation results in continuous exposure of the uterine lining (endometrium) to estrogen. This may cause excessive thickening of the endometrium and heavy, irregular bleeding. Over many years, endometrial cancer may result due to the continuous stimulation of the endometrium by estrogen unopposed by progesterone.

Does PCOS change at menopause?

PCOS affects many systems in the body. So, many symptoms may persist even though ovarian function and hormone levels change as a woman nears menopause. For instance, excessive hair growth continues, and male-pattern baldness or thinning hair gets worse after menopause. Also, the risks of health problems from PCOS, such as heart attack, stroke, and diabetes, increase as a woman gets older.

 Next: 5. How is PCOS diagnosed? What tests are done?

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