- Irregular menstrual cycles with severe cramping and bleeding; pelvic pain,
- Acne, oily skin and dandruff,
- Coarse facial and body hair (stops progressing with improved insulin sensitivity),
- Male pattern baldness and thinning hair (body thinks its male),
- Frizzy hair (usually improves with enhanced insulin sensitivity),
- Weight gain and a constant battle to keep the weight off (improves with increased insulin sensitivity),
- Dark thickened skin around the neck, underarms, groin and skin folds (improves with increased insulin sensitivity),
- Skin tags (usually on the neck, armpit area or bra line) caused by insulin-resistance (slows with improved insulin sensitivity),
- Sleep apnea (improves with weight loss),
- Diabetes or pre-diabetes (impaired glucose tolerance) is likely prior the age of 40,
- Heart attack is 400 to 700% more likely, compared to women of the same age without PCPS,
- High blood pressure risk elevation,
- Lipid profile imbalance, with higher LDL and lower HDL cholesterol levels,.
- Anxiety, depression, and/or mood swings,
- Endometrial cancer is more likely due to endometrial hyperplasia, a condition where the endometrial lining of the uterus grows too thick, and/or
- Infertility and higher rates of miscarriage, gestational diabetes, pregnancy induced high blood pressure, and premature delivery.
These are the symptoms of polycystic ovary syndrome (PCOS), an increasingly common female hormonal disorder which involves unusual monthly cycles, cysts in ovaries, and and certain ‘male’ traits.
Today it is estimated that PCOS affects as many as 15% to 20% of females.
And interestingly, 50%-70% of women with PCOS are affected with insulin resistance.
The effects and ramifications of living with PCOS are staggering, consider that:
- Women with PCOS are more likely to have calcium deposits within their coronary arteries and thickening of their carotid arteries.
- Binge eating disorders are more common in women with PCOS and weight-loss and/or improved insulin sensitivity improves the most serious symptoms of PCOS.
- Depression, anxiety, bipolar disorder and binge eating disorder occur more frequently in women with PCOS.
However, there is considerable inter-individual variation in PCOS presentation.
Up to 70% of women with PCOS have increased hair growth on their upper lip, chin/face, chest, back, abdomen, arms, and thighs and over 90% of women (normally menstruating women) with increased hair growth of of this nature do have PCOS.
Even with lesser degrees of unwanted hair growth are an indicator of underlying PCOS in 50% of women.
Acne is less common with PCOS, but with women with severe acne, over 40% are likely to have PCOS.
Ultrasound is used to measure ovarian volume and measure ovarian cysts and this aids diagnosis.
PCOS and is one of the most frequent causes of infertility, with about 40% of women with PCOS being infertile.
PCOS a diagnosis of exclusion, and other diagnoses, such as:
- Congenital adrenal hyperplasia,
- Nonclassic adrenal hyperplasia,
- Cushing syndrome,
- Androgen-secreting tumor,
- Idiopathic hyperandrogenism,
- Idiopathic hirsutism,
- Thyroid disorders, and
- Valproic acid (a drug used to treat epilepsy, bipolar disorder, and migraine which causes PCOS symptoms).
- Ovarian cysts alone do not confirm a diagnosis of PCOS because 20%–30% of otherwise normal women multiple cysts on their ovaries.
PCOS is probably a heritable disorder because it tends to cluster in families, and also an ancient disorder affecting women for millennia.
A history of weight-gain often precedes onset of PCOS and weight-loss improves the hormonal imbalances and excess hair growth associaed with PCOS, with about 30% of females referred for assistance with weight-loss (in one study) having PCOS.
Gestational diabetes is associated with an increased prevalence of PCOS and a number of factors associated with an increased risk of PCOS have been identified in children, to include:
- High birth weight in girls born to overweight mothers,
- Congenital virilization,
- Low birth weight,
- Premature pubarche,
- Atypical central precocious puberty,
- Obesity syndromes,
- Acanthosis nigricans,
- Metabolic syndrome, and
- Persistently irregular menses.
Although the demonstration of insulin resistance or metabolic syndrome are not required to make the diagnosis of PCOS, it is clear that hyperinsulinemic insulin resistance plays a prominent role in PCOS, with the prevalence of insulin resistance in PCOS ranging from 50%–70% and occurring independently of obesity.
Even lean women with PCOS are more likely to have insulin resistance or metabolic syndrome than lean women without PCOS.
It is well accepted that hyperinsulinemia alters normal female (and male) hormonal balance.
Many women, even lean women with PCOS have difficulty tolerating dietary sugar.
Blood lipid balances are also frequent with PCOS with elevation of cardiovascular disease risk factors such as LDL and triglycerides. Along with this it is known that insulin resistance promotes a high hepatic triglyceride content, increased VLDL particles, high small dense LDL particle levels and hypertension.
Insulin resistance is also associated with reduced clearance of VLDL particles and chylomicrons by reducing the activity of lipoprotein lipase, increasing levels of apolipoprotein C-III, and impairing apolipoprotein E-mediated clearance of triglyceride rich (the ones that causing hardening of he arteries), and hypertension.
Even after adjusting for obesity, women with PCOS have a higher prevalence of high blood pressure.
Indeed, menstrual cycle irregularity is strongly linked with heart attack (coronary artery disease) and stroke. With this, carotid artery thickness is directly predictive of myocardial infarction or sudden cardiac death. Some experts even recommend that carotid artery thickness be measured every 3 to 5 years in all women with PCOS over age 30.
Over and above pharmaceutical and surgical approaches such as birth control pills, male hormone blocks, creams for hair removal, insulin sensitizing drugs, and ovarian “drilling” and laser treatment, weight-loss or dietary improvement of insulin resistance perhaps hold the greatest hope for many who suffer with PCOS.
The benefits of weight loss can be evident with a loss of 5% of initial body weight, with male hormone levels improving (reducing) for many women with PCOS.
Indeed, weight-loss is increasingly recommended as a first-line therapy for the management of infertility in overweight and obese women with PCOS, with weight-loss of 5% to 10% increasing improving menstrual cycle regularity and increasing spontaneous conception.