Doctors in a range of specialties—dermatologists, primary care doctors, ob-gyns—should be more aware of symptoms of polycystic ovary syndrome (PCOS) in women and help those patients maintain a healthy body mass index (BMI) from the moment they’re diagnosed in order to reduce the increased risk of diabetes, metabolic syndrome, heart disease and infertility that PCOS confers, says reproductive endocrinologist and assistant professor of endocrinology at Rush University Medical Center in Chicago Jennifer Glueck, MD, speaking on May 3rd about trends in PCOS at the 26th Annual Meeting of American Association of Clinical Endocrinologists in Austin, TX. “Although PCOS is most known for symptoms such as thinning of the hair on the head, acne, weight gain, excessive body-hair growth, and irregular periods, patients are less aware that the condition and the weight-gain associated with it [PCOS] puts them at a much higher risk for other serious health conditions as early as their 30s and 40s,” Dr. Glueck told EndocrineWeb.com.
PCOS is an endocrine disorder characterized by menstrual irregularities and the excessive production of the androgen hormone testosterone, says endocrinologist Priyathama Vellanki, MD, assistant professor, division of endocrinology, metabolism and lipids, Emory University School of Medicine in Atlanta. PCOS is thought to occur in 1 in 5 women. “Half of women with PCOS visit three health professionals before getting diagnosed, and for one-third of patients, the diagnosis takes longer than two years,” says Dr. Glueck. Confusion about the evolving diagnostic criteria is one reason for the delay.
But getting hormone treatment as soon as possible, and living a healthy lifestyle to shed pounds, is critical to stemming the cascade of metabolic processes that leads to diabetes, heart disease and metabolic syndrome, a constellation of biochemical factors that raise a person’s risk for these chronic conditions. “Obesity doesn’t cause PCOS, but it exacerbates it and worsens many symptoms and conditions associated with it,” says Dr. Glueck. In obese women who have PCOS, 95% are insulin resistant; that percentage is 75% for lean women with PCOS; and 65% for obese women without PCOS 1 (insulin resistance is a main risk factor for developing type 2 diabetes). For type 2 diabetes risk, obese women with PCOS have a 4-fold risk increase, while lean women with PCOS have no increased risk, according to a new study in Human Reproduction 2. Dr. Vellanki, who is an advisory board member to EndocrineWeb.com, notes, however, that because PCOS in this study was self-reported, and because it can be misdiagnosed, these numbers may be skewed. “What’s needed is a prospective longitudinal study of lean, insulin resistance women to determine if they develop diabetes,” she adds.
Regardless, excess weight is proven to worsen many conditions associated with PCOS. “The age when the weight gain is put on that confers the risk for diabetes is likely ages 14 to 30,” says Dr. Glueck, which is why diagnosing young women as soon as possible and aggressively treating weight gain early on —via a low-carbohydrate diet and medication or even surgery if necessary— is so important.
When it comes to infertility, a classic PCOS symptom, overweight women who lose just 6 to 7% of their body weight have a 1.4 increased chance of ovulation and a live birth compared to overweight women who don’t lower their BMI.
The name PCOS is itself a misnomer. In fact, cysts aren’t involved at all, says Dr. Glueck. Instead, the condition is associated with arrested ovarian follicles that overproduce androgen, which in turn increases insulin, and—in a vicious circle—stimulates more androgen. An international effort is underway to change the name, and Metabolic Reproductive Syndrome is one of the names that may better reflect the complex metabolic processes that involve more than the ovaries, including the pituitary and adrenal interactions.3 In addition, there are different phenotypes, or clinical presentations, of PCOS, notes Dr. Vellanki, and each one has distinct metabolic risk factors.