Polycystic Ovarian Syndrome

What is this complex condition and what are the underlying causes. Published in IVF Friends Newsletter in May 2003.

Polycystic ovarian disease or syndrome (PCOS) is a condition characterized by multiple cysts in the ovaries and has been found on ultrasound surveys to affect 20% or more of apparently normal women. Many of these women have no symptoms at all.1 Polycystic ovarian syndrome is a complex condition that is characterized, not only by multiple cysts, but also by hormonal disturbance. Common clinical features of the disease include: excessive production of androgens, which can lead to hirsutism (male pattern hair growth on the face and body); irregular (or complete failure of) ovulation; giving rise to infertility; menstrual disorders such as irregular or absent periods, or long cycles; and obesity. Some women can have this disease and manifest very few of these symptoms.

The hormonal symptoms associated with PCOS are complex and can be a self perpetuating cycle. The ovaries and the adrenal glands produce increased levels of androgens (male hormones), which are then converted to a weak form of oestrogen (called oestrone) by peripheral fatty tissue. These high levels of androgens can cause male pattern hair growth in some women. The continuous and elevated levels of oestrone cause the pituitary gland to produce increased levels of Luteinising Hormone (LH) but low levels of Follicle Stimulating Hormone (FSH), giving a high ratio of these two pituitary hormones. The elevated LH levels, in turn, trigger the ovaries to produce androgens – and so the cycle continues!! Elevated LH levels may also be influenced by the hypothalamus not releasing its hormone, GnRH, in a pulse manner but continuously. Increased levels of prolactin, the hormone responsible for lactation, is a common occurrence in women with PCOS.2

To further complicate the issue, there is much evidence showing that women with PCOS have elevated insulin levels and insulin resistance. This means that the body cells no longer recognize how much insulin is available and send signals that more is required, thus causing high levels of insulin in the blood. The more insulin in the blood, the more insulin resistant the cells become. This is another self perpetuating cycle. Research has shown that insulin stimulates adrenal androgen secretion3 and that “hyperinsulinaemia (high blood insulin) plays a pivotal role in the pathogenesis of PCOS.”4

There are many ways of improving this condition naturopathically. One of the most important is to address the insulin problem. This can be done by incorporating dietary changes and taking a supplement of chromium. Chromium is a mineral that “increases insulin binding to cells, insulin receptor number … leading to increased insulin sensitivity.”5

Exercise can also be beneficial and herbal medicine can be used to balance the hormones, but should only be in conjunction with therapy to improve insulin resistance.

REFERENCES

1. Mackay, E.V., Beischer, N.A., Pepperell, R.J. and Wood, C. (1992). Illustrated Textbook of Gynaecology. W.B. Saunders, London.

2. Goldzieher, J.W. and diZerega, G.S. (1985). “Polycystic ovarian disease” in Clinical Reproductive Endocrinology. R.P. Shearman. Chruchill Livingstone, Edinburgh.

3. Maitikainen, H., Salmela, P. et al. (1996). “Adrenal steroidogenesis is related to insulin in hyperandrogenic women.” Fertility and Sterility. 66 (4): 564-70.

4. Nestler, J.E. (1997). “Insulin regulation of human ovarian androgen”. Human Reproduction, 12 (1): 53.

5. Anderson, R.A. et al (2000). “Chromium the prevention and control of diabetes”. Diabetes and Metabolism, 26: 22-27.


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