Our bodies require delicate balances of a myriad of hormones to keep them healthy and running smoothly.
For women in particular, it seems hormones are credited — or blamed — for everything. We cite them for helping us multitask and blame them for causing chocolate and caffeine cravings. When our body temperatures are rising and our moods are falling, it's the hormones.
For an estimated one in 10 women of child-bearing age, an imbalance of hormones can lead to a medical condition called polycystic ovary syndrome, or PCOS. It is one of the top two leading causes of infertility, says Dr. Christopher Stroud, an obstetrician-gynecologist with Parkview Physicians Group-OB/GYN. The other leading cause is endometriosis.
With PCOS, several serious health concerns co-exist with the infertility issue, concerns that many women may ignore if they are not trying to get pregnant, Stroud explains.
The woman with PCOS usually has painful menstrual periods or ones that are shorter or longer, heavier or lighter than normal. Some women with PCOS have only two or three periods a year. The ovaries may develop multiple cysts — thus the name, polycystic. A spectrum of other symptoms such as acne, weight gain and insulin resistance often coincide.
“At one extreme, you get a picture of a woman who is typically obese, has unwanted hair, has acne and is infertile,” Stroud says. But a woman with PCOS can also be thin, have beautiful skin and few or no cysts on the ovaries, the paired female glands which produce eggs.
The ovaries contain follicles, or tiny fluid-filled sacs in which the eggs develop. In the first half of a woman's menstrual cycle, estrogen helps eggs grow. As that process moves along, the woman starts producing more of the hormone progesterone.
As progesterone levels increase, the fully mature egg bursts out of the follicle. This is called ovulation. The egg then begins its journey through the fallopian tube in search of sperm for fertilization.
But in the woman with PCOS, an egg rarely or never develops and the follicles turn into cysts.
“If you don't make the egg and (the follicle) doesn't rupture, you don't get progesterone,” Stroud says.
Additionally, most women with PCOS produce higher than normal levels of male hormones. That leads to acne and hirsutism, which is excess hair growth on the body, particularly on the face, chest, back, thumbs and toes. Abnormal levels of male hormone can also cause loss of hair on the head.
Normally, a woman produces 10 to 20 follicles a month but only one follicle in one ovary grows an egg that reaches maturity and pops through the wall of the ovary. The undeveloped follicles are reabsorbed.
But with PCOS, the cysts remain in the ovary. Doctors sometimes describe what they see on an ultrasound as “a string of pearls,” Stroud says, noting, “The ovaries are usually enlarged and full of immature follicles or cysts.”
Besides an ultrasound of the ovaries, diagnosis comes through checking hormone levels and taking a medical history. PCOS has a genetic link. Further complicating the PCOS puzzle is insulin resistance, so blood glucose levels are checked.
“You make too much insulin, but you don't respond to the insulin you make,” which indicates type 2 diabetes. ”That creates other problems,” Stroud says, including obesity, high levels of bad, or LDL, cholesterol and hypertension. “I try to get my patients to think of (PCOS) as a pre-diabetes state.”
Medications that decrease the amount of glucose absorbed from food and increase the body's response to insulin are commonly prescribed.
Other treatments include regulating periods with birth-control pills and surgery. Though birth-control pills are the most common treatment, they are not always the best treatment in the long run, Stroud says, pointing out the teenage girl who is prescribed birth control pills to regulate her periods may be on them for a decade or more.
Then, several years after marriage, she wants to get pregnant but is unsuccessful. She is then diagnosed with PCOS and begins treatment. By then she may also be 50 pounds overweight and pre-diabetic.
“I want to impress upon women to find out why they've got irregular periods,” Stroud says. “Maybe the pill will be the treatment of choice at the end of the day, but find out what's wrong.”
A lesser-used but quite successful treatment for PCOS is ovarian “drilling.”
In a laparoscopic procedure, the ovary is punctured with a needle. A current of electricity destroys a small section of the ovary. This causes the ovary to produce less male hormone and increases ovulation. The effects last only a few months, however, so the woman's best chances of getting pregnant are soon after the procedure.
The most serious complication of PCOS is endometrial cancer, which can develop when a woman doesn't ovulate, is not producing progesterone and doesn't regularly shed the lining of the uterus, or endometrium. The lining thickens and predisposes a woman to cancer.
Stroud recently diagnosed a woman in her early 30s for endometrial cancer. She had undiagnosed PCOS for years. Because children were not in her future plans, she had just lived with heavy periods. Though her prognosis is excellent, a hysterectomy, including removal of her ovaries, was required.
“This is something that should not be ignored,” Stroud says of symptoms that may indicate PCOS. “Women with PCOS are more likely to develop diabetes and heart disease and endometrial cancer.”