“Polycystic Ovary Syndrome” By Jennifer S. Hayes, DO, FACOOG Visionary Centre for Women Clearwater, FL

What is PCOS?

•  The most common female endocrine condition in women age 15 – 30. - 5 to 10% of US women

- approximately 5.4 million women or 1 in 22 - symptoms typically begin in adolescence

•  The most common cause of infertility in the United States.

Historical Perspective

400 B.C. Hippocrates described 2 cases of hirsute women with amenorrhea. 1921- a report of a bearded woman with diabetes. 1935 – a report published by Dr. Stein & Dr. Leventhal •  7 women with amenorrhea, hirsutism, obesity, and enlarged polycystic appearing ovaries. •  They named it Stein-Leventhal Syndrome

The classic ovaries of PCOS

Actually, only 25% of women with PCOS have classic polycystic ovaries.

Ultrasound of Polycystic Ovary

Numerous tiny follicle cysts line the edge of the ovary, giving the “String of Pearls” picture.

Common Findings

•  Irregular or missed periods •  Infertility •  Obesity / easy weight gain •  Excess facial hair •  Thinning hair •  Acne •  High testosterone levels •  Polycystic ovaries

Spectrum of PCOS

Amenorrhea/ Oligomenorrhea

Ultrasound features

Clinical features of too much androgen & too much insulin

What causes PCOS?

1.  Excess androgens (male hormones) produced by a woman’s ovary and adrenal glands.

2.  Insulin resistance (elevated insulin levels from the pancreas).

3.  Hypothalamic-Pituitary dysfunction in the brain

3 Common Theories

Excess Androgens

Although not fully understood, women with PCOS have high levels of male-type hormones created in both the adrenals and ovaries.

Examples of Male Hormones

• Testosterone

• Androstenedione

• DHEA – S

• 17OHP (17 Hydroxyprogesterone)

• SHBG (sex hormone-binding globulin)

Excess Androgens

The elevated androgen levels are responsible for excess facial hair growth, acne, and male pattern hair thinning.

Excess androgens also help suppress the ovary from ovulating and can contribute to increased incidence of miscarriage.

Gaining weight while feeling hungrier

Many PCOS patients have excess insulin in their blood. Our insulin is used in our body to regulate blood sugar and to help our muscles use sugar for energy. If too much insulin is around, it slows our metabolism, telling the body to hold on to body fat for energy. Any refined carb drives up the insulin. The extra insulin makes our blood sugar drop too fast causing our brain to send signals to EAT NOW!

The cycle is to keep gaining weight and getting hungrier.

Insulin Resistance (excess insulin)

Insulin Resistant Cell

Gaining weight while feeling hungrier

High insulin levels are also associated with: •  Type II Diabetes •  High Blood Pressure

•  Heart Disease •  Stroke

Insulin Resistance (excess insulin)

Normal Menstrual Cycle

The brain, ovaries, and uterus normally help to prepare the body for pregnancy once per month.

1st FSH gets the ovary going. Little follicles start growing inside the ovary and produce estrogen. The rising estrogen builds the inner uterine lining and makes the brain produce LH. This surge of LH makes 1 follicle ovulate (pop an egg out). The ovary then cranks out estrogen and progesterone to support the egg if we get pregnant. If we don’t get pregnant, the progesterone level drops and we get our period.

PCOS Menstrual Cycle

The LH is higher than the FSH level making the follicles stay

small. They don’t trigger ovulation so lots of little follicles

stay in the ovary. If we don’t ovulate, we don’t get the surge

in progesterone that will help time the period in the

uterus.The estrogen from lots of little follicles builds the

menstural lining but no egg ever comes (therefore causing

infertility). We skip periods and the lining continues to build.

When the lining gets too thick, it results in heavy, irregular

periods.

How do we test for PCOS?

LH / FSH Fasting Insulin Free & Total Testosterone Androstenedione DHEA-S TSH Prolactin Sex hormone-binding globulin

•  Pelvic Ultrasound •  Blood Tests

Treatment Goals

No single treatment works on all aspects of PCOS 1. Regulate periods 2. Stabilize hair & skin issues 3. Help someone who wants to get pregnant to ovulate 4. Reduce the chance of a pregnancy to miscarry 5. Speed up metabolism, assist with weight loss efforts 6. Reduce the chance of uterine cancer 7. Reduce the risk of developing diabetes or heart disease

Treatments

• Low glycemic food plan - less insulin produced

Weight Management

More importantly CARB Management!

Carbohydrates are all the sugars, starches, vegetables and fruits we eat.

Treatments

• Exercise –

Drop weight Look more shapely Forces the body to use sugar and insulin more

Also as actual weight drops, there are less androgens made in peripheral fat.

Treatments

• Insulin lowering medicines – Metformin (Glucophage) Brings on ovulation as it lowers insulin and reduces incidence of miscarriage in pregnancy

Treatments

• Hormonal Contraceptives (pill, patch, ring) – Regulates your period – Lightens flow and lightens cramps – Decreases androgens (testosterone) by increasing SHBG (sex hormone – binding globulin) – thereby controlling hair and acne issues – Some progesterones are less androgenic than others – Drosperinone (in YAZ & YASMIN) is a progesterone that has ANTI-androgenic qualities .

Treatments

Anti-androgen medicine Spironolactone (Aldactone)

- Blocks the conversion of testosterone to

dihydrotestosterone (DHT), the form of hormone that causes excessive hair growth.

- Makes hair follicle and oil glands less sensitive to stimulation

- Benefits adult acne.

- Reduces hair scores in 50% of women in one year

Alternative Additions

§  Flaxseed oil – lowers SHBG §  Fish Oil – raises insulin sensitivity and

POS effects on lipids §  D-chiro-inositol – insulin regulation §  Chromium – treating insulin resistance §  Stinging nettle – raises SHBG §  Saw palmetto – altered cholesterol metabolism,

and anti-estrogenic, anti-androgenic, and anti-inflammatory properties

Most women with PCOS are able to lead a normal life without significant complications.

The Good News

Questions & Answers

Thank You for Coming Jennifer S. Hayes, DO, FACOOG | Visionary Centre for Women

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