Polycystic ovary syndrome Tufts University Health & Nutrition Letter; New York; Jul 2001; Anonymous; EXCESS FACIAL hair, irregular menstrual cycles, ovarian cysts, difficulty getting pregnant. Perhaps you've heard of the cluster of symptoms known in scientific circles as Polycystic Ovary Syndrome (PCOS)-a hormonal disorder that can cause infertility in younger women. But what you may not know is that up to 10 percent of all women are affected by PCOS, and its effects extend far beyond the ovaries-and the reproductive years. Often undiagnosed by health professionals, if left untreated PCOS raises the risk for diabetes and heart disease throughout life. What is PCOS? PCOS is a group of symptoms rather than a single condition per se. In fact, cysts on the ovaries, the symptom for which the disorder is named, are not even necessarily present. The classic signs are obesity (present in 50 to 60 percent of cases), excessive facial hair growth, and irregular periods. Also common are elevated triglycerides (undesirable fats in the blood), high LDL, or bad cholesterol, and low HDL, or good cholesterol. The exact cause of PCOS is not clearly understood. Indeed, even the way the disorder manifests itself varies. Some women have all of the symptoms, while others have very few, which can make diagnosis somewhat tricky. But blood tests often reveal hormonal imbalances. In fact, it's believed that the majority of women who have PCOS are compromised by a hormonal imbalance known as insulin resistance. That means the body resists the workings of the hormone insulin, whose job it is to get sugar channeled from the bloodstream to all of the tissues and organs, where it's needed for energy. To overcome the resistance, more insulin is secreted, and many of the symptoms of PCOS are thought to be the result of excess levels of this hormone. For instance, according to Stanford University insulin expert Gerald Reaven, MD, too much insulin causes the ovaries to manufacture abnormally high levels of the male hormone testosterone, which in turn contributes to irregular menstruation. The high testosterone levels are also to blame for the ovarian cysts (that can interfere with fertility), excess facial hair, acne, and male-pattern hair thinning seen in some women with PCOS, as well as the tendency for these women to store excess body fat in their abdomens, like men. Research shows that excess abdominal fat only further aggravates insulin resistance-and thereby worsens the symptoms of PCOS. Complications of the disorder While the outward signs of PCOS can lead to serious problems with body image, the physiologic effects of insulin resistance can be harmful to lifelong health. Not only is PCOS the number-one cause of infertility, those who do become pregnant are also at higher risk for miscarriage and pregnancy-induced diabetes. At least as troubling is research connecting PCOS with an increased risk for heart disease and diabetes, both during childbearing years and later. Studies show that the excess insulin characteristic of the syndrome can raise the risk for heart disease by increasing blood pressure and blood levels of LDL-cholesterol and triglycerides, while lowering protective HDL-cholesterol. Insulin resistance can also be a precursor to diabetes. It's estimated that up to 40 percent of women with PCOS will develop either impaired glucose tolerance (a pre-diabetic condition) or diabetes by age 40. What's a woman to do? Unfortunately, there's no single set of tests for PCOS. But you can be tested for insulin resistance, both directly and indirectly. Your best bet is to see a clinician experienced with PCOS, like a reproductive specialist or endocrinologist (a physician whose expertise is in hormone regulation), who can order the appropriate blood tests and interpret your results. For overweight women with PCOS, experts agree that the primary treatment is weight loss and exercise, both of which improve insulin resistance naturally. Research shows that during, and for several hours after, exercise, muscle cells are more sensitive to the workings of insulin, so less has to be secreted. Exercise should include aerobic activity, like brisk walking, cycling, or swimming, for 30 minutes on most days of the week, and strength training two to three times per week using free weights, weight machines, or exercise bands. The ideal diet for PCOS is up for debate, but there's some support for modestly cutting carbohydrates from the generally recommended 55 percent of calories to 45 percent. That's because it's mainly carbohydrates that increase insulin secretion after a meal. In other words, limiting carbs a little (and replacing the missing carb calories with small amounts of the good fats found in oily fish, nuts and nut butters, and olive and canola oil) may lower insulin levels. Most women diagnosed with PCOS are also prescribed medications like Metformin (glucophage). These increase the body cells' sensitivity to insulin, so less needs to be secreted. The combination of improved diet, exercise, and, sometimes, drugs, often allows previously infertile women to become pregnant as well as women of any age with PCOS to reduce their risk for heart disease and diabetes.