Polycystic ovary syndrome (PCOS)OVARIAN CYSTS
is a condition in which a woman’s levels of the sex hormones estrogen and progesterone are out of balance. This leads to the growth of ovarian cysts (benign masses on the ovaries). PCOS can affect a women’s menstrual cycle, fertility, cardiac function, and appearance.
Ovarian cysts are fluid-filled sacs or pockets within or on the surface of an ovary. Women have two ovaries — each about the size and shape of an almond — located on each side of the uterus. Eggs (ova) develop and mature in the ovaries and are released in monthly cycles during your childbearing years.
History
The condition was first described in 1935 by American gynecologists Irving F. Stein, Sr. and Michael L. Leventhal, from whom its original name of Stein–Leventhal syndrome is taken. The earliest published description of a person with what is now recognized as PCOS was in 1721 in Italy. Cyst-related changes to the ovaries were described in 1844
Epidemiology
In the United States, polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders of reproductive-age women, with a prevalence of 4-12%. Up to 10% of women are diagnosed with PCOS during gynecologic visits. In some European studies, the prevalence of PCOS has been reported to be 6.5-8%.
A great deal of ethnic variability in hirsutism is observed. For example, Asian (East and Southeast Asia) women have less hirsutism than white women given the same serum androgen values. In a study that assessed hirsutism in southern Chinese women, investigators found a prevalence of 10.5%. In hirsute women, there was a significant increase in the incidence of acne, menstrual irregularities, polycystic ovaries, and acanthosis nigricans.
PCOS affects premenopausal women, and the age of onset is most often perimenarchal (before bone age reaches 16 years). However, clinical recognition of the syndrome may be delayed by failure of the patient to become concerned by irregular menses, hirsutism, or other symptoms or by the overlap of PCOS findings with normal physiologic maturation during the 2 years after menarche. In lean women with a genetic predisposition to PCOS, the syndrome may be unmasked when they subsequently gain weight.
Types of polycystic ovary syndrome
1) Insulin-Resistant PCOS
This is the classic type of PCOS and by far the most common. High insulin and leptin impede ovulation and stimulate the ovaries to make testosterone. Insulin resistance is caused by sugar, smoking, trans fat, and environmental toxins.
2) Pill-Induced PCOS or Post-Pill PCOS
Hormonal birth control suppresses ovulation. For most women, it’s a temporary effect, and ovulation will usually resume fairly soon after the Pill is stopped. But for some women, ovulation-suppression can persist for months or even years. During that time, it is not unusual to be given the diagnosis of PCOS. Some experts deny the existence of Pill-induced PCOS, but it is very real. It is the second most common type of PCOS.
3) Inflammatory PCOS
Inflammation or chronic immune activation results from by stress, environmental toxins, intestinal permeability and inflammatory foods like gluten or A1 casein. Inflammation is a problem for PCOS because it impedes ovulation, disrupts hormone receptors, and stimulates adrenal androgens such DHEA and androstenedione.
4) Hidden-Cause PCOS
This is the ‘simpler-than-you-think’ type of PCOS. There is one simple thing that is blocking ovulation. Once that single thing is addressed, this type of PCOS resolves very quickly, usually within 3-4 months. Common hidden causes of PCOS include:
Too much soy, because it is anti-estrogen and can block ovulation in some women. (A small amount is okay.)
Thyroid disease, because your ovaries need T3 thyroid hormone.
Vegetarian diet, because it causes zinc deficiency, and your ovaries need zinc.
Iodine deficiency, because your ovaries need iodine.
Artificial sweeteners, because they impair insulin and leptin signaling.
Too little starch in your diet, because your hormonal system needs Gentle Carbs.
Risk factors of polycystic ovary syndrome
Having PCOS can increase your chances of developing other health problems in later life. For example, women with PCOS are at increased risk of developing:
Type 2 diabetes: A lifelong condition that causes a person’s blood sugar level to become too high
Depression and mood swings: Because the symptoms of PCOS can affect your confidence and self-esteem
High blood pressure and high cholesterol: This can lead to heart disease and stroke
Sleep apnoea: overweight women may also develop sleep apnoea, a condition that causes interrupted breathing during sleep
Women who have had absent or very irregular periods (fewer than three or four periods a year) for many years have a higher-than-average risk of developing cancer of the womb lining (endometrial cancer).
Causes
The exact cause of PCOS is not known. Most experts think that several factors, including genetics, play a role:
High levels of androgens: Higher than normal androgen levels in women can prevent the ovaries from releasing an egg (ovulation) during each menstrual cycle, and can cause extra hair growth and acne.
High levels of insulin: Insulin is a hormone that controls how the food you eat is changed into energy. Insulin resistance is when the body’s cells do not respond normally to insulin. As a result, your insulin blood levels become higher than normal. Many women with PCOS have insulin resistance, especially those who are overweight or obese, have unhealthy eating habits, do not get enough physical activity, and have a family history of diabetes (usually type 2 diabetes). Over time, insulin resistance can lead to type 2 diabetes.
SOME OTHER CAUSES OF CYST(OVARIAN)/PCOS
- Follicular cyst. Around the midpoint of your menstrual cycle, an egg bursts out of its follicle and travels down the fallopian tube in search of sperm and fertilization. A follicular cyst begins when something goes wrong and the follicle doesn't rupture or release its egg. Instead it grows and turns into a cyst.
Corpus luteum cyst. When a follicle releases its egg, the ruptured follicle begins producing large quantities of estrogen and progesterone for conception. This follicle is now called the corpus luteum. Sometimes, however, the escape opening of the egg seals off and fluid accumulates inside the follicle, causing the corpus luteum to expand into a cyst.
The fertility drug clomiphene (Clomid, Serophene), which is used to induce ovulation, increases the risk of a corpus luteum cyst developing after ovulation.
Some types of cysts are not related to the normal function of your menstrual cycle. These cysts include:
- Dermoid cysts. These cysts may contain tissue, such as hair, skin or teeth, because they form from cells that produce human eggs. They are rarely cancerous .
- Cystadenomas. These cysts develop from ovarian tissue and may be filled with a watery liquid or a mucous material.
- Endometriomas. These cysts develop as a result of endometriosis, a condition in which uterine endometrial cells grow outside your uterus. Some of that tissue may attach to your ovary and form a growth.
Dermoid cysts and cystadenomas can become large, causing the ovary to move out of its usual position in the pelvis. This increases the chance of painful twisting of your ovary, called ovarian torsion.
Symptoms of polycystic ovary syndrome
Some of the symptoms of PCOS include:
- Irregular menstrual cycle. Women with PCOS may miss periods or have fewer periods (fewer than eight in a year). Or, their periods may come every 21 days or more often. Some women with PCOS stop having menstrual periods.
- Too much hair on the face, chin, or parts of the body where men usually have hair. This is called “hirsutism.” Hirsutism affects up to 70 percent of women with PCOS.
- Acne on the face, chest, and upper back
- Thinning hair or hair loss on the scalp; malepattern baldness
- Weight gain or difficulty losing weight
- Darkening of skin, particularly along neck creases, in the groin, and underneath breasts
- Skin tags, which are small flaps of excess skin in the armpits or neck area
- Pelvic pain — a dull ache that may radiate to your lower back and thighs
- Pelvic pain shortly before your period begins or just before it ends
- Pelvic pain during intercourse (dyspareunia)
- Pain during bowel movements or pressure on your bowels
- Nausea, vomiting or breast tenderness like that experienced during pregnancy
- Fullness or heaviness in your abdomen
- Pressure on your bladder that causes you to urinate more frequently or have difficulty emptying your bladder completely
What are the potential complications of PCOS?
Women with PCOS have a higher risk of developing:
- Infertility
- Hypertension (high blood pressure)
- High cholesterol
- Anxiety and depression
- Sleep apnea
- Endometrial cancer
- Heart attack
- Diabetes
- Breast cancer
If you become pregnant, your doctor may refer you to a doctor who specializes in high-risk pregnancies. Women with PCOS have a higher rate of miscarriage, gestational diabetes, and premature delivery. They may need extra monitoring during pregnancy.
The earlier your PCOS is diagnosed and treated, the lower your risk of developing these complications. Avoiding tobacco products and participating in regular exercise can also reduce your risk of some of these comorbidities.
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