Polycystic ovarian syndrome (PCOS) is a disorder involving excessive hormone production by the ovaries and the adrenal glands. It affects approximately 5 percent of women in the United States and usually begins during puberty. The cause is unknown.
Common symptoms include obesity, hirsutism (growth of thick hair in areas where hair is normally minimal or absent, such as the face, chest, and breasts), and absence of menstrual periods. Affected women generally have multiple ovarian cysts and may be infertile. They often have diabetes, male-pattern baldness, and acne.
Although PCOS has no specific cure, weight loss, medical treatment, and dietary changes can usually control most symptoms.
Risk Factors
- Obesity
- Epilepsy: Both epilepsy and the use of anti-seizure medications increase the risk of PCOS.
- Family History: Approximately 40 percent of first-degree relatives are affected.
Polycystic Ovarian Syndrome: Overview and Risk Factors
Diagnosis
- For diagnosis, two of the following three criteria should be met, and other diseases with similar symptoms should be ruled out:
- Menstrual irregularity: Lack of periods, decreased frequency of periods, or irregular bleeding may all occur.
- Signs of increased androgen hormones: This may appear as hirsutism, acne, male-pattern baldness, or elevated testosterone concentration in the blood.
- Polycystic ovaries, visible on transvaginal ultrasound: However, an isolated finding of polycystic ovaries in the absence of symptoms is common and does not indicate PCOS.
- Several blood tests are necessary to evaluate the effects of the disease, including measurements of various hormones, blood glucose, and insulin.
- Because coronary artery disease is common in patients with PCOS, cardiovascular risk factors should be evaluated (e.g., high cholesterol levels), and further testing may be necessary, such as an electrocardiogram and stress testing. Smoking should also be discouraged.
Treatment
- Weight loss, increased physical activity, and diabetes medications (e.g., metformin) are usually necessary.
- Oral contraceptives are used to regulate the menstrual cycle and protect the uterus in women who are not interested in becoming pregnant.
- Hirsutism is treated by hair removal (e.g., electrolysis or laser treatment) and various medications, including oral contraceptive pills, anti-androgen medication (e.g., spironolactone), or gonadotropin-releasing hormone analogs (e.g., leuprolide).
- Acne is treated with topical or oral medications.
- Treatment of infertility is often necessary if the patient desires pregnancy. This may include medical therapies (e.g., clomiphene ormetformin) or assisted reproductive technologies (e.g., in–vitro fertilization).
Polycystic Ovarian Syndrome: Nutritional Considerations
PCOS appears to be, in part, related to diet and lifestyle factors, particularly those that influence body weight and insulin. Although weight loss is an accepted treatment, even relatively lean women may develop PCOS, and diet changes may affect the outcome of this disorder even in the absence of weight change.
A diet that addresses cardiovascular risk factors is appropriate for women with PCOS. Roughly half of women with PCOS are obese, and losing as little as 5 to 10 percent of weight results in a resumption of menstrual periods and a decrease in androgen hormones.
There are several reasons why a diet low in fat and high in fiber and whole grains is superior to other weight-loss treatments. Such a diet helps reverse diabetes, which affects 50 to 70 percent of women with PCOS. Low-fat, high-fiber diets also reduce body weight and effectively address unhealthy cholesterol levels. See the chapter on How to Lose Weight.
