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How does polycystic ovary syndrome affect the body?

Spencer D. Kroll, MD
Internal Medicine
Another manifestation and possibly a contributory cause of polycystic ovarian syndrome is an underlying insulin-resistant state. Patients with PCOS have a high prevalence of the metabolic syndrome (high triglycerides, low HDL, obesity) and as a result are at increased risk for type II diabetes as well as increased risk for cardiovascular disease.
Structural vascular abnormalities in PCOS include increased carotid intimal medial thickness (CIMT), endothelial dysfunction and increased coronary calcium scores.  Young, obese women with PCOS have a high prevalence of early asymptomatic coronary atherosclerosis.  
Since insulin resistance is at the core of the cardiovascular pathophysiology of this disorder, it would seem prudent to address this problem. Excess insulin leads to decreased sex hormone binding globulin (SHBG) synthesis in the liver and therefore increased levels of circulating free testosterone. It is this pathway that may create the androgen excess.  The initial treatment of PCOS should be aimed at weight loss. Even a small reduction of body weight by 2–5 % can restore ovulation, lower insulin levels, increase insulin sensitivity, increase SHBG and reduce testosterone levels and acne. LDL-C and LDL-P will generally improve with the weight loss.  When lifestyle changes are not effective, targeting insulin resistance with medication and understanding the unique lipid abnormalities in these patients is very important.  
Polycystic ovarian syndrome (PCOS) is due to an imbalance in a woman's sex hormones with increased androgen (ex. testosterone) production. While testosterone is a male hormone, women also have this hormone at lower levels. This increased "male hormone" production is typically seen in women in their 20s or 30s but can even be seen in teenagers. Women with PCOS are often overweight and can be obese, with irregular periods, increased acne, and growth of male pattern hair (under the nose, chin, around the nipples, etc.). This hormone imbalance can cause recurrent miscarriages or elevate the woman's blood glucose level. The diagnosis can be suggested based on the patient's history and physical exam. Some patients will have this diagnosis suggested after undergoing a pelvic ultrasound (or pelvic MRI) which has a non-specific but characteristic appearance of prominent but symmetric ovaries which contain numerous follicles along the periphery of each ovary. The diagnosis is confirmed by a blood test to measure not only the testosterone level but other androgens as well. The treatment is aimed at treating the potential obesity-related conditions (Type II diabetes, hypertension, cardiovascular disease) with diet, exercise, along with medications to treat the hormone imbalance/regulate the period (birth control pills) and elevated glucose level (Metformin) if present.
During your menstrual cycle your ovaries produce estrogen, progesterone, and androgens to prepare for pregnancy. If your egg is not fertilized during that time the body gets rid of the uterus lining during menstruation. If you have polycystic ovary syndrome (PCOS), however, your ovaries produce too much androgen, causing problems like an irregular period, surplus body hair, acne, and infertility. If left untreated, it can also cause insulin resistance and lead to type 2 diabetes, among other complications.

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