Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is a chronic hormonal disorder that affects fertility, physical health and emotional wellbeing. It is thought to affect 12-18 % of reproductive aged women across Australia.

Symptoms of PCOS may vary between individuals and in severity.  Not everyone with PCOS will have all the symptoms and very few women will have the same set of symptoms.

The principal signs and symptoms of PCOS are related to menstrual disturbances and elevated levels of male hormones (androgens). Menstrual disturbances can include delay of normal menstruation, the presence of fewer than normal menstrual periods, or the absence of menstruation for more than three months. Menstrual cycles may not be associated with ovulation and therefore may be quite heavy.

Symptoms related to elevated androgen levels include acne, excess hair growth on the face and body (hirsutism) and male-pattern hair loss.

Other signs and symptoms of PCOS include:

• obesity
• elevated insulin levels and insulin resistance
• sub fertility or infertility
• elevated cholesterol
• hypertension
• multiple, small cysts in the ovaries

PCOS increases the risk of poor pregnancy outcomes and recent research in Sweden found increased rates of gestational diabetes, pre-term birth, stillbirth and pre-eclampsia due to PCOS. The exact cause of PCOS is not known; however there appears to be a connection with genetics, insulin resistance and lifestyle factors.

Being overweight worsens insulin resistance and the existing symptoms of PCOS. Some women with PCOS will only show symptoms once they gain weight. The symptoms of PCOS can therefore be reduced if a healthy weight and lifestyle is achieved.

12 to 18 percent of women of reproductive age have PCOS. This increases to up to 30 per cent in overweight women. With the obesity epidemic in Australia, the prevalence of PCOS and the severity of the symptoms of PCOS are both likely to increase. This means a healthy lifestyle and weight management is important not only in treating PCOS, but also in preventing it.

References

• www.managingpcos.org.au
• www.MedicineNet.com
  

Obesity and Infertility

Obesity is correlated with decreased fertility and suboptimal pregnancy outcomes.

In women, early onset of obesity favours the development of irregular periods, absence of ovulation and infertility during the reproductive years. Obesity in women can also increase the risk of miscarriage and impair the outcomes of fertility treatments and pregnancy, when the body mass index exceeds 30 kg/m2. Insulin excess and insulin resistance are thought to be the main factors at play here. These adverse effects of obesity are specifically evident in polycystic ovary syndrome. PCOS is associated with a 5-10 fold greater risk of type 2 diabetes, with the age of onset being 30 years younger than the general population. In pregnancy there is an increased risk of PCOS patients developing gestational diabetes (type 2 diabetes).

In men, obesity is associated with low testosterone levels. In massively obese individuals, reduced spermatogenesis may favour infertility. Moreover, the frequency of erectile dysfunction increases with increasing weight.

On the positive side, considerable evidence shows that weight loss in PCOS can lead to the return of ovulatory cycles, decreased acne and hairiness and improved fertility. The weight loss has to be at least 5% of body weight, but surprisingly, does not require a return to the normal range.

See Wesley Weight Management Success Story, Helena Schulke’s Channel 10 News Story on ‘Fertility Fears.’

References

1. Queensland fertility Group
2. Current Opinion in Endocrinology, Diabetes and Obesity: December 2007,volume 14- issue 6