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What and What? PCOS and Metabolic Syndrom


Polycystic Ovary Syndrome and Metabolic Syndrome are two very common and interrelated conditions that many women experience. Because the two have broad and inexact definitions the number of women affected is unknown but estimated to be between 5-10 percent of reproductive age women.
The term Polycystic Ovary Syndrome is historical in that the ovaries demonstrate an abundance of immature follicles but not because they contain pathologic “cysts”. The term Metabolic Syndrome is newer and relates to a myriad of abnormalities related to insulin metabolism.
The classic presentation of PCOS includes obesity, male pattern hair growth, acne and a lack of regular menstrual cycles. Because PCOS is a spectrum of abnormalities, only a minority of women actually present with the classic profile. Most women will not have the condition identified until they may experience difficulty getting pregnant.
Metabolic syndrome presents with impaired glucose tolerance, central obesity, hypertension and hypercholesterol. Women with Metabolic Syndrome are at higher risk for the development of diabetes and cardiovascular disease including heart attack and stroke.
The causes of both PCOS and Metabolic Syndrome remain undetermined but relate to genetic and environmental factors. Generally, an overproduction of insulin or insensitivity to insulin causes an imbalance of hormones leading to excess androgen (male hormones) in the body. These excess male hormones cause the secondary symptoms and associated risks.
The number one treatment is lifestyle changes such as losing weight by eating a lower calorie diet and getting more physical activity. Even a 5% weight loss can have a positive effect and reduce the symptoms of PCOS and Metabolic Syndrome. Women with PCOS who lose weight are more likely to have restored ovulation with better pregnancy rates. They also are likely to have lower androgen level and blood pressure. Weight loss alone can lead to a cascade of hormonal changes that get ride of symptoms without medical intervention.
Common medical treatments include oral contraceptives to restore cycles and reduce androgen levels, insulin-sensitizing agents to regulate cycles and reduce infertility, antiandrogen agents to improve acne and male pattern hair changes and cosmetic methods to eliminate unwanted hair. Your health care provider can assist you in prescribing the best regimen for you.
If pregnancy is desired often clomid, metformin or a combination can be effective in establishing normal ovulation. Occasionally more intense treatment with gonadotropins may need to be administered by a reproductive specialist. Even with pregnancy women with PCOS are at increased risk for pregnancy complications related to diabetes and hypertension.
PCOS and Metabolic Syndrome remain conditions receiving research and study regarding cause and improved treatment. However you can take control by maintaining an ideal body weight through exercise and diet and receiving regular evaluations from your health care provider.
Dr. Adam Blickley is a board certified OB/GYN. He specializes in normal and high risk pregnancy, ultrasound as well as other gynecologic conditions. When not working, Dr. Blickley enjoys spending time with his family and traveling the world doing medical mission work.


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