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What is PCOS? PCOS stands for Polycystic Ovarian Syndrome – which describes the condition of having multiple small cysts on the ovaries. Up to 15 percent of women in the states suffer from PCOS. It is the leading cause of infertility in the Western world.
What is PCOS: The Diagnosis
In order to be diagnosed with PCOS, women need to have at least two of the three following characteristics:
1) Irregular or absent menstrual cycles
2) Elevated testosterone or other male sex hormone levels
3) Poly cystic ovaries (diagnosed via ultrasound)
What is PCOS: Signs and symptoms
PCOS is a disorder of the endocrine system.Testosterone is the primary hormone to be concerned about for most women, though a hormone produced by the adrenal glands called DHEA-S is also a major concern.
Sometimes female sex hormone levels are low, but that’s not always the case. The two hormones to be on the look out for here are estrogen and progesterone. They need to be in proper balance with testosterone in order for the menstrual cycle to function normally.
When the menstrual cycles stops functioning normally, here are any of the symptoms you may experience. Most women with PCOS suffer from some, but not all, of the symptoms:
-Irregular or absent menstruation
-Acne, which typically appears around the mouth, chin, and jawline
-Male pattern hair growth (hirsutism)
-Male pattern hair loss (alopecia)
-Weight gain and increased difficulty in losing weight
-Mood swings or disruptions in regular mood
What is PCOS: What Happens to the Menstrual Cycle
In order to understand how menstrual dysfunction occurs, it is important first to review normal menstruation:
The first day of a menstrual cycle is the first day of bleeding. During this period, the lining of the uterus is shed. This bleeding constitutes the first 3-8 days of the first half of the menstrual cycle, which lasts about two weeks and is called the follicular phase. Throughout the follicular phase, levels of estrogen rise and make the lining of the uterus grow and thicken.
During this phase pituitary gland produces follicle-stimulating hormone (FSH). FSH stimulates the growth of 3 to 30 follicles. Each follicle contains an egg. With time, the levels of FSH decrease, so only one of the follicles continues to grow. It produces estrogen, and other stimulated follicles break down.
Detecting this shift, the pituitary then releases luteinizing hormone (LH). This makes the follicle bulge and rupture, releasing its egg. This is ovulation. During ovulation testosterone surges, and estrogen drops.
After ovulation comes the luteal phase. Here the ruptured follicle closes and forms the corpus luteum. This makes the endometrium thicken, which produces progesterone. Estrogen rises again too. But if the egg has not been fertilized during ovulation or in the days immediately following ovulation, progesterone levels fall. This triggers shedding and bleeding. Here the cycle begins again. Cycles are generally “known” to be 28 days long, but the length of a regular, healthy cycle can vary from ~20 to ~35 days.
We remain a bit uncertain precisely where the problem enters into the picture with PCOS, but something we know for sure it that it varies between women. Some possibilities are that:
-Low levels of the hormone sex-hormone binding globulin, a “result” of PCOS, decreases the rate of conversion from testosterone to estrogen. This might make estrogen too low to send the proper signals to the pituitary.
-High androgen levels coming right from the ovary or from the adrenal glands can block estrogen and progesterone activity.
-Insufficient pituitary signaling with LH or FSH could be the primary problem. In PCOS, the ratio of LH to FSH is typically around 2:1, instead of the more normal 1:2.
-Failure to signal progesterone elevation and decline. The one hormone that is absolutely crucial for menstruation is progesterone. Without progesterone, the corpus luteum never “knows” when to shed.
The question of what precisely is going on in each woman’s body is a complicated one. Therefore, it’s important to test testosterone, DHEA-S, estrogen, progesterone, LH and FSH at the very least when trying to figure out precisely what’s going on with your PCOS. A liver panel, fasting glucose levels, thyroid tests, micronutrient levels, and adrenal hormone such as cortisol are all important for background endocrine understanding, too.
What is PCOS: What now?
Do you suffer from acne? From facial hair growth? From trouble with weight gain? It is possible that you have PCOS.
The first and most important thing to do when you have PCOS is get educated! PCOS on the surface is very complicated – many different factors can play a role, and it is different for every woman. Fortunately I’ve figured a great deal of it out and have blogged about it extensively. Through the posts on this blog and in working with my manual, you can figure out what’s causing your PCOS, and how to overcome it.
What is PCOS? You tell me! What has PCOS been to you? What is your experience?