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PCOS - Polycystic Ovary Syndrome
One of 20 North American women suffers from polycystic ovary syndrome (PCOS) that often causes obesity, large bones and muscles, hair to grow on faces and bodies, male-pattern baldness, acne, irregular periods. It is a common cause of infertility (24) and it increases their chances of developing diabetes (12), heart attacks, strokes (1) and uterine cancer. A study from Italy shows that polycystic ovary syndrome can be cured with the diabetic medication, metformin (Glucophage), and a low-refined-carbohydrate diet (26). We have known about this condition for more than 200 years, but only in the last few years have we have found a cause and cure.
Exciting research shows that drugs and diets to treat diabetes (23) and drugs to block male hormones can protect these women from developing diabetes, heart attacks, obesity and masculinizing traits such as hair on their bodies, acne, and large muscles and bones and that progesterone can protect them from uterine cancer (13,14,15,16).
A woman is born with about 4 million eggs. In a normal woman, each month one egg ripens and pops off the ovary to travel into the uterus. Women whose eggs ripen, but do not pop off the ovaries, have polycystic ovary syndrome. Their high insulin and male hormone levels cause the ovaries to make male hormones (9) that cause acne and dark body hair (2). Glucophage, Actos and Avandia are drugs that reduce insulin levels and therefore, lower blood levels of the male hormone, testosterone (7,21). So does a diet that favors whole grains and restricts foods made with flour or sugar, such as bakery products and pasta. Drugs that block male hormones also reduce masculinizing traits, lower cholesterol (10) and help the eggs to pop from the ovaries (3,4), but drugs to treat diabetes may be more effective (5,6). These women also are at increased risk for developing uterine cancer, so they are often prescribed birth control pills that contain progesterone and should try to lose weight when overweight.
If you think that you may have this condition, get a sonogram of your ovaries. Even if you don't have cysts, you could still have PCOS. Then you should avoid all bakery products, pastas, sugar-added foods and drinks, and fruit juices; and eat root vegetables and fruits only with meals. Base your diet on a wide variety of WHOLE grains, vegetables, beans and other seeds. Also check with your doctor to see if you are a candidate for Glucophage before each meal.
1) Birdsall MA et al. Annals of Internal Medicine. January, 1997
2) NEJM, 1996(August 29);335(9):617-623.
3) Finasteride (5 mg daily) or flutamide (259 mg twice daily) for 6 consecutive months. L Falsetti, D Defusco, G Eleftheriou, B Rosina. Treatment of hirsutism by finasteride and flutamide in women with polycystic ovary syndrome. Gynecological Endocrinology 11: 4 (AUG 1997):251-257.
4) V Deleo, D Lanzetta, D Dantona, A Lamarca, G Morgante. Hormonal effects of flutamide in young women with polycystic ovary syndrome. Journal of Clinical Endocrinology and Metabolism 83: 1(JAN 1998):99-102.
5) O Acbay, S Gundogdu. Can metformin reduce insulin resistance in polycystic ovary syndrome? Fertility and Sterility 65: 5 (MAY 1996):946-949. Metformin does not decrease insulin resistance in PCOS. This finding suggests that the cellular mechanism of insulin resistance in PCOS is different from other common insulin-resistant states such as noninsulin-dependent diabetes mellitus and obesity.
6) E Velazquez, A Acosta, SG Mendoza. Menstrual cyclicity after metformin therapy in polycystic ovary syndrome. Obstetrics and Gynecology 90: 3 (SEP 1997):392-395. Excellent editorial in The Lancet, January 31, 1998 351:305-6. lots of references.
7a) LC Morinpapunen, RM Koivunen, A Ruokonen, HK Martikainen. Metformin therapy improves the menstrual pattern with minimal endocrine and metabolic effects in women with polycystic ovary syndrome. Fertility and Sterility 69: 4 (APR 1998):691-696. A Lidor, D Soriano, DS Seidman, J Dor, S Mashiach, J Rabinovici. Combined somatostatin analog and follicle-stimulating hormone for women with polycystic ovary syndrome resistant to conventional treatment. Gynecological Endocrinology 12: 2 (APR 1998):97-101. human urinary follicle-stimulating hormone (FSH) Somatostatin analog subcutaneously by means of an infusion pump, providing a total daily dose of 200 mu g starting from days 1-3 of the cycle.
7) Nestler JE et al. Effects of metformin on spontaneous and clomiphene-induced ovulation in polycystic ovary syndrome. NEJM, 1998(June 25);338:1876-1880.
8) N Mauras, S Welch, A Rini, MW Haymond. Ovarian hyperandrogenism is associated with insulin resistance to both peripheral carbohydrate and whole-body protein metabolism in postpubertal young females: A metabolic study. Journal of Clinical Endocrinology and Metabolism 83: 6(JUN 1998):1900-1905.
9) JE Nestler, DJ Jakubowicz, A Falcon, VC Brik, N Quintero, F Medina. Insulin stimulates testosterone biosynthesis by human thecal cells from women with polycystic ovary syndrome by activating its own receptor and using inositolglycan mediators as the signal transduction system. Journal of Clinical Endocrinology and Metabolism 83: 6(JUN 1998):2001-2005.
10) E Diamantikandarakis, A Mitrakou, S Raptis, G Tolis, AJ Duleba. The effect of a pure antiandrogen receptor blocker, flutamide, on the lipid profile in the polycystic ovary syndrome. Journal of Clinical Endocrinology and Metabolism 83: 8(AUG 1998):2699-2705.
11) M Ciampelli, A Lanzone. Insulin and polycystic ovary syndrome: a new look at an old subject. Gynecological Endocrinology 12: 4 (AUG 1998):277-292.
12) RS Legro, AR Kunselman, WC Dodson, A Dunaif. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: A prospective, controlled study in 254 affected women. Journal of Clinical Endocrinology and Metabolism 84: 1(JAN 1999):165-169.
13) D Guzick. Polycystic ovary syndrome: Symptomatology, pathophysiology, and epidemiology. American Journal of Obstetrics and Gynecology. 179: 6 Suppl. S Part 2 (DEC 1998):S89-S93.
14) AE Taylor. Understanding the underlying metabolic abnormalities of polycystic ovary syndrome and their implications. American Journal of Obstetrics and Gynecology 179: 6 Suppl. S Part 2 (DEC 1998):S94-S100.
15) RS Legro. Polycystic ovary syndrome: Current and future treatment paradigms. American Journal of Obstetrics and Gynecology. 179: 6 Suppl. S Part 2 (DEC 1998):S101-S108.
16) SL Berga. The obstetrician-gynecologist's role in the practical management of polycystic ovary syndrome. American Journal of Obstetrics and Gynecology. 179: 6 Suppl. S Part 2 (DEC 1998):S109-S113.
17) DA Ehrmann, RB Barnes, RL Rosenfield, MK Cavaghan, J Imperial. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care 22: 1 (JAN 1999):141-146.
18) R Koivunen, T Laatikainen, C Tomas, I Huhtaniemi, J Tapanainen, H Martikainen. The prevalence of polycystic ovaries in healthy women. Acta Obstetricia Et Gynecologica Scandinavica 78: 2(FEB 1999):137-141. 14.2% (27/189).
19) PA Radon, MJ McMahon, WR Meyer.Impaired glucose tolerance in pregnant women with polycystic ovary syndrome.Obstetrics and Gynecology, 1999, Vol 94, Iss 2, pp 194-197.
20)V DeLeo, A laMarca, A Ditto, G Morgante, A Cianci.Effects of metformin on gonadotropin-induced ovulation in women with polycystic ovary syndrome.Fertility and Sterility, 1999, Vol 72, Iss 2, pp 282-285.
21) K Unluhizarci, F Kelestimur, F Bayram, Y Sahin, A Tutus.The effects of metformin on insulin resistance and ovarian steroidogenesis in women with polycystic ovary syndrome.Clinical Endocrinology, 1999, Vol 51, Iss 2, pp 231-236.
22)HJHMT vanDessel, PDK Lee, G Faessen, BCJM Fauser, LC Giudice.Elevated serum levels of free insulin-like growth factor I in polycystic ovary syndrome.Journal of Clinical Endocrinology and Metabolism, 1999, Vol 84, Iss 9, pp 3030-3035.
23) MFM Mitwally, NK Kuscu, TM Yalcinkaya.High ovulatory rates with use of troglitazone in clomiphene-resistant women with polycystic ovary
syndrome. Human Reproduction, 1999, Vol 14, Iss 11, pp 2700-2703.
24) E Kousta, DM White, E Cela, MI McCarthy, S Franks.The prevalence of
polycystic ovaries in women with infertility.Human Reproduction, 1999, Vol 14, Iss 11, pp 2720-2723.
25) RA Lobo, E Carmina. The importance of diagnosing the polycystic ovary syndrome. Annals of Internal Medicine, 2000, Vol 132, Iss 12, pp 989-993Address Lobo RA, Columbia Univ, Coll Phys & Surg, Dept Obstet & Gynecol, 630 W 168th St, New York,NY 10032 USA
26) Effect of long-term treatment with metformin added to hypocaloric diet on body composition, fat distribution, and androgen and insulin levels in abdominally obese women with and without the polycystic ovary syndrome. R Pasquali, A Gambineri, D Biscotti, V Vicennati, L Gagliardi, D Colitta, S Fiorini, GE Cognigni, M Filicori, AM MorselliLabate. Journal of Clinical Endocrinology and Metabolism, 2000, Vol 85, Iss 8, pp 2767-2774.
Checked 3/1/07