Dr. Ashton Off Duty


May 21, 2014

Everyday in my practice, I see teenage girls and adult women witih PCOS. It is such a common, and poorly-recognized hormonal issue, that I am always surprised when my patients haven’t had it explained to them in a thorough manner! So by popular request, I have started to post these PCOS blog entries to help women of all ages glean a better understanding of what is happening to their bodies.

Disclaimer: the information I present here is not meant to be the final word, but rather a ‘starter’ of sorts in helping clarify a syndrome that effects anywhere from 5-20% of the female population! Not only is Polycystic Ovarian Syndrome an ugly, off-putting name…it's not even accurate! It doesn't just affect the ovaries—it also involves the pancreas and a bunch of other organs. And there may be no cysts at all (which are basically little liquid filled sacks that form inside an organ). Plus its daunting acronym PCOS sounds like it must be a dread disease…but it's not a disease at all. It's a syndrome—a collection of symptoms--which is a fancy way of saying "This is just the way your body is."
PCOS isn’t something temporary that goes away, like a sinus infection. You don't catch it and then get over it like a cold, or take a pill to get rid of it, like strep throat. And there's no single test that definitely proves whether you have it or not.
Instead, PCOS is a hormonal condition you’ll have for your entire reproductive life. Just as you have brown hair or blue eyes, so, too, do you have PCOS.
If you catch on and start treating PCOS early, chances are it will never be dangerous or have serious health consequences. If you don't catch it early on, you might have problems getting pregnant or develop diabetes or even endometrial cancer later.

What Drives Hormones Wild?
No one knows exactly what causes PCOS. It seems to run in families, and might be related to obesity, since fat tissue produces hormones and can exacerbate hormonal imbalances. Whatever the cause, the main feature of PCOS is overactive ovaries and an overproduction of insulin and androgens (male sex hormones), particularly testosterone. (It was extra testosterone that caused Ashley’s acne and excessive body hair.) Ironically, teens with PCOS sometimes face an increased risk of pregnancy, since their irregular cycles make it even harder to predict when they're ovulating.
When patients have PCOS, their hormones could be out of whack in four specific ways. 
1. Their pituitary glands (in the brain) don’t consistently secrete the right level of two hormones that talk to the ovaries and tell them how to behave. These are called FSH (follicle stimulating hormone) and LH (luteinizing hormone). 
2. Their ovaries are producing abnormally high levels of sex steroids (like testosterone) and progesterone .
3. Their adrenal glands (on top of the kidneys) are also producing too much testosterone.  
4. Their muscle cells resist insulin. In addition, certain cells called endothelial cells, also resist insulin. These cells line our blood vessels. This means more insulin circulates in their blood, which, in turn, eventually leads to higher levels of testosterone and the other hormones I just mentioned.
Bottom line: All these hormones "talk" to each other in very complicated ways, so when one is out of balance, it's a lot easier for the others to get out of balance, too. A vicious cycle of high insulin levels, insulin resistance and weight gain ensues! The key to managing PCOS, so it doesn’t manage you, is breaking this cycle!

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Jennifer Ashton MD