1. Polycystic Ovary Syndrome Melissa McCarthy June 1, 2010

2. What is PCOS? • Polycystic ovary syndrome (PCOS) is the most common hormonal disorder among women of reproductive age. • PCOS is a health problem that can affect a woman's: • Menstrual cycle • Ability to have children • Hormones • Heart • Blood vessels • Appearance

3. Symptoms One May Have • You may recognize the symptoms of PCOS soon after your first menstruation. Menstrual abnormality may signal the condition in adolescence, or PCOS may become apparent later following weight gain or difficulty becoming pregnant • Infrequent or prolonged menstrual periods • excess hair growth • Acne, oily skin, or dandruff • Obesity, usually with extra weight around the waist • High levels of androgens. (male hormones) • Many small cysts (fluid-filled sacs) in their ovaries • Women also have problems regulating their insulin, which can later lead to Type 2 Diabetes. • Acanthosis nigricans- darkened, velvety skin on the nape of your neck, armpits, inner thighs, vulva or under your breasts. • Skin tags — excess flaps of skin in the armpits or neck area • Pelvic pain • Anxiety or depression • Sleep apnea — when breathing stops for short periods of time while asleep • Male pattern baldness or thinning hair

5. What Causes PCOS? • Excess Insulin: If you have insulin resistance, your ability to use insulin effectively is impaired, and your pancreas has to secrete more insulin to make glucose available to cells. The excess insulin is thought to boost androgen production by your ovaries. • Low-Grade Inflammation: Your body's white blood cells produce substances to fight infection in a process called inflammation. When this happens, white blood cells produce substances that can lead to insulin resistance and cholesterol accumulation in blood vessels (atherosclerosis). • Heredity • Abnormal Fetal Development: New research shows that excessive exposure to male hormones (androgens) in fetal life may permanently prevent normal genes from working the way they're supposed to. • The pituitary gland, a gland in the brain which regulates your hormones, changes the levels of androgen and progesterone in the brain and ovaries. • The pituitary gland produces follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which control the growth and release of eggs (ovulation) in the ovaries. • In polycystic ovary syndrome, the pituitary gland may secrete high levels of LH and the ovaries may make excess androgens. This disrupts the normal menstrual cycle and may lead to infertility, excess body hair and acne.

6. Why do Women with PCOS have Problems Menstruating? • Normally, in a woman’s ovaries, there are fluid sacs called follicles. As an egg matures, the follicle will build up more fluid. Once the egg is ready for ovulation, the follicle breaks open and releases the egg. The egg will travel through the fallopian tubes to the uterus where it will become fertilized. • Women who have PCOS lack the ability to fully mature an egg, so when it is time for ovulation, the follicle has not developed nor released the egg. These follicles just stay in the woman’s ovaries and produce cysts.

7. What Can PCOS Lead to in the Future? • Abnormal uterine bleeding • Cancer of the uterine lining (endometrial cancer), caused by exposure to continuous high levels of estrogen • Gestational diabetes or pregnancy-induced high blood pressure, if you do become pregnant • Type 2 diabetes • High blood pressure • Cholesterol abnormalities, such as high triglycerides or low high-density lipoprotein (HDL) cholesterol, the so-called "good" cholesterol • Elevated levels of C-reactive protein, a cardiovascular disease marker • Metabolic syndrome, a cluster of signs and symptoms that indicate a significantly increased risk of cardiovascular disease • Nonalcoholic steatohepatitis, a severe liver inflammation caused by fat accumulation in the liver

8. How is it Treated? • Modify your lifestyle: Go to a Nutritionist who can help make a meal plan for you. They will recommend limiting your intake of carbohydrates and sugars. Also, increase your daily exercise. Lowering your weight will help with the symptoms of PCOS. • Take Medications that will balance out our hormones: androgen, estrogen, progesterone, and insulin. • Birth Control: control the production of progesterone • Metformin: affects the way insulin controls blood glucose and lowers testosterone production, slows the growth of abnormal hair, and may help ovulation to return. Recent research has shown metformin to have other positive effects, such as decreased body mass and improved cholesterol levels. • Spironolactone: an anti-androgen medication taken to reduce hair growth and clear acne. • “Ovarian Drilling”: surgery that increases ovulation. First, you puncture the ovary with a small needle and then send an electric current to destroy part of the ovary. http://www.youtube.com/watch?v=JKEFEOy9O1s

9. Facial Hair Treatments • Vaniqa: cream to reduce facial hair • Laser hair removal or electrolysis to remove hair • Hormonal treatment to keep new hair from growing

10. Doctors Recommended to See • Gynecologist: A doctor who is specialized in conditions affecting the female reproductive tract • Endocrinologist: A doctor who specializes in hormonal disorders • Reproductive Endocrinologist: A doctor who specializes in both female reproduction and hormonal disorders

11. Reasons to See a Doctor • More than 50 percent of women with PCOS will have diabetes or pre-diabetes (impaired glucose tolerance) before the age of 40. • The risk of heart attack is 4 to 7 times higher in women with PCOS than women of the same age without PCOS. • Women with PCOS are at greater risk of having high blood pressure. • Women with PCOS have high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol. • Women with PCOS can develop sleep apnea. This is when breathing stops for short periods of time during sleep.