Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women who are old enough to get pregnant. Each year, it affects nearly five million women, and the rates have been rising over the past decade. Doctors have long understood that PCOS is linked with unexplained weight gain, though it is often thought of as mainly a side effect for those who already have the disease. Some research shows, however, that weight gain may also be a factor in the development of the disease for some women.
As a disorder of the endocrine system, PCOS affects the functions of the body involved in sending messages between cells and organs; this messaging happens via hormones secreted by endocrine glands like the ovaries. In addition to producing the eggs that eventually can be fertilized by sperm in the uterus, the ovaries are one of the body’s major producers of the hormones estrogen and progesterone; estrogen and progesterone are both involved in promoting the growth of egg follicles and preparing the body for pregnancy.
Also alternatively known as polycystic ovarian syndrome, PCOS is so named because of small, fluid-filled cysts that sometimes form on the ovaries; interestingly, the cysts don’t need to have formed in order to diagnose the condition, but it does occur for a majority of patients. It is most common for women to learn that they have PCOS while in their 20s or 30s, but it can actually happen any time after puberty. The majority of women don’t know they even have the condition until they encounter difficulties in trying to get pregnant.
Even though PCOS is one of the leading causes of infertility in women, it is often difficult to diagnose earlier because it doesn’t always cause symptoms. When symptoms are present, however, the most common example is having irregular periods or no periods at all. The rise in androgen levels has also been known to cause a variety of other symptoms in some cases:
The underlying cause of PCOS is not fully understood, but the main mechanism is a hormonal imbalance that can temporarily prevent pregnancy. This is thought to be mostly due to the overproduction of androgen, a male hormone that primarily regulates the development of male characteristics; though women generally have lower androgen levels, the hormone is also important in triggering the onset of puberty in females. When androgen production is increased, the menstrual cycle can be disrupted as ovulation is inhibited.
What leads to this increase in androgen levels in some women is also still unclear, but it appears to be partly explained by genetics. Recent research also shows that it might be related to the level of insulin, a different endocrine hormone that regulates metabolism and blood sugar levels. Insulin is released in the bloodstream when blood sugar (glucose) goes up after eating food; the insulin allows the glucose to actually be used by cells to perform their functions. When insulin levels get sufficiently high, however, they can also trigger an overproduction of androgen that can lead to PCOS.
Higher insulin levels don’t just affect androgen production, however; as these levels increase, the body can also start developing insulin sensitivity or even become insulin resistant. This means that even though more and more insulin is being produced, it becomes less and less effective at reducing blood sugar. So instead of being used for the body’s energy needs, glucose gets stored in fat deposits around the body, which eventually results in overweight and obesity. Indeed, insulin resistance is known to be a key precursor to obesity and the development of obesity-related conditions like type 2 diabetes, high blood pressure, sleep apnea, or heart disease.
There is still an ongoing debate in the medical community about whether weight gain can be said to cause PCOS or whether PCOS leads to weight gain. In some cases as noted, originally higher androgen levels appear to cause higher insulin levels that then contribute to the accumulation of fat deposits and overweight. There is also evidence that higher insulin levels that come from a long-term diet that is high in sugar and other carbohydrates may be the reason for the higher androgen levels.
There’s no doubt that PCOS is linked to obesity, and it appears that one can be the trigger for the other in some women and vice-versa in other women. The bottom line is that the higher insulin levels related to weight gain are sometimes a factor in the development of PCOS. One way obesity can be defined is the level of extra body weight that begins to negatively affect health. This is typically measured by a diagnostic tool known as body mass index (BMI), a number that compares a person’s weight in proportion to their height.
Polycystic ovary syndrome doesn’t have a cure, but it is typically treated with either birth control pills or anti-androgen medication; this can improve the regularity of the menstrual cycle as well as manage some of the other symptoms. Because of the link with insulin levels, diabetes medication like Metformin can also be used as a treatment and has been shown to resolve infertility. In general, most women who experience infertility because of PCOS eventually become fertile again.
To the extent that PCOS is linked to genetics, it may be unavoidable for some women. There are, however, numerous lifestyle changes that prevent it where insulin resistance is the main factor. Switching to a diet higher in fruits, vegetables, and whole grains and away from simple carbohydrates is an important first step; this step has the added benefit of being good for overall health, cholesterol levels, and weight loss. The other important step is to increase daily physical activity; by using more calories for the body’s energy needs, less blood glucose will be available to be stored in fat deposits.
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