PCOS and Hirsutism
Definition:
PCOS or Polycystic Ovarian Syndrome is a virilizing syndrome seen in young women characterized by menstrual irregularities, infertility, obesity, hirsutism and acne.PCOS is the most common ovarian cause of hirsutism. It is also called Polycystic Ovarian Disease (PCOD) and Stein Levinthal Syndrome.
Hirsutism in turn can be defined as excessive growth of hair in places where it is usually minimal or absent.
Hypothalamic - Pituitary -Ovarian axis:
The ovaries secrete sex hormones - mainly estrogen and progesterone, the female sex hormones, and a small quantity of androgen, the male sex hormone.This secretion is stimulated by the luteinizing hormone (LH) and the follicular stimulating hormone (FSH) secreted by the pituitary gland in the brain which in turn is controlled by the releasing hormones of the hypothalamus of the brain.
The sex hormones in turn inhibit the secretion of the hormones by the pituitary and the hypothalamus by a negative feedback mechanism.
In PCOS, this axis is disturbed. There is secretion of increased levels of LH and androgens and decreased levels of FSH. These increased levels of androgen cause hirsutism in PCOS.
In PCOS, no ovulation occurs in the ovaries. Also the ovaries become enlarged, filled with multiple cysts and interspersed with scar tissue.
Disease Statistics:
The disease was first reported by Stein and Levinthal in 1935. But only in 1990, at a conference conducted by the National Institute of Health, were the key features for the diagnosis of PCOS defined.- Both in the US and Internationally, PCOS affects 6-10% of women
- 30% of women with infertility have PCOS
- 69% of women with PCOS have hirsutism
Disease Characteristics:
PCOS is a familial disorder transmitted as an autosomal dominant disorder. The causative gene is yet to be identified.Following are features of PCOS:
- Menstrual Irregularities - 80%
- Infertility - 74%
- Hirsutism - 69%
- Obesity - 49%
- Recurrent pregnancy loss
- Acne
- Acanthosis nigrigans - a skin manifestation
- Sometimes without any symptom
- PCOS is associated with a few long term complications:
- There is an increased incidence of heart disease because of the associated increased blood pressure and increased lipid levels.
- There is an increased risk of Type II diabetes because of Insulin resistance due to obesity.
- There is an increased risk for uterine cancer.
Diagnosis of PCOS:
Two types of investigations are necessary to diagnose PCOS - Hormonal studies and ultrasonography.Hormonal studies show:
- Increased androgen levels
- LH- FSH ratio more than 2
- Increased insulin levels
Treatment of POCS:
Medical treatment includes- Metformin - The most recent treatment
- Oral contraceptives to suppress the excess hormone production by ovaries
- Clomiphene citrate to stimulate ovaries for fertility
- Treatment for acne like Retin A
- Treatment for Type II diabetes
- Surgical treatment includes
- Ovarian diathermy - The most recent treatment Wedge resection- An older method where part of the ovaries is removed
nutritional counseling for obesity and diabetes and hair removal in hirsutism.
Hirsutism and PCOS:
PCOS is the most common ovarian cause of hirsutism. Increased blood levels of androgen present in PCOS results in hirsutism. Hirsutism is seen in approximately 69% of the cases of PCOS.Increased androgen levels in PCOS cause a male type of hair distribution. It leads to growth of hair in androgen-dependent areas like the face, chest and areola in women. Because of the male type of distribution of hair and also the increased male sex hormone levels, PCOS is called a virilizing syndrome which means it is a masculinizing syndrome. Treatments mentioned above will cure hirsutism associated with PCOS.
This page was last updated on June 20, 2006