Polycystic Ovary Disease

Polycystic ovary syndrome (PCOS), also known as Stein-Leventhal syndrome or functional ovarian hyperandogenism, is a reproductive-age endocrine metabolic disorder of women. The prevalence of PCOS is 4 to 12 percent in the United States and 6 to 18 percent worldwide. PCOS is associated with peripheral insulin resistance, hyperinsulinemia, dyslipidemia, and hyperglycemia. PCOS with obesity enhances other complications. The principal features of PCOS are lack of regular ovulation and excessive amounts or effects of androgenic hormones such as testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEA-S).

In 1990, the National Institutes of Health (NIH)/National Institute of Child Health and Huma Development (NICHD) defined PCOS as women with the signs of androgen excess hormones and oligoovulation. In 2003, the European Society for Human Reproduction & Embryology (ESHRE)/American Society of Reproductive Medicine (ASRM) defined PCOS as women having at least two out of three factors: oligoovulation and/or anovulation, excess androgen activity, polycystic ovaries. The contributing risk in PCOS are acne; weight gain and have trouble losing weight; male pattern baldness or thinning hair on the scalp; hair growth on the face, back, or chest; high blood sugar (hyperglycemia); and endometrial hyperplasia and endometrial cancer (cancer of the uterine lining) are possible due to overaccumulation of uterine lining, and also lack of progesterone resulting in prolonged stimulation of uterine cells by estrogen, high blood pressure, dyslipidemia (disorders of lipid metabolism—cholesterol and triglycerides), and increasing inflammatory mediators. The symptoms vary with each individual woman.

The development steps of PCOS are increase of GnRH pulse frequency, LH over FSH dominance, [Page 614]increase in ovarian androgen production, decreased follicular maturation, and decreased SHBG binding. Women with PCOS have a higher risk of miscarriage, irregular cycles and lack of ovulation. The major diagnostic tool is pelvic ultrasound with biochemical screening including two-hour glucose tolerance tests, and hormone levels and lipid panel will help to diagnose PCOS in reproductive women. They can become normal with early treatment regimen (diet and drugs such as insulin-lowering medications, e.g., metformin hydrochloride [Glucophage®], pioglitazone hydrochloride [Actos®], and rosiglitazone maleate [Avandia®]).

An alternative nutritional adjunctive therapy, chromium supplementation, may be effective for PCOS women with insulin resistance. Chromium is an essential trace mineral required to maintain insulin health. Low-chromium status is associated with a number of metabolic syndrome risk factors. Recently, two pilot studies on chromium picolinate supplementation to PCOS women have shown significant improvements in insulin sensitivity. Long-term studies are required to show their effect on other risk factors in the long run. Surgical treatments include laparoscopy electrocauterization or laser cauterization, old procedure of ovarian wedge resection, and ovarian drilling.