Polycystic Ovarian Disease (PCOD)
Stein Leventhal Syndrome
Often Related to Metabolic Syndrome
 

An Article Submitted by  Dr. Elizabeth Ritchey

There are women who are experiencing weight gain, while eating the same amounts and types of food they always have. These women may also notice increased facial hair and hair loss on the top of their head. Others are experiencing acne on their faces, and rarely, acne on their back, and even more severe type of acne called Hydrandintis Suppurativa, with cystic acne under the breast, arms and pelvic region. What could cause these women of all ages to suffer from fatigue after meals, severe fatigue after fasting, irregular periods and often a history of infertility? What could cause these women to experience dark pigmentation under the arms, elbows and knuckles? Polycystic Ovarian Syndrome – a frustrating syndrome that is still not talked about.
Polycystic Ovarian Syndrome is a disorder seen in women who have tiny multiple cysts on their ovaries. These cysts are too small to be seen by CT scan or ultrasound, but nevertheless these cysts produce high levels of testosterone. Irregular periods occur because of abnormal feedback to the brain and disturbed cycling of the pituitary hormones. The hormones are normally released in a sequence that triggers a menstrual flow every 28 days. Testosterone is the hormone causing all the trouble. Weight gain occurs due to the testosterone and a related problem with insulin resistance that is genetically associated with polycystic ovaries.
These women crave carbohydrates and experience a surge in appetite as the body increases insulin. Insulin interacts with a receptor to unlock the door to cells which allows proteins, fats, sugars or carbohydrates to move into these cells. The receptor site and insulin don’t interact, which causes the body to overproduce insulin to overcome this mismatch.
The liver is also affected by the insulin overproduction, causing it to produce sugar twenty-four hours a day, seven days a week. The pancreas produces even more sugars, which generates even more insulin, ultimately leading to fat production and storage. This causes the patient to eat more carbohydrates. When this happens, patients experience severe reactive hypoglycemia with episodes of sweating, nausea, shaking, irritability, and mental confusion.
A diagnosis of insulin resistance and metabolic syndrome is confirmed with elevated levels of insulin and C-peptides (another form of insulin). High levels of testosterone will also be seen in affected women. Most of these patients will have elevated triglyceride levels and low HDL (the good cholesterol), increasing their risk for heart disease. The fat accumulates frequently around the middle, which also increases the risk for heart disease. Polycystic Ovarian Syndrome is treated with the drug Glucophage, (the generic term is Metformin), since it will decrease testosterone levels and allow normal menstrual cycling to resume. Many women are able to get pregnant because of this effect on the menstrual cycle. Glucophage also blocks sugar production in the liver, decreasing insulin levels and appetite, and then weight loss. In the non-diabetic Polycystic Ovarian Syndrome patient, Glucophage is thought to prevent or delay the development of diabetes. In females who do not desire pregnancy, the addition of birth control pills will help suppress testosterone production in the ovaries and will actually help with weight loss in some cases.
Medications that can help clear up the skin include Glucophage, the birth control pill, a hormone blocker called Propecia, a hormone blocker called Aldactone (both can only be used in women who do not desire pregnancy), Phisoderm or Phisohex (a prescription soap), and antibiotics like tetracycline. For excess weight, appetite suppressants like Adipex help, and gastric bypass surgery is often recommended. Medications that lower triglyceride levels and raise HDL are sometimes recommended. Diet is a cornerstone of treatment, as is exercise.
The key to successful treatment is to recognize Polycystic Ovarian Syndrome as early as possible, before harmful changes in the body occur.
It is important for women to develop a relationship with their doctor and discuss sign and symptoms they might be experiencing. Through this relationship and open discussion doctors have a better chance to diagnosis POS or other conditions before they get out of hand.