Polycystic ovarian syndrome (PCOS) a condition marked by signs such as irregular menstrual cycle and excess androgens in the body. Androgens are a class of sex hormones that include testosterone and androstenedione. While androgens are commonly referred to as “male
sex hormones,” they are also present in women, but in small amounts, and are essential for the creation of estrogen.1 PCOS was first discussed in 1935 after researchers observed seven women who presented with infrequent or absent periods, excessive hair growth, obesity, and infertility.2–4 The women in this case report were treated by way of partial or complete surgical removal of their enlarged ovaries. The condition was termed polycystic ovarian disease, or PCOS.4
PCOS affects women of childbearing age, though specifics of the condition can vary among different ethnic groups.5 Estimates of the prevalence of PCOS in the general population have been said to range between 2 and 20 percent.6,7 The key steps in the development of PCOS are as follows: 4 1) Increased secretion of gonadotropin-releasing hormone from a part of the brain called the hypothalamus signals the pituitary gland to produce and secrete abnormal levels of luteinizing hormone, a gonadotrophic hormone that regulates ovarian function throughout the menstrual cycle;8,9 2) The increase in luteinizing hormone causes cells in the ovaries to produce and release an abnormal number of androgens, which then triggers PCOS symptoms; and 3) Abnormalities in insulin receptors lead to insulin resistance, which has been identified as a hallmark of PCOS. This insulin resistance, in turn, leads to continued overproduction of androgens.
Interestingly, recent research conducted in mice suggests that PCOS might be related to
a hormonal imbalance present in the mother before birth, in that pregnant women with PCOS have 30-percent higher levels of anti-Müllerian hormone than normal.7 Anti-Müllerian hormone is mainly responsible for the formation of sex- specific reproductive organs during prenatal development, and exposure to high levels of anti-Müllerian hormone while a fetus has been linked to the later development of PCOS in adult women.11
Often, affected yet undiagnosed patients might initially seek a dermatology consultation for complaints such as acne, excessive hair growth, thinning of hair on the scalp, skin tags, and a benign skin condition called acanthosis nigricans, characterized by the darkening and thickening of the skin on the armpits, neck, groin, elbows, knees, knuckles, lips, palms, and/or the soles of the feet.4 Four forms of PCOS have been identified.12,13 Women with different forms of PCOS can demonstrate varying symptoms and presentations of the condition.13 One study found that women with PCOS were more likely to have an existing diagnosis of diabetes, high cholesterol, high blood pressure, obesity, infertility, obstructive sleep apnea, anxiety, depression, bipolar disorder, metabolic abnormalities, and/ or glucose intolerance, compared with healthy controls.14
Recent research has begun to focus on the link between hormone imbalances as a result of PCOS and the effects these imbalances have on other parts of the body. One study pointed out that the many hormone imbalances involved in PCOS can influence bone metabolism, resulting in an increased risk for osteoporosis; furthermore, the drugs taken during the treatment of PCOS can increase the risk of bone fracture by way of endocrine disruption.15 Other research considered whether an imbalance between the hormones estradiol and progesterone plays a role in the high prevalence of Hashimoto’s thyroiditis in patients with PCOS.16 Hashimoto’s thyroiditis, also known as Hashimoto’s disease, is an autoimmune disorder in which antibodies attack the thyroid gland, causing inflammation of the thyroid and subsequent hypothyroidism.17 PCOS can also result in more severe dry eye symptoms and increased central corneal thickness measurements18 and might lead to alterations in the composition of the microflora within the mouth, impacting periodontal health.19 There are methods to address PCOS signs and symptoms, including lifestyle modification, pharmaceutical options, and ovarian surgery however, the condition has no definitive cure.4 Because women with PCOS frequently experience insulin resistance, a low-glycemic diet that is high in fiber and relatively low in saturated fat is recommended in order to help balance hormones and ameliorate PCOS symptoms.20 Diets rich in fruits, vegetables, whole grains, and low-fat dairy products and low in saturated fats, cholesterol, refined grains, and sweets, much like the DASH diet, have been shown to improve insulin resistance and decrease inflammatory markers in women with PCOS.21 In addition, insulin resistance and excess weight frequently co-exist in women with PCOS, and weight loss is recommended as a means of reducing insulin resistance and PCOS symptoms. However, weight loss is markedly more difficult in women with PCOS, and professional nutrition counseling is recommended.22 Regular exercise is recommended for women with PCOS and has been shown to ease symptoms of PCOS, regulate the menstrual cycle, improve insulin resistance, and aid in weight loss.23
