Polycystic Ovary Syndrome

It is Common.  8% of women in USA of childbearing age have Polycystic Ovary Syndrome.  The majority is unaware of it.

It is more common than Diabetes or Thyroid disease.

It is the leading cause of female-factor infertility in the United States.

Symptoms
Hirsutism (excess hair), irregular infrequent period (about 4 per year), difficulty getting pregnant, frequently over weight (50%), mild acne.

Diagnostic test
The most helpful test is bioavailable (unbound) testosterone.  Total testosterone is not helpful.

Helpful for excluding other Diagnosis: TSH, free T4- excluding thyroid disease, DHEAS (dehydroepiandrosterone sulfate)- excluding adrenal disease as source for hirsudtism, prolactin- excluding pituitary tumor as source for infrequent periods.

Insulin connection
Insulin stimulates androgen (testosterone/male hormone) and decreases sex hormone-binding globulin (a protein that binds/absorbs testosterone).  Both of these factors increase the “active” testosterone. The increased bioavailable testosterone confuses the hypothalamus causing abnormal rations of LH (to high) FSH (to low).  LH (Lutinizing Hormone) and FSH (Follicle Stimulation Hormone) are Pituitary hormones that regulate ovulation and the menstrual cycle. 

All women with Polycystic Ovary Syndrome have been found to have excess insulin production.

Not all women with high insulin production have Polycystic Ovary Syndrome, it require a genetic predisposition for this to develop.

What causes excess insulin? 
Insulin resistance is the cause.  Insulin is the hormone that regulates blood sugar as its primary function.  If you have an insufficient amount of insulin to keep your blood sugar normal, you have diabetes.  If the body cells do not respond to insulin in a normal way, but require more insulin to keep the blood sugar normal this is insulin resistance.

What causes insulin resistance?
It is a genetic disorder that is manifested by life style factors.  It is like heart disease, hypertension, and diabetes in this respect.  In many cases it is preventable and curable with lifestyle changes.  

Treatments for Polycystic Ovary Syndrome
Life style therapy 
 A diet to promote weight loss, including a reduction of fat, refined sugar and white bread. Increase the amount and quality of fiber and vegetables. Exercise 20 min per day, a fast walking or equivalent. 
Medications
Birth Control Pills for acne, irregular periods and hirsutism.
Aldactone (50mg BID) for hirsutism and acne
Clomiphene for ovulation induction
Glucophage (work up to 500mg) TID for insulin resistance (the root problem)