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Polycystic Ovary Syndrome (PCOS) and Hirsutism

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PCOS

Polycystic Ovary Syndrome (PCOS) is one of the causes of hirsutism, a condition of unwanted hair in women which results in excessive amounts of coarse and pigmented hair on body areas where men typically grow hair. But what exactly is PCOS and how does it cause hirsutism in our clients? PCOS is one of the most common endocrine disorders facing women today, affecting as many as five million women in the U.S. It affects up to 10 percent of women of reproductive age (12 to 45 years) although it can be found in girls as young as seven or eight and women well past menopause. This disorder is thought to be the leading cause of diminished capacity for fertility in women. Although PCOS is one of the leading causes of infertility, the reproductive aspects of the disorder are secondary as PCOS is not limited to women of reproductive age and may not improve after menopause.

PCOS is also known as polycystic ovarian syndrome, polycystic ovary disease (PCOD), functional ovarian hyperandrogenism, Stein-Leventhal syndrome (original name, not currently used), ovarian hyperthecosis, and sclerocystic ovary syndrome. The name "polycystic ovarian syndrome" or "polycystic ovary syndrome" is a poor name of the condition; however attempts to agree on renaming the condition have failed so far.

Common symptoms of PCOS may include irregular or no menstrual periods for women of reproductive age; irregular ovulation with or without bleeding; severe acne including cystic acne; thinning scalp hair; excessive hair growth on face and body (hirsutism); build up of follicles on the edges of the ovaries, these are often mislabeled as “cysts” and called “polycystic ovaries.” It is not necessary to have all of these symptoms to have PCOS and in fact, it is not necessary to have the “polycystic ovaries” to have PCOS.

Weight management issues are found in over 60 percent of those suffering from PCOS. This can lead to obesity even with normal caloric intake due to the glucose which is stored as fat instead of being used as energy, or being made available for other functions within the body. This can lead to chronic fatigue and under nourishment. It is important to note that 40 percent of women with PCOS exhibit normal weight and may even fall under the normal weight range.

Insulin resistance and diabetes are also exhibited in those with PCOS. More than 50 percent of women with PCOS will have diabetes or impaired glucose tolerance (pre-diabetes) before the age of 40. Acanthosis nigricans may also be present. This is the medical term for darkened, velvety skin on the nape of the neck, armpits, inner thighs, vulva, or under breasts. This skin condition is a sign of insulin resistance.

The risk of heart attack is almost seven times higher in women with PCOS than those without this condition. These women also have a greater risk of high blood pressure, stroke, higher LDL (bad) cholesterol and low levels of HDL (good) cholesterol, and often develop sleep apnea, when breathing stops for short moments during sleep. PCOS sufferers may also develop anxiety and depression.

Women with PCOS may also be a risk for endometrial cancer. Estrogen is produced, but progesterone is not due to the irregular menstrual cycles and lack of ovulation. Without progesterone the lining of the womb, called endometrium, will become thick and will not shed during the menstrual period. Over time this can cause heavy or irregular bleeding and can lead to a condition where the lining grows too much and may cause cancer.

More than 75 percent of clients with PCOS have some level of hirsutism. This is caused by a condition known as hyperandrogenemia. This is an over production of the hormone, androgen. Hirsutism can be caused by an increased level of androgens or an oversensitivity of hair follicles to androgens. New studies implicate high circulating levels of insulin in women that contribute to the development of hirsutism. It is speculated that insulin, at high enough concentration, stimulates the ovarian theca cells to produce androgens. The theca folliculi comprise a layer of the ovarian follicles. The thecas are divided into two layers, the theca interna and the theca externa. The theca folliculi are responsible for the production of Androstene. There may also be an effect of high levels of insulin to activate the insulin-like growth factor-I receptor in those same cells. The result is increased androgen production.

While the actual cause of PCOS is unknown, these factors likely play a role: Insulin is the hormone produced in the pancreas that allows cells to use sugar (glucose), it is the body's primary energy supply. If the body has insulin resistance, the ability to use insulin effectively is impaired, and the pancreas has to secrete more insulin to make glucose available to cells. The excess insulin is thought to boost androgen production by the ovaries.

Research has shown that women with PCOS have low-grade inflammation. The body's white blood cells produce substances to fight infection in a process called inflammation. Eating certain foods can trigger an inflammatory response in some predisposed people. When this happens, white blood cells produce substances that can lead to insulin resistance and cholesterol accumulation in blood vessels (atherosclerosis). Atherosclerosis causes cardiovascular disease.

Heredity may also play a role in PCOS. If a female family member has PCOS, the client might have a greater chance of having it, too. Researchers are also looking into the possibility that mutated genes are linked to PCOS.

New research shows that excessive exposure to androgens in fetal life may permanently prevent normal genes from working the way they are supposed to — this process is known as gene expression. This may promote a male pattern of abdominal fat distribution, which increases the risk of insulin resistance and low-grade inflammation. Research continues to establish to what extent these factors might contribute to PCOS.

There is no specific test to definitively diagnose polycystic ovary syndrome. The diagnosis is one of exclusion. A medical history and physical exam will take menstrual cycles, weight, blood pressure, and various symptoms into consideration. A pelvic examination and ultrasound will inspect reproductive organs for signs of masses, growths, or other inconsistent abnormalities. Blood tests will also be performed to measure hormones, cholesterol, and triglyceride levels.

Treatment of PCOS is usually centered on specific concerns. Scheduling regular checkups, to help in managing cardiovascular risks, such as obesity, high blood cholesterol, type 2 diabetes, and high blood pressure, is important. Adjust lifestyle habits like making healthy-eating choices and getting regular exercise is a must for controlling the risks associated with PCOS. The physician might suggest regulating menstrual cycles through prescription medications. As professional hair removal specialists, we can work with the PCOS client to assist in removal of the excess hair associated with hirsutism. Surgical procedures, including ovarian drilling and hysterectomy may help, but they will not cure this condition. In addition to prescription medications, your client with PCOS might investigate more holistic or natural forms of care such as a diet rich with complex carbohydrates such as whole grains, brown rice and beans; increased exercise program and supplements like alpha lipoic acids, B12 and B6, Folic acid, vitamin D, magnesium, and cinnamon root.

Treatment of symptoms can often mask the underlying issues which can lead to more serious conditions, like diabetes and endometrial cancer, so discuss a team approach to care including a primary physician or ob/gyn, endocrinologist, dermatologist, nutritionist, physical trainer, and you! Women with managed PCOS are among the healthiest within the population due to their lifestyle choices and attention to their health.

Helping our clients deal with the hirsutism or acne associated with PCOS will alleviate some of the stress that goes along with this condition. Understanding the underlying causes and symptoms may allow you to help a client struggling with undiagnosed PCOS to seek a physician’s care and perhaps discover the answer to a long time health concern.

Read 6115 times Last modified on Thursday, 07 March 2013 22:56
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