Polycystic Ovarian Syndrome (PCOS) (cont.)
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PCOS leads to disruptions in the menstrual cycle that typically begin around the onset of puberty. Menstrual cycles may be normal at first and then become irregular, or the onset of menses may be delayed. The menstrual irregularities of PCOS are accompanied by a lack of ovulation, so affected women may experience infertility. The desire for pregnancy is a factor that prompts many women with PCOS to first seek medical attention.
An increase in the production of androgens (male hormones) by the ovaries in PCOS may lead to excess hair growth in areas suggesting a male pattern, known as hirsutism. Thick, pigmented hair growth occurs on the upper lip, chin, around the nipples, and on the lower abdomen. Excess androgens can also lead to acne and male pattern balding.
Because of the absence or reduction in ovulation, women with PCOS have reduced levels of the hormone progesterone (normally produced after ovulation in the second half of the menstrual cycle). This can result in growth stimulation of the endometrium (lining tissues of the uterus), leading to dysfunctional uterine bleeding and breakthrough bleeding. Increased stimulation of the endometrium in the absence of progesterone production is a risk factor for the development of endometrial hyperplasia and uterine cancer.
Insulin resistance, weight gain, and obesity are also common in PCOS. Observers have suggested that about one-half of women with PCOS are obese. Insulin resistance, accompanied by elevated blood levels of insulin, occurs in most women with PCOS, independent of the presence of obesity.
Women with PCOS have also been reported to have an increased risk of developing type 2 diabetes, and many studies have shown abnormal blood lipid levels and elevated levels of C-reactive protein (CRP), a predictor of coronary artery disease. The combination of type 2 diabetes, elevated cholesterol and LDL levels, and elevated CRP levels suggest an increased risk of coronary heart disease on women with PCOS, although this risk has not yet been scientifically established.
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