PCOS part 2

This is part 2 in our series on PCOS. Here's a link for Part 1.

Most women with PCOS see a health care provider for a few common reasons. Either they aren't having periods, their periods come infrequently, or they have heavy bleeding.

This is what PCOS looks like with an ultrasound

Poly = Many

Notice that there are many small black areas within the ovary.
Each of these black appearing areas are cysts that are filled with fluid.
It's not unusual to see 10 - 12 cysts on each side.
Each month more cysts begin as others regress.
Most women do not feel these cysts.
These cysts are usually small and rarely burst causing pain.

Is there a cause for PCOS?

Can it be prevented?

Can PCOS ever go away on it's own?

Review
In order to understand what happens with PCOS, let's briefly review what happens in a typical menstrual cycle.

• When a woman starts her period, the ovary is also active. Several follicles, which are where the eggs develop begin to grow under the influence of FSH (follicle stimulating hormone).
• These follicles produce the hormone Estrogen.
• One of the follicles really grows fast, producing the most Estrogen and it becomes known as the dominant follicle, which will ultimately be the one that releases the egg.
• This high level of Estrogen triggers the release of LH (luteinizing hormone).
• About midway through the cycle, there is a surge in LH which causes the egg to be released about 24-36 hours later.

• Having only 1 dominant follicle prevents multiple eggs from being released.
• The follicle is now known as the corpus luteum and it produces Progesterone.
• As the corpus luteum decreases in size, the levels of Estrogen and Progesterone also decrease dramatically.
• The drop in hormone levels trigger a menstrual period and the cycle begins again.

The Quickest explanation

FSH ––> Estrogen ––> LH ––> Ovulation ––>Progesterone

What happens with PCOS?

For women with PCOS, there are complex biochemical imbalances within the ovary that:
• Prevent her ovary from making one dominant follicle with the high level of Estrogen.
• She doesn't have a LH surge because everything is out of balance, so her LH levels become higher than the FSH levels.
• She has relatively high levels of Estrogen all the time, without a balance in Progesterone.
– This can stimulate the uterus to grow an unstable lining, which may lead to heavy and prolonged bleeding.
• Some of her hormones are converted to more androgenic hormones, (DHEA, DHEAS, and Testosterone).
• This conversion of hormones into androgenic ones leads to more hair growth and acne.
• The imbalance in hormones may cause or may be caused by an insulin resistance, which makes her more at risk for diabetes.

There's more coming on PCOS next week, so please check back.