PCOS, Polycystic Ovary Syndrome is a common cause for fertility problems among women. PCOS affects between 5%-10% of all women of reproductive age. It is characterized by an inconsistent menstrual cycle, hormonal imbalances which can cause chronic anovulation, oligomenorrhea, and hyperandrogenism. Most women suffering from PCOS, will have enlarged ovaries, with a large number of cysts on the perimeters of the ovaries. These cysts are actually immature follicles, that, due to the hormonal imbalance, have arrested.
What causes PCOS?
It is not entirely clear what causes a women to develop PCOS. Most cases point to a number of factors, both genetic and acquired. Recently, studies have shown that the overwhelming cause for PCOS is a peripheral resistence to insulin leading to an increased release of insulin (hyperinsulinaemia)
Peripheral resistance to insulin is a condition where the insulin targeted tissues don't react well to the insulin. As a result, the pancreas release larger amounts of insulin to get rid of the excess sugar in the body and prevent the development of diabetes. Despite the resistence to insulin shown by the fat and muscle tissue, the ovaries remain relatively senstitive to insulin and a state of hyperinsulinaemia causes the ovaries to produce a larger amount of male hormones. The insulin also affects the liver and causes a decrease in the production of SHBG, a protein which attaches testosterone. As a result, the active testosterone levels in the body increases.
Resistence to insulin can, in part, be genetic, but obesity and lack of physical activty make the condition worse. Two-thirds of women with PCOS suffer from obesity.
Resistence to insulin and abdominal obesity also influence the way fat is broken up. There is an increase in free fatty acids in the blood stream which causes an increase in the production of triglycerides in the liver. The changes in the liver cause a decrease in the HDL levels ('good' cholesterol) and an increase in LDL levels ('bad' cholesterol).
PCOS is part of the syndrome X spectrum and women who are diagnosed with PCOS have four times the risk of high blood pressure and seven times the risk of type II diabetes (increasing the risk of cardiovascular disease).
How to Treat PCOS?
PCOS treatment varies from patient to patient, depending on the symptoms she exhibits.
|irregular menstrual cycle
||birth control pills|
|infertility due to anovulation
||cyproterone acetate and ethinylestradiol|
|irregular cycle; infertility
|obesity; abdominal obesity;
|medications to lower resistence to insulin,|
such as metformin
Will Changing Your Eating Habits Help Your PCOS?
The treatments listed above treat the symptoms, not the probelm. Recently, Hadassah Ein Kerem has opened a clinic to treat women with PCOS. The treatment approach is multidisciplinary, and the team consists of doctors from the Department of Obstetrics and Gynecology, The Department of Diet and Nutrition and the Diabetes Clinic. For the past few years we've treated women through a special program which combines physical exercise and dieting. This plan was created by dieticians Penina Stein and Dorit Adler. The goal of the treatment plan is to get rid of the negative effects of hyperinsulinaemia and resistence to insulin and improve the patient's metabolic, endocrine and fertility profile. The biggest advantage to this approach is the fact that it treats the root of the problem and does not use medication or surgerical methods.
Losing weight has been shown to reduce symptoms and increase fertility by 40%. The diet we offer has a number of different aspects. Both overweight and non-overweight women wil benefit from a low-carbohydrate diet. The diet prefers whole grains and complex carbohydrates. As a result, there is a decrease in the level of insulin release. The diet tackles the initial resistenc to the insulin. Additionally, it will help overweight wome lose weight and cause a decrease in the secondary insulin resistence. This is not a starvation diet, rather it is a lifestyle change aimed at minimizing the long-term health risks.