Hey everyone! In this lesson, I'm going to be talking to you guys about polycystic
ovary syndrome, what it is, what are some of the causes of the syndrome, what are
some diseases that are highly associated with polycystic ovary syndrome, and then
finally, I'm going to talk to you guys about some treatment methods to help
alleviate some symptoms of polycystic ovary syndrome. So to begin, what is
polycystic ovary syndrome? Well as the name suggests, it involves a polycystic
ovaries. So ovaries with multiple cysts, and you can actually see this on an
ultrasound of a patient's ovaries. You can actually see these like black little
holes, that look like black hole - they're actually cysts within the ovary.
So what are some of the characteristics, or what are some of the symptoms of the
syndrome? Well one of the main ones is menstrual irregularity, and this
irregularity can happen as soon as the patient actually enters
puberty. So a lot of times, these patients will have a delayed onset of menarche,
or a delayed onset of their first period. So they have their first period a little
bit later or a little bit older than average. They also can have oligomenorrhea,
which is having less than nine menstrual periods per year. So
they have less menstrual periods, and during their adulthood, sometimes
they can even have amenorrhea, which is no menstrual periods at all - so they
just go through their life without having any periods
whatsoever. But interestingly enough, they can have a
regularization after the age of 40 and what I mean by that is they often have a
lot of these symptoms such as oligomenorrhea and/or amenorrhea, but these can
actually kind of normalize after the age of 40. So after 40 years of age
they can have more regular periods. And another main
characteristic of polycystic ovary syndrome is hyperandrogenism, and this is
kind of one of the big ones (kind of one of the big characteristics) that cause a
lot of the visible symptoms that you see with these patients.
The first one is acne - acne is very common in patients with polycystic ovary
syndrome because of the high levels of androgens. Another one is hirsutism - now
hirsutism is actually just a growth of hair, so these patients oftentimes will
grow or have more terminal hair growth so you get this kind of darker hair
growing particularly on their face or on other parts of their body. And
another one is actually hair loss - so it's almost a kind of a male
pattern hair loss due to high levels of androgens. Now what is the incidence of
this syndrome. Well the incidence is quite alarming. It's actually one of the
most common endocrine operatives in women and typically about 6.5
to 8% of women are affected with this syndrome. So what are
some of the medical conditions that are highly associated with the polycystic
ovary syndrome? Well first off approximately 40 to
85% of women with polycystic ovary syndrome are overweight
or obese so there's oftentimes a connection
between BMI and polycystic ovary syndrome so this leads us to a list of
conditions that are associated with overweight and obesity itself, such as
type 2 diabetes. So women with PCOS typically have an
increased risk of type 2 diabetes again this follows in line with glucose
intolerance and insulin resistance. They are also at risk for dyslipidemia -- which again
follows insulin resistance and because they are at a higher risk of being
overweight or obese, they have a higher risk of having obstructive sleep apnea (OSA).
Another condition that's associated with insulin resistance in obesity is
non-alcoholic fatty liver disease and women with polycystic ovary syndrome
have a higher incidence of non-alcoholic fatty liver disease, and you can see here
that on the left that's a normal liver on the left, but the one on the right is a
fatty liver, and you can see there's a lot of lipid droplets within the liver.
Again, a lot of these women also suffer from depression and
anxiety. And because, as I mentioned before, they have menstrual irregularity
they can often have anovulatory infertility, so if they have amenorrhea,
typically they have something known as anovulatory infertility, so they actually
don't ovulate properly and they become infertile as a result.
Another one is endometrial hyperplasia - now endometrial hyperplasia is just
an overgrowth or excessive growth of the endometrium within the uterus and now
this also leads to an increased risk of endometrial cancer because of the
hyperplasia. Now moving on to some of the etiology and pathogenesis of polycystic
ovary syndrome - to begin the etiology is unclear, it's hasn't really been
elucidated at present; however, although the etiology is unclear it is known that
certain individuals are at a higher risk of polycystic ovary syndrome. Individuals
again who are obese are typically at higher risk of having polycystic
ovary syndrome (association, not necessarily causation). As I mentioned before those that are insulin resistant are at
a higher risk of polycystic ovary syndrome. Type 1 and type 2 gestational
diabetic moms are also at a higher risk for polycystic ovary syndrome. Another
one is premature adrenarche. Now adrenarche is the start or the
commencement of the adrenal glands to produce
androgens. So during childhood people typically produce some amounts of
androgens very low amounts, but individuals
that have a premature adrenarche seem to be at a higher risk of
polycystic ovary syndrome. Also people with first-degree relatives that have
polycystic ovary syndrome are at a higher risk of getting it themselves and
now this lends credence to possible genetic influences. So a lot of these may
be the cause of polycystic ovary syndrome or maybe the result - it's still
not known for sure, but again the first-degree relatives seem to
show that there are some genetic influences with regards to polycystic
ovary syndrome. And that kind of leads into the pathogenesis, and indeed there
have been multiple studies showing that there is some genetic trait involved and
there does appear to be environmental factors that influence the onset or the
phenotype of the polycystic ovary syndrome. Some studies have shown that
perhaps there are certain genes on chromosome 2 or chromosome 9 - here's a
handful of different genes or proteins that may be involved in polycystic
ovary syndrome. One is luteinizing hormone receptor. Another one is human
chorionic gonadotropin receptor. The other one is called FATA. Another one is
androgen receptor, another one is sex hormone binding globulin. Another one is
DENN/MADD domain-containing protein 1a and the last one again is insulin. So there
still could be some issue with insulin or insulin signaling that's predisposing
individuals for polycystic ovary syndrome. And in fact as most of
the associated risks involved with polycystic ovary syndrome
show is that a lot of them seem have insulin being involved such as
insulin resistance and obesity and different types of diabetes. And another
important thing is that insulin is actually an activator of
thecal cell production of androgens, so thecal cells are the cells that actually
surround a developing follicle within the ovary and insulin actually
stimulates the thecal cells to release androgens. So again, that's another
possible mechanism by which polycystic ovary syndrome causes hyperandrogenism.
So now that we know some of the symptoms and some of the risks and some of the
diseases associated with polycystic ovary syndrome, what are some of the
treatments we can give to these patients? Well one of the first things we like to
focus on are some lifestyle changes, because as I mentioned before
a large amount of patients with PCOS are overweight or obese, so
we like to try to change some of those parameters. So we like to get them on a
diet or exercise just to try to reduce their BMI try to
reduce their weight and to try to normalize their insulin, insulin
tolerance, and glucose tolerance. There's also some pharmacologic treatments as
well and this is particularly important for stabilizing the menstrual
irregularity. So some of these include the following: combined estrogen progestin
contraceptives are very effective, oral contraceptives can treat not only
the menstrual irregularity but also hyperandrogenism something else that's
important is medroxyprogesterone acetate and you can
give this to patients and this is very important for treating and for
protecting these patients against any endometrial cancer as I mentioned before.
This may not treat the hyperandrogenism directly
but it treats or protects the endometrium from any hyperplasia or
cancer. Metformin again is a regulator of insulin signaling and this has been
been shown to help a little bit with with the polycystic ovary syndrome
symptoms. Now for patients that are just not getting the effect that
they want, they're not seeing, you know, the changes that they want maybe they
still have hirsutism or bad acne you can give these patients
antiandrogens, such as spironolactone and finasteride. These two
drugs can act to inhibit androgen influence and treat some of those
hyperandrogenism symptoms such as acne, hirsutism. And another set of
pharmacologic treatment is the gonadotropin releasing hormone agonists that can
help stabilize the mental cycle as well. Anyways guys, that was a brief lesson on
polycystic ovary syndrome. I hope you found it helpful and thank you so much for
watching and have a great day!