PCOS and PCO-Like Syndrome
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive aged women. In premenopausal women, polycystic ovarian syndrome (PCOS) affects 5% to 10% of women of reproductive age. About 30% of women have some of the characteristics of the syndrome, and may be best described as PCO-Like Syndrome because they do not have the full PCOS set of signs and symptoms.
Women with PCOS and PCO-Like syndrome often have additional problems such dysfunctional uterine bleeding and infertility due to the anovulation commonly observed in PCOS. PMS or PMDD are more common in women with PCOS and PCO-Like syndrome. However, this does not mean that every woman with PMS or PMDD has PCOS and PCO-Like syndrome.
PCOS, PCO-Like syndrome and other androgen excess conditions in women primarily involve androgen excess and often include low progesterone. These condition very often can also include low estrogen function and/or hypothyroidism, which can both affect blood sugar levels and increase the risk of developing insulin resistance and type 2 diabetes.
While obesity and infertility are the dysfunctions typically focused on in women with PCOS, recognizing the additional dysfunctions, and addressing the underlying metabolic imbalances, is the key to restoring optimal health and quality of life, and correcting the complex pathophysiology of androgen excess. These women are at great risk for insulin resistance, diabetes, dyslipidemia, cancers and cardiovascular disease. (1) In addition, many suffer with increased discomforts due to a predisposition towards inflammation, and with psychiatric distress due to a higher risk for aggressive and depressive mood disorders.
To make matters more complicated, there is a more nascent form of PCOS described as PCO-like syndrome that has been observed at a relatively young age in girls undergoing precocious adrenarche. (2)
Androgen excess may additionally affect women of child bearing age by precipitating and increased risk of preeclampsia. In addition, the significant increase in androgen concentrations during pregnancy in PCOS women could provide a potential source of androgen excess for the fetus.(3)
Additional Imbalances Associated with Androgen Excess in Women.
In addition to infertility and obesity, the variant presentation of androgen excess in women typically present with twelve additional dysfunctions, which are caused by the collective actions of various metabolic imbalances.
1. Acne: Acne, with inflammation of the pilo-sebaceous follicle may be one of the symptoms of androgen excess in women which may be observed from puberty through menopause.(4,5,6)
2. Aggression: Significant positive correlations were seen between serum testosterone concentrations and the tests scores for verbal aggression and anger.(7) Elevated testosterone levels are significantly related to moods such as anger and tension.(8) Even a single dosage of testosterone (0.5 mg) induced an inclination toward aggression in healthy young women.(9) Testosterone concentrations also correlated with anger prepartum & postpartum.(10)
3. Alopecia: Androgenic alopecia in women may be related to both androgen excess and higher levels of 5-alpha reductase and androgen receptors in some hair follicles.(11,12) Sustained microscopic follicular inflammation with connective tissue remodeling, eventually resulting in permanent hair loss, is considered a possible cofactor in androgen alopecia.(13)
4. Cancer Risk: There are increased endometrial cancer risks among pre- and postmenopausal women who have elevated plasma androstenedione and testosterone. Chronic hyperinsulinemia, common in women with androgen excess, is also a risk factor for endometrial cancer.(14,15)
5. Hirsutism: Over 50% of women with even minimal unwanted hair growth may have androgen excessive disorders and should have an evaluation of their hormones.(16)
6. Hyperlipidemia: Women with androgen excess are at a higher than normal risk for hyperlipidemia especially when accompanied by obesity.(17,18) Women with PCOS typically have increased triglyceride levels, decreased total HDL and HDL2 levels, and increased total cholesterol and fasting LDL levels.(19)
7. Hypoprogestinemia: The frequent observation of low progesterone levels in studies of PCOS indicate that there is a frequent need to support the ability of the body to make endogenous progesterone.(20,21,22,23)
8. Hypertension: Androgen excess in women results in increased risk for hypertension & heart disease.(24)
9. Hypothyroidism: Hypothyroidism has often been associated with PCOS, though it does not occur in all cases. Hypothyroidism (often autoimmune hypothyroidism) can either initiate, or maintain or worsen the syndrome. Correction of hypothyroidism, if present, would therefore form an important aspect in the management of PCOS.(25,26)
10. Inflammation: Some women with androgen excess have a genetic predisposition towards elevated inflammation, which may further exacerbate the metabolic processes leading to the androgen excess disorder.(27)
11. Insulin Resistance: Insulin resistance is also a common finding in women with androgen excess, as is the compensatory hyperinsulinemia, and increased risk of type 2 diabetes mellitus.(28,29)
12. Oxidative Stress: There is both an increase in oxidative stress and a decrease in antioxidant status in androgen excess women with PCOS. This increased oxidative stress and decreased antioxidant capacity is related to central obesity, age, blood pressure, serum glucose, insulin and triglyceride levels and insulin resistance. This increased oxidative stress may contribute to the increased risk of cardiovascular disease in women with PCOS.(30,31,32)
13. Preeclampsia: An association has been noted between preeclampsia and androgen excess. A history of preeclampsia appears to be associated with elevated levels of testosterone based on a study comparing twenty-two women with prior preeclampsia and 22 control women matched by age and body mass index.(33)
Controlling Androgen Excess Disorders
Pharmacological interventions aimed at controlling the dangers of androgen excess in women include various agents such as oral contraceptives(34), peripheral androgen blockade (spironolactone, flutamide, cyproterone acetate, or finasteride)(35,36), insulin-sensitizing agents (metformin, rosiglitazone).(37,38) and antiandrogen (bicalutamide for treatment of hirsutism)(39).
Natural interventions for PCOS and PCO-like syndrome and other androgen excess disorders in women include diet, lifestyle, and nutrients and hormone health formulation that address specific metabolic imbalances often seen in woman with PCOS and PCO-like syndrome. Of interest, many of these imbalances are also evidenced in androgen excess Menopause Types®, seen in perimenopause, menopause & postmenopause women. So there is evidence that androgen excess continues even after menopause.
How to address the Metabolic Imbalances of PCOS, PCO-like Syndrome, & Other Androgen Excess Conditions in Women:
- Decrease oxidative stress with antioxidant rich multi-vitamin/mineral formulation.
- Decrease inflammation and improve cell membrane response to hormones with an essential fatty formulation that has a high EPA:DHA ratio. Also consider systemic enzyme therapy, such as Wobenzym PS.
- Decrease androgen function and affects of androgens with a phytotherapeutic anti-androgen formulation that also addresses inflammation, insulin resistance and other effects of androgen excess.
- Increase progesterone production and function with a phytotherapeutic formulation that improves the function of progesterone producing tissue, and the function of tissues that respond to progesterone.
- Improve the function of insulin producing cells in the pancreas, and the function of cells that respond to insulin, so as to decrease the insulin resistance, by using a phytotherapeutic formulation to improve insulin and glucose function.
- Improve the function of thyroid producing cells within the thyroid, and the function of cells throughout the body which respond to thyroid, by using a phytotherapeutic formulation to improve thyroid function.
By addressing oxidative stress, inflammation and membrane health at the cellular level, androgen excess, and the production and function of progesterone, insulin and thyroid hormones, we are able to restore optimal function, and improve quality of life in women with androgen excess disorders.
For more information on natural approaches to PCOS and PCO-like syndrome and other androgen excess disorders in women, see the Polycystic Ovary Syndrome Protocol.
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