Polycystic Ovarian Syndrome
by Loren Wissner Greene, M.D.

In 1921, Archard and Thiers described what they called the "diabetes of bearded women". This related to the more severe form of what was later defined as polycystic ovarian syndrome (PCOS). In 1935, Stein and Leventhal described a classic triad in seven patients: they noted amenorrhea (absent menses) or oligomenorrhea (few menses), along with hirsutism (excess hair) and infertility.

Polycystic ovary syndrome is a syndrome, not a disease, because it may be due to a number of different diseases that have a similar clinical appearance. Also, there is probably no one symptom that defines polycystic ovary syndrome, except anovulation or lack of ovulation during menstrual cycles. About 52% of women with PCOS have some evidence of excess male hormones such as excess body hair or hirsutism. About 45% have some irregularity of the menstrual cycle.

There is no one good biochemical test for PCOS. Some of the findings include increased free testosterone, decreased binding protein for sex hormones, increased ratio of LH:FSH (these are two pituitary hormones that control ovulation).

Ovarian ultrasound may show the classic string of pearls appearance of the little cysts on the periphery of the ovaries, but many normal women have this finding on ultrasound and also some women with PCOS do not have this ultrasound picture.

Acanthosis nigricans (a dark pigmentation of the skin of the back of the neck, under the breasts, in the groin area) is often associated with insulin resistance. This means that high levels of insulin from the pancreas are needed to control the blood sugar level.

For many years, therapies for PCOS have included drugs to control the symptoms, such as birth control pills for irregular menses, spironolactone (Aldactone) for excess hair, and fertility drugs to induce ovulation. Since many women with PCOS have insulin resistance, some of the new drug therapies that are proposed for PCOS have included drugs called insulin sensitizers, or drugs to decrease insulin resistance. These medications have included metformin (Glucophage) and the thiazolidinediones such as Rezulin, Avandia and Actos. Other drugs that have been tried include Octreotide and Dyazoxide.

Of concern is that women with PCOS may also suffer from chronic health consequences including hypertension, diabetes, increased risk of breast and uterine cancer, increased triglycerides, obesity and increased risk of heart disease.

Loren Wissner Greene, M.D. is Clinical Associate Professor of Medicine at New York University School of Medicine. Dr. Greene spoke at AIA's 1999 symposium on PCOS on the topic of "Insulin Resistance, Glucose Intolerance and Diabetes: Treating the Problem, Not Just the Symptoms.". She is the co-author of The Unofficial Guide to Living With Diabetes which was published in 1999. She recently appeared on "Lifetime Live," on the Lifetime Network to discuss PCOS.