Polycystic Ovarian Syndrome (PCOS)
PCOS is thought to be the most common endocrine disorder in reproductive age women, affecting about 5 – 12% of that population.
It is a complex syndrome whose causes are still not well understood. It results in dysregulation of normal ovarian hormone production and overproduction of the hormone testosterone.
It is characterized by either menstrual dysfunction and the presence of signs of increased levels of male hormones (increased terminal hair growth on the face, chest and other parts of the body, acne or male pattern hair loss) or increased male hormone levels in the blood. Menstrual dysfunction can present as either the absence of menses or irregular menses. It is not necessary to have “cysts” in the ovaries to be diagnosed with PCOS. Up to 17% of women without any hormonal issues can have ovarian cysts.
40 – 85% of women with PCOS are overweight or obese. Insulin resistance is present in both, lean and obese, women with PCOS. Because of this, they are at higher risk to develop diabetes mellitus type 2, fatty liver, sleep apnea, mood and eating disorders. There is also a concern that women with PCOS have an increased risk for cardiovascular disease, but data is inconclusive currently.
Women with PCOS are at risk for infertility and often struggle with cosmetic issues such as increased hair growth, acne or hair loss.
The diagnosis of PCOS can be delayed for many years. Irregular periods, in many cases, start in puberty. If PCOS is not recognized, many girls are started on birth control pills that delays the diagnosis for years.
When PCOS is suspected, it is important to see an Endocrinologist and undergo a full hormonal evaluation. Several other medical conditions, such as thyroid disease, cortisol overproduction and adrenal androgen overproduction can mimic the symptoms of PCOS and need to be excluded before treatment for PCOS can be started.
After the evaluation is done and diagnosis of PCOS is confirmed, we discuss all treatment goals. They can vary from patient to patient. Some women may focus on fertility induction, some maybe troubled by hair growth or acne, some may need significant weight loss. Due to the pathophysiology of the syndrome and the prevalence of insulin resistance, the most important first step in most of the cases is weight loss via lifestyle changes. There are also several medications such as Metformin, Spironolactone and birth control pills that we use to help with insulin resistance, acne/hair growth and menstrual dysfunction.
Hypogonadism is a disease characterized by a low testosterone level in men.
Testosterone is produced in the testicular tissue in response to hormonal signaling from the pituitary gland. The reason for the low testosterone production could be that patient’s testicular tissue is not able to produce testosterone (primary hypogonadism) or that there is a problem with regulatory hormones (secondary hypogonadism).
Symptoms of low testosterone vary from person to person and also depend on the age when the deficiency develops. More specific symptoms are: decreased sexual desire (libido), infertility, erectile dysfunction, decreased hair growth, increased breast tissue and decrease in muscle mass. Less specific symptoms are: fatigue, depression, decreased stamina and weight gain.
Primary hypogonadism can be caused by genetic diseases, traumas, infections, tumors and medications.
Secondary hypogonadism can be caused by pituitary tumors, genetic disorders, medications, sleep apnea, obesity, head trauma, radiation or it can be idiopathic (unexplained).
It is very important to undergo a full evaluation by a skilled endocrinologist to establish the underlying cause of hypogonadism before initiating therapy.