Oral contraceptives (CO, pill) are usually prescribed by the gynecologist to regulate the menstrual cycle of the patient with PCOS. This standard therapy is by no means the best. There is a more logical alternative that actually works better, namely bioidentical progesterone, which is a far better alternative to birth control pills. But we will see later why. PCOS is the end result of an absence of ovulation, (resulting in absent progesterone production) over a long period of time (several years), which results in a vicious cycle that perpetuates anovulation, causing the ovary to increase testosterone production. Insulin-resistant diabetes and obesity exacerbate the problem.
As might be expected, PCOS is a major cause of infertility.
PCOS was rare when it was first described in 1935 by Stein and Leventhal, and it is nowadays quite common. Why the increase in incidence? Some believe that endocrine disrupting chemicals in the environment are to blame. Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders of women of reproductive age and can affect 10% of women and accounts for 30% of gynecological visits. PCOS is the most frequent cause of infertility.
Characteristic for PCOS are anovulatory cycles (without ovulation) resulting in irregular, long cycles or prolonged bleeding and elevated androgen (male hormone) levels with hirsutism, acne, hair loss, infertility. Hirsutism is excessive hair growth on the face and body. A hair above the upper lips is not hirsutism and is common. True hirsutism is characterized by excessive hair on the chin, cheeks, belly, and around the nipples.
Basically, PCOS is a problem of absent ovulation resulting in overproduction of androgens such as testosterone and other androgens. Androgens are male sex hormones such as testosterone, androstendione, and DHEA. They are necessary for our mood, libido, healthy bones. If they are in excess they can cause acne, hair loss, hirsutism.
Clinical signs and symptoms of PCOS:
1) Irregularity of menstrual cycle: oligomenorrhea or amenorrhea (no menstruation), anovulation (no ovulation)
2) Excess androgen (hirsutism, androgenetic alopecia, acne)
3) Weight gain, obesity
4) Insulin resistance (pre-diabetes),
5) Infertility and abortions,
6) Mood disorders
7) Multiple small ovarian cysts on ultrasonography,
8) Acanthosis Nigrans (appearance of dark patches of skin with a thick, velvety texture especially at the nape of the neck and under the arms), indicative of hyperinsulinemia.
Definition of ovulation: This is the time when an egg exits the follicle of the ovary and begins the long journey down the fallopian tube to the uterine cavity where it can be fertilized to form a new embryo. Ovulation causes a high production of progesterone by the corpus luteum in the ovary. Menstrual cycles are regular.
Definition of Anovulation: The egg does not come out and there is no progesterone production. Cycles are irregular or absent.
