Adolescence and young adulthood can be a very difficult time for young women as they deal with the challenges of physical and emotional changes.  During puberty their body begins to change rapidly and dramatically in response to the maturation of their hormonal system.  During this transition a girl’s body transforms from one of a child to that of a woman.  It is also during this time that social pressure on girls increases.  The desire to be attractive, popular, fit in, etc is immense during the teen years.  Anyone who has raised a teenage daughter knows what a difficult time this is for everyone; there are no small problems for a teenage girl.  Adolescence is difficult enough when everything proceeds normally with pubertal maturation but is infinitely more challenging when it does not.

Polycystic Ovarian Syndrome (PCO) is a very common condition in young women.  The most common physical changes associated with it are obesity, acne, and excessive hair growth.  It can be easily understood how a young girl with these physical symptoms could have a negative self image. This is especially true in a society that inflates the value of physical beauty.  Another very common symptom is infrequent menstrual bleeding (oligomenorrhea).  Young women with PCO often have problems with fertility because they do not ovulate on a regular basis.  PCO also adversely affects a woman’s health later in life.  The risk for developing uterine cancer, heart disease, diabetes mellitus, hypertension, and stroke is greatly increased.  Because of the potential physical, emotional, and health impact of PCO it is very important to recognize it and address it as early as possible.

What is PCO?  To understand PCO one must first understand what happens during the normal menstrual cycle.  The timing and sequence of hormone secretion is a very delicate balance in the release of hormones from the brain, pituitary gland, and the ovaries.  Gonadotropin Releasing Hormone (GNRH) is a hormone released from the brain that causes the release of Follicle Stimulating Hormone (FSH) in the pituitary gland.  FSH stimulates the ovary causing one follicle (egg) to begin to mature. During this time, estrogen secretion by the ovary begins to increase.  Estrogen is formed from the conversion of testosterone under the influence of specific enzymes.  Estrogen stimulates the lining of the uterus to grow in anticipation of pregnancy.  At mid cycle, the high estrogen level stimulates the release of Luteinizing Hormone (LH) from the pituitary gland resulting in ovulation (release of the mature egg). After ovulation, the ovary begins producing a progesterone hormone in addition to estrogen.  The progesterone causes the lining of the uterus to mature to be receptive to a possible pregnancy.  If pregnancy does not occur, the estrogen and progesterone levels drop resulting in menstrual bleeding. The cycle then repeats itself.

In PCO this delicate cycle is disrupted. Women with PCO are thought to have insensitivity to insulin.  Insulin is produced by the pancreas and is required to maintain the body’s blood sugar at the appropriate level.  Because of this insulin insensitivity women with PCO produce higher levels of estrogen to balance their blood sugar.  It is thought that the high level of insulin interferes with and disrupts the balanced release of the reproductive hormones.  The excessive insulin prevents the normal conversion of testosterone to estrogen in the ovary resulting in higher levels of this male hormone.  The high level of testosterone prevents the normal maturation of a single ovarian follicle or egg.  This results in the ovaries developing many small cysts (polycystic ovaries) which are seen on ultrasound. This also inhibits ovulation which prevents the production of progesterone. Without cyclic progesterone production infrequent menstrual bleeding occurs; also without ovulation infertility results and the risk for uterine cancer increases.  The elevated testosterone level, in addition, causes acne and abnormal hair growth on the face, chest, and abdomen. The high insulin levels and testosterone levels also contributes to obesity by enhancing appetite and encouraging the storage of fat by the body. This is what makes dieting so ineffective and frustrating for women with this condition; they are fighting their own body.

There are many young women suffering from this condition but there is good news; treatment is very effective.  The sooner that treatment begins the easier it is to reverse the changes that PCO causes.  I have had patients experience dramatic results from treatment in terms of weight loss and improvement in other symptoms associated with PCO.  For treatment to be effective however it is important that young girls and women with this condition understand what is happening within their body and are committed to long term lifestyle changes.  Click here for the blog concerning evaluation and treatment

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