An emerging
body of research has linked a common but misunderstood gynecological disorder
among women with one of the most rapidly growing illnesses in the United
States -- diabetes.
Polycystic ovarian
syndrome, or PCOS, affects up to 10 percent of American women of childbearing
age. It occurs when the ovaries manufacture too much testosterone, the
so-called male hormone, rendering them unable to produce eggs.
"There's no
question about the association," Dr. Geoffrey Redmond, an endocrinologist
specializing in women's health and founder of the Hormone Center in New
York City, told United Press International.
"One of the
problems is that people haven't put the pieces together," Redmond said.
"If you have PCOS you probably have subtle insulin resistance," the key
characteristic of diabetes. "The focus has been on infertility and menstrual
changes" with regards to PCOS, he explained, "but now health care professionals
need to recognize anybody who has clear-cut signs needs to be screened
for diabetes."
Although PCOS
typically is perceived as a gynecological disorder -- because it impairs
fertility and can cause irregular periods or no periods at all -- a growing
body of evidence suggests PCOS is more of a disorder of the endocrine system
with gynecological consequences.
The ovaries
are part of the endocrine system, which regulates the body's hormones,
including the hormones that govern menstruation as well as production of
insulin -- another hormone critical to
metabolism.
Redmond said
PCOS appears to be genetic, particularly among women with family histories
of diabetes. Although dietary restrictions, such as cutting down on carbohydrates,
and exercise can influence the body's hormone levels and even improve insulin
sensitivity, PCOS is not curable. However, it can be easily managed with
oral contraceptives or other hormone-based medications.
Many scientists
and doctors now think PCOS actually is a diabetes precursor.
For example,
estimates from Northwestern University in Evanston, Ill. -- which last
November received a $5 million grant from the National Institutes of Health
to study PCOS and diabetes -- indicate PCOS patients face a risk of diabetes
seven times higher than women who do not have the condition. Diabetes can
lead to heart disease and kidney and eye problems.
PCOS symptoms
include acne, obesity and growth of facial hair, though scientists have
said women without these symptoms still can have the condition. Irregular
periods also are a PCOS trait, though women's health experts caution that
not every woman with an irregular period has PCOS.
One medication
receiving attention among those studying PCOS is Metformin, an anti-diabetic
drug. For example, at the Pennsylvania State Hershey Medical Center, researchers
are comparing whether Metformin can help PCOS patients become pregnant
by helping to treat their hormone imbalances.
The research
will compare the women with other PCOS patients who either are taking just
Clomid, an ovulation inducer that does not treat endocrine disorders, a
combination of Metformin and Clomid, or a placebo. Results will not be
available for several months.
"It's a difficult
condition to study because there is a wide spectrum (of conditions) that
looks like polycystic ovarian syndrome," Dr. Ann Brown, an endocrinologist
and director of the Academic Program in Women's Health at Duke University
Medical Center in Durham, N.C., told UPI.
"Plenty of people
have irregular periods, but they don't have the problems with androgens
(testosterone) and that's not PCOS," Brown said, adding that research has
found 40 percent of obese women with PCOS have impaired glucose tolerance,
a marker signaling diabetes, and these women have the full onset of diabetes
by age 40.
Although obesity
can affect hormone balances, thin women with PCOS are just as likely to
develop diabetes because of their bodies' inability to process hormones
properly, which can lead to insulin resistance, Brown explained. "That's
something that's found in lean women (with PCOS) as well as overweight
women."
In addition,
Brown said, "All women with PCOS should do their own research and try to
find information about insulin resistance and the risk factors for it."
--
Copyright 2003 by United
Press International.
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