Ovarian Syndrome Is Under-Diagnosed

Polycystic ovarian syndrome, affecting at least 5 million American women, has the rather startling symptoms of excessive facial hair, acne, high male hormone levels, irregular periods, infertility, significant weight gain and a propensity toward diabetes. These factors notwithstanding, it's believed to be vastly under-diagnosed.It's only recently that endocrinologists have pieced together the links between the seemingly obvious gynecological symptoms such as infertility and ovaries full of tiny cysts (unreleased egg follicles), and the more complex and widespread hormonal disruption.

The syndrome, once called "diabetes of the bearded woman," is now viewed as a serious hormonal imbalance triggered in part by faulty genes for sex hormones and other genes involved in a serious condition called insulin resistance, which often leads to diabetes.

Women with PCOS have seven times the normal risk of diabetes, as well as a higher risk of gestational diabetes (which starts while a woman is pregnant and can later become standard adult onset diabetes). Preliminary research also suggests that women with the syndrome have a 50% increased risk of heart disease and stroke as well.

Essentially, PCOS is a "vicious cycle," though it's unclear which biochemical glitches come first, says Dr. Stanley Korenmann, an endocrinologist at the UCLA School of Medicine. Once the cycle gets started, the hallmark is insulin resistance, which can also be triggered or exacerbated by obesity and inactivity.

In insulin resistance, the pancreas goes into overdrive to make more and more insulin--a frantic attempt to get enough sugar into cells, notes Dr. Edward Horton, director of clinical research at the Joslin Diabetes Center in Boston.

Even if a person is just insulin-resistant and never develops outright diabetes, the insulin resistance itself is linked to "a whole metabolic cluster" of problems, Horton notes. This cluster, dubbed PCOS syndrome, is characterized by some of the well-known risk factors for heart disease: elevated triglycerides (fatty acids), low HDL ("good" cholesterol), high blood pressure, changes in blood clotting patterns and a buildup of fatty plaques in arteries.

And that's just the beginning. In the ovary, excess insulin messes up the normal process by which an aromatase enzyme converts male hormones such as testosterone into estrogen. The result for many women with PCOS is unusually high levels of testosterone in the blood. The excess testosterone, in turn, causes women to sprout hair in a male pattern (on the face, chest and abdomen), and to get severe acne (which is driven by breakdown products of testosterone).