If you are reading this, it is because a close relative or friend of yours of has Polycystic Ovary Syndrome (PCOS). This has significant implications for your future health and it is important for you to understand what this all means.
PCOS is the most common hormone problem in women of reproductive age (puberty to menopause). However, the implications and consequences of PCOS extend beyond menopause.
We now recognize that the cause of PCOS is an abnormality in the insulin receptor. This means that the insulin your body produces is not able to work as effectively as it should to keep your blood sugar normal. To overcome this defect, your pancreas has to produce more and more insulin.
The excess insulin affects the way the ovaries function and causes them to produce increased amounts of male hormone. This interferes with normal ovulation and many women with PCOS have very irregular menstrual cycles.
The increased male hormone production also leads to facial hair growth and/or acne.
It is also becoming increasingly apparent that the excess insulin production with the resulting elevated levels of insulin in your bloodstream has significant implications for your overall health and well-being. We now know that these excess insulin levels are a significant risk factor for cardiovascular disease including heart attacks and stroke - even in those people who are not yet diabetic. This whole problem falls under the heading of "Syndrome X". I can talk to you more about it if your wish.
There is rapidly accumulating evidence that these high insulin levels also play a significant role in causing high cholesterol levels and hypertension as well.
We know that women with PCOS are more likely to develop diabetes when pregnant and are also more likely to develop diabetes in later life. Insulin resistance is probably the abnormality that sets the stage for this.
PCOS is an inherited disease and 50% or more of the close relatives of women identified as having PCOS will also have the disease although not all will manifest every symptom.
Men can also inherit the genetic abnormality that in women would lead to PCOS.
Although not everyone who is insulin resistant will ultimately develop diabetes, many do. Furthermore, you do not go from being normal to diabetic in one step. There are intermediate stages where you would not be classified as being officially diabetic but your body is not handling sugar properly and your blood sugars are higher than they ought to be.
As a result of all of this, we strongly urge you to be evaluated for possible insulin resistance. It is a simple blood test - one that our office can easily provide for you. All that is necessary is that you come into the office first thing in the morning - fasting. Nothing to eat or drink from the time you go to bed at night until your blood is drawn in the morning.
We would also encourage any men who are close relatives of our patient to undergo the same testing. This would especially include men who are significantly overweight with elevated cholesterol and hypertension as well.
source: http://www.infertilityphysician.com/...ovulation.html
Saturday, February 1, 2014
Prevalence of Fatty Liver Disease in PCOS Patients
lin Gastroenterol Hepatol. 2007 Apr
Prevalence of nonalcoholic fatty liver disease in women with polycystic ovary syndrome.
Gambarin-Gelwan M, Kinkhabwala SV, Schiano TD, Bodian C, Yeh HC, Futterweit W.
Division of Gastroenterology and Hepatology, Weill Medical College of Cornell University, New York, NY 10021, USA.mag2046@med.cornell.edu
BACKGROUND & AIMS: Insulin resistance has been implicated in the pathogenesis of both nonalcoholic fatty liver disease (NAFLD) and polycystic ovary syndrome (PCOS). We hypothesized that NAFLD would be common in both obese and nonobese women with PCOS. The aim of this study was to estimate the prevalence of and identify associated factors for hepatic steatosis in women with PCOS.
CONCLUSIONS: Fatty liver was identified in 55% of subjects with PCOS, nearly 40% of whom were lean women. High BMI and insulin resistance appeared to be important associated factors. Early recognition of NAFLD in this group of young patients is warranted, and further investigation including liver biopsy might be indicated.
METHODS: This is a retrospective study of 88 consecutive premenopausal women with PCOS. Clinical history, height, weight, and laboratory values were obtained. Fasting measurements of serum glucose and insulin were used to calculate homeostasis model assessment of insulin resistance (HOMA-IR). Abdominal ultrasonography was used to determine the presence and severity of hepatic steatosis.
RESULTS: Of the 88 women (median age, 31.4 years), 48 (55%) had steatosis; 15 (39%) of them were lean women. The presence of steatosis was associated with a greater body mass index (BMI) (P = .005) and HOMA-IR (P = .033), a lower fasting high-density lipoprotein (P = .003), and a greater prevalence of impaired fasting glucose, impaired glucose tolerance, and diabetes mellitus (P = .013). Only 7 (15%) subjects with hepatic steatosis had abnormal liver chemistries.
Prevalence of nonalcoholic fatty liver disease in women with polycystic ovary syndrome.
Gambarin-Gelwan M, Kinkhabwala SV, Schiano TD, Bodian C, Yeh HC, Futterweit W.
Division of Gastroenterology and Hepatology, Weill Medical College of Cornell University, New York, NY 10021, USA.mag2046@med.cornell.edu
BACKGROUND & AIMS: Insulin resistance has been implicated in the pathogenesis of both nonalcoholic fatty liver disease (NAFLD) and polycystic ovary syndrome (PCOS). We hypothesized that NAFLD would be common in both obese and nonobese women with PCOS. The aim of this study was to estimate the prevalence of and identify associated factors for hepatic steatosis in women with PCOS.
CONCLUSIONS: Fatty liver was identified in 55% of subjects with PCOS, nearly 40% of whom were lean women. High BMI and insulin resistance appeared to be important associated factors. Early recognition of NAFLD in this group of young patients is warranted, and further investigation including liver biopsy might be indicated.
METHODS: This is a retrospective study of 88 consecutive premenopausal women with PCOS. Clinical history, height, weight, and laboratory values were obtained. Fasting measurements of serum glucose and insulin were used to calculate homeostasis model assessment of insulin resistance (HOMA-IR). Abdominal ultrasonography was used to determine the presence and severity of hepatic steatosis.
RESULTS: Of the 88 women (median age, 31.4 years), 48 (55%) had steatosis; 15 (39%) of them were lean women. The presence of steatosis was associated with a greater body mass index (BMI) (P = .005) and HOMA-IR (P = .033), a lower fasting high-density lipoprotein (P = .003), and a greater prevalence of impaired fasting glucose, impaired glucose tolerance, and diabetes mellitus (P = .013). Only 7 (15%) subjects with hepatic steatosis had abnormal liver chemistries.
PCOS Treatment in Non- Obese Women
Insulin resistance in non-obese women with PCOS is much less dramatic than that seen in obese women. Metformin is still, however, a very important component of the treatment. This was first demonstrated by Dr. Jean-Patrice Baillargeon5, who found that up to 90% of thin women with PCOS ovulated in the six month after initiating metformin treatment. The direct effect of metformin on steroidogenesis by ovarian tissue seems to account for this effect. It has been shown in in-vitro culture that metformin has a significant inhibitory effect on androgen production by ovarian cells.6 Thin women usually do best with regular metformin 500 mg up to three times per day.
Weight loss is obviously not advised for this group of women, and they must in fact be cautioned about the weight loss often associated with the use of metformin.
While many women with PCOS will respond to metformin, a significant subset will not. These women present a particular challenge. Clomiphene, which is the treatment of choice for normalization of ovulation in obese PCOS women, is difficult to use in thin women. Clomiphene is an anti-estrogen, and the anti-estrogenic properties of clomiphene often result in inadequate endometrial development as documented by mid-cycle ultrasound. We have observed that the use of clomiphene in this particular group of women in associated with an extremely low probability of conception. The use of gonadotropins is also difficult in this group – ovarian hyper-responsivity is typical with the attendant risks of multiple pregnancy and ovarian hyperstimulation.
In 1998 we treated the first of this group of women with ovarian diathermy. Ovarian diathermy, a procedure first described by Gjönnaess7, involves the cauterization of ovarian stromal tissue using unipolar cautery. This procedure differs significantly from other laparoscopic procedures such as ovarian drilling in that diathermy does not involve destruction of any of the cortical part of the ovary. It is rather, the stromal part of the ovary that produces the excess testosterone and androstenedione that result in PCOS and diathermy results in dramatic reductions in levels of both of these hormones8 and normalization of cycles in a significant percentage of patients.
Between 8/98 and 7/03 we have performed 108 ovarian diathermy procedures. (Data under preparation for submission for publication.) Diathermy was performed at the time of laparoscopy. The pelvis was filled with an irrigation solution of lactated Ringer’s with 5,000 units of heparin per liter. The ovary was immobilized using an atraumatic grasping forceps and the Corson needle (Karl Storz Endoscopy- America, Inc. Culver City, CA. cat # 30677CN ) introduced into the ovary at a right angle to the ovarian cortex. The Corson needle has a diameter of only 1mm. The tip of the needle protrudes 10mm beyond the insulation that covers the remainder of the needle. Cautery is performed to a depth of 15mm with a monopolar coagulating current set at 40-W for five seconds at each of three to as many as eight sites. This cauterizes the stroma without affecting the ovarian cortex. Any other pathology encountered such as endometriosis or adhesions was treated and chromotubation was performed.
Of these, 74 women had a Body Mass Index of 25 or less (thereby meeting the definition of thin woman PCOS) and were 38 years of age or younger at the time of the procedure. This if the first reported series of this nature. Of these, 59 patients desired conception and were available for follow-up. They had a mean duration of infertility of 3.7 years and a mean body mass index of 23.9. 49 (83%) of these patients have conceived with a mean time to conception of 4.2 months. Most of these conceptions have occurred without further intervention, although 11 of these women conceived with the subsequent use of clomiphene/FSH for IUI and three conceived through IVF because of male factor issues. None of these women experienced hyperstimulation. There have been no post-operative complications and there have been no cases of ovarian failure.
One of the serious concerns about surgical treatment of PCOS is the risk of adhesion development. This is much more of a concern with procedures that destroy cortical tissue such as ovarian drilling than it is with ovarian diathermy. We have performed 10 repeat procedures, all of these in individuals who conceived following the initial procedure and then had recurrence of their oligo-/anovulatory pattern.
There have been no adhesions in any patient. In another study of 20 repeat procedures8 no adhesions were noted. Many thin women with PCOS do not have elevated androgen levels as usually defined. It has been estimated that as many as 20% of patients with PCOS have normal androgen levels.9 We found this to be true in our patient population and have in fact observed that many of these women were, at one point, very thin and frequently athletic. It has, in fact, been hypothesized that the relative hyperandrogenicity of these young women may account for some of their athletic ability10.
We believe they experience relative hyperandrogenicity at this point. Their androgen levels are not really increased but their estrogen levels may actually be lower than normal owing to the low percent body fat (an important source of estrogen production). The ovaries continue to function, demonstrated by persistent menstrual cycles, in all but a very small percentage of these women. But in the absence of estrogen production from peripheral fat cells, the environment is actually relatively hyperandrogenic.
And it has been demonstrated that even brief exposure to elevated androgen levels can set up a “self-propagating cycle of abnormal follicular growth and function”11. We hypothesize that this relative hyperandrogenism sets the stage – that the pattern of PCOS is set up in these thin women at a young age and this pattern persists into adulthood even in the absence of demonstrably elevated androgen levels at that time.
It has been demonstrated that ovaries from women with PCOS have fewer healthy primordial follicles than do normal ovaries with their growth arrested when they are between 5 and 8 mm in diameter10. This abnormal development is due to the relative excess of the ovarian androgens. And fewer healthy follicles develop in spite of a significantly greater density of follicles per mm3 in PCOS than is seen in normal ovaries.10
These two facts explain why women with PCOS have a much greater risk of ovarian hyperstimulation and lower success rates when undergoing, for example, IVF (In Vitro Fertilization). Correction of insulin status, with medical treatment and/or surgical intervention, is crucial prior to the use of gonadotropins in these women to ensuring safe, successful, and cost-effective procedures, be it simple ovulation induction and insemination or IVF. Ovarian diathermy has been shown to significantly improve pregnancy rates in POCS women undergoing IVF13.
Reduction of ovarian androgen production not only improves ovulation and pregnancy rates, but also reduces spontaneous abortion rates. The high loss rate experienced by women with PCOS is partly due to compromised oocyte quality, but may also be due to the compromised uterine perfusion that occurs as a result of elevated androgen levels12. Correction of androgen status clearly results in a decrease in the spontaneous abortion rate in these individuals.
In conclusion, PCOS is tremendously more treatable than ever before, owing to medical treatment with metformin and surgical treatment with ovarian diathermy. Correction of the underlying insulin abnormalities, particularly in the obese individuals with PCOS is of paramount importance whether or not conception is desired. Decreasing ovarian androgen production allows many women to conceive without further intervention. If further intervention is required, these women will experience a better chance of success with less risk than ever before.
A note about the algorithms: Our experience suggests that, if individuals who have undergone the full gamut of treatment for PCOS still require ovulation induction, the combination of clomiphene and FSH is the most efficacious approach. The anti-estrogenic properties of clomiphene are offset by the estrogenic properties of FSH. Adequate endometrial development can be anticipated without risking the potentially excessive response encountered when using FSH alone.
Click here for an additional (free) PDF Handout on PCOS:
http://www.jarrettfertility.com/PCOS...%20handout.pdf
1. Nestler JE, Stovall D, Akhter N, Iuomo MJ, Jakubowic DJ. Strategies for the use of insulin-sensitizing drugs to treat infertility in women with polycystic ovary syndrome. Fertil Steril 2002;77:209-215.
2. The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2005;81:19-25.
3. Dunaif A, Segal KR, Futterwait W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 1989;38:1165-74.
4. Azzizz R. Androgen excess if the key element in polycystic ovary syndrome. Fertil Steril 2002;80:252-254.
5. Barbieri, RL. Metformin for the Treatment of Polycystic Ovary Syndrome. Obstet Gynecol 2003;101:785-93.
5. Baillargeon J-P. Oral presentation. The Endocrine Society. San Francisco, 2002.
6. Mansfield R, Galea R, Brincat M, Hole D, Mason H. Metformin has direct effects on human ovarian steroidogenesis. Fertil Steril 2003;79, 956-62.
7. Gjonnaess H. Polycystic ovarian syndrome treated by ovarian electrocautery through the laparoscope. Fertil Steril 1984;41:20.
8. Amer SAK, Li T-C, Coole ID. Repeated laparoscopic ovarian diathermy is effective in women with anovulatory infertility due to polycystic ovary syndrome. Fertil Steril 2003;79:1211-5.
9. Knochenhauer ES, Sanchez LA, Azziz R. The different phenotypes of the polycystic ovary syndrome (PCOS) [abstract]. Fertil Steril 2001;76:S208.
10. Rickenlund A, Carlström K, Ekblom B, Brismar TB, von Schoultz B, Hirschberg AL. Hyperandrogenicity is an alternative mechanism underlying oligomenorrhea or amenorrhea in female athletes and may improve physical performance. Fertil Steril 2003;79:947-55.
11. Webber LJ, Stubbs S, Stark J, Trew GH, Margara R, Hardy K, Franks S. Formation and early development of follicles in the polycystic ovary. The Lancet 2003;362:1017-21.
12. Ajoss S, Guerriero S, Paoletti AM, Orrừ M, Melis, GB. The antiandrogenic effect of flutamide improves uterine perfusion in women with polycystic ovary syndrome. Fertil Steril 2002;77:1136-40.
13. Colacurci N, Zullo F, De Franciscis P, Mollo A, De Placido G. In vitro fertilization following laparoscopic ovarian diathermy in patients with polycystic ovarian syndrome. Acta Obstet Gynecol Scand 1997;76:555-558.
© 2005 Jarrett Fertility Group
http://www.jarrettfertility.com/pcds.html
Weight loss is obviously not advised for this group of women, and they must in fact be cautioned about the weight loss often associated with the use of metformin.
While many women with PCOS will respond to metformin, a significant subset will not. These women present a particular challenge. Clomiphene, which is the treatment of choice for normalization of ovulation in obese PCOS women, is difficult to use in thin women. Clomiphene is an anti-estrogen, and the anti-estrogenic properties of clomiphene often result in inadequate endometrial development as documented by mid-cycle ultrasound. We have observed that the use of clomiphene in this particular group of women in associated with an extremely low probability of conception. The use of gonadotropins is also difficult in this group – ovarian hyper-responsivity is typical with the attendant risks of multiple pregnancy and ovarian hyperstimulation.
In 1998 we treated the first of this group of women with ovarian diathermy. Ovarian diathermy, a procedure first described by Gjönnaess7, involves the cauterization of ovarian stromal tissue using unipolar cautery. This procedure differs significantly from other laparoscopic procedures such as ovarian drilling in that diathermy does not involve destruction of any of the cortical part of the ovary. It is rather, the stromal part of the ovary that produces the excess testosterone and androstenedione that result in PCOS and diathermy results in dramatic reductions in levels of both of these hormones8 and normalization of cycles in a significant percentage of patients.
Between 8/98 and 7/03 we have performed 108 ovarian diathermy procedures. (Data under preparation for submission for publication.) Diathermy was performed at the time of laparoscopy. The pelvis was filled with an irrigation solution of lactated Ringer’s with 5,000 units of heparin per liter. The ovary was immobilized using an atraumatic grasping forceps and the Corson needle (Karl Storz Endoscopy- America, Inc. Culver City, CA. cat # 30677CN ) introduced into the ovary at a right angle to the ovarian cortex. The Corson needle has a diameter of only 1mm. The tip of the needle protrudes 10mm beyond the insulation that covers the remainder of the needle. Cautery is performed to a depth of 15mm with a monopolar coagulating current set at 40-W for five seconds at each of three to as many as eight sites. This cauterizes the stroma without affecting the ovarian cortex. Any other pathology encountered such as endometriosis or adhesions was treated and chromotubation was performed.
Of these, 74 women had a Body Mass Index of 25 or less (thereby meeting the definition of thin woman PCOS) and were 38 years of age or younger at the time of the procedure. This if the first reported series of this nature. Of these, 59 patients desired conception and were available for follow-up. They had a mean duration of infertility of 3.7 years and a mean body mass index of 23.9. 49 (83%) of these patients have conceived with a mean time to conception of 4.2 months. Most of these conceptions have occurred without further intervention, although 11 of these women conceived with the subsequent use of clomiphene/FSH for IUI and three conceived through IVF because of male factor issues. None of these women experienced hyperstimulation. There have been no post-operative complications and there have been no cases of ovarian failure.
One of the serious concerns about surgical treatment of PCOS is the risk of adhesion development. This is much more of a concern with procedures that destroy cortical tissue such as ovarian drilling than it is with ovarian diathermy. We have performed 10 repeat procedures, all of these in individuals who conceived following the initial procedure and then had recurrence of their oligo-/anovulatory pattern.
There have been no adhesions in any patient. In another study of 20 repeat procedures8 no adhesions were noted. Many thin women with PCOS do not have elevated androgen levels as usually defined. It has been estimated that as many as 20% of patients with PCOS have normal androgen levels.9 We found this to be true in our patient population and have in fact observed that many of these women were, at one point, very thin and frequently athletic. It has, in fact, been hypothesized that the relative hyperandrogenicity of these young women may account for some of their athletic ability10.
We believe they experience relative hyperandrogenicity at this point. Their androgen levels are not really increased but their estrogen levels may actually be lower than normal owing to the low percent body fat (an important source of estrogen production). The ovaries continue to function, demonstrated by persistent menstrual cycles, in all but a very small percentage of these women. But in the absence of estrogen production from peripheral fat cells, the environment is actually relatively hyperandrogenic.
And it has been demonstrated that even brief exposure to elevated androgen levels can set up a “self-propagating cycle of abnormal follicular growth and function”11. We hypothesize that this relative hyperandrogenism sets the stage – that the pattern of PCOS is set up in these thin women at a young age and this pattern persists into adulthood even in the absence of demonstrably elevated androgen levels at that time.
It has been demonstrated that ovaries from women with PCOS have fewer healthy primordial follicles than do normal ovaries with their growth arrested when they are between 5 and 8 mm in diameter10. This abnormal development is due to the relative excess of the ovarian androgens. And fewer healthy follicles develop in spite of a significantly greater density of follicles per mm3 in PCOS than is seen in normal ovaries.10
These two facts explain why women with PCOS have a much greater risk of ovarian hyperstimulation and lower success rates when undergoing, for example, IVF (In Vitro Fertilization). Correction of insulin status, with medical treatment and/or surgical intervention, is crucial prior to the use of gonadotropins in these women to ensuring safe, successful, and cost-effective procedures, be it simple ovulation induction and insemination or IVF. Ovarian diathermy has been shown to significantly improve pregnancy rates in POCS women undergoing IVF13.
Reduction of ovarian androgen production not only improves ovulation and pregnancy rates, but also reduces spontaneous abortion rates. The high loss rate experienced by women with PCOS is partly due to compromised oocyte quality, but may also be due to the compromised uterine perfusion that occurs as a result of elevated androgen levels12. Correction of androgen status clearly results in a decrease in the spontaneous abortion rate in these individuals.
In conclusion, PCOS is tremendously more treatable than ever before, owing to medical treatment with metformin and surgical treatment with ovarian diathermy. Correction of the underlying insulin abnormalities, particularly in the obese individuals with PCOS is of paramount importance whether or not conception is desired. Decreasing ovarian androgen production allows many women to conceive without further intervention. If further intervention is required, these women will experience a better chance of success with less risk than ever before.
A note about the algorithms: Our experience suggests that, if individuals who have undergone the full gamut of treatment for PCOS still require ovulation induction, the combination of clomiphene and FSH is the most efficacious approach. The anti-estrogenic properties of clomiphene are offset by the estrogenic properties of FSH. Adequate endometrial development can be anticipated without risking the potentially excessive response encountered when using FSH alone.
Click here for an additional (free) PDF Handout on PCOS:
http://www.jarrettfertility.com/PCOS...%20handout.pdf
1. Nestler JE, Stovall D, Akhter N, Iuomo MJ, Jakubowic DJ. Strategies for the use of insulin-sensitizing drugs to treat infertility in women with polycystic ovary syndrome. Fertil Steril 2002;77:209-215.
2. The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 2005;81:19-25.
3. Dunaif A, Segal KR, Futterwait W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 1989;38:1165-74.
4. Azzizz R. Androgen excess if the key element in polycystic ovary syndrome. Fertil Steril 2002;80:252-254.
5. Barbieri, RL. Metformin for the Treatment of Polycystic Ovary Syndrome. Obstet Gynecol 2003;101:785-93.
5. Baillargeon J-P. Oral presentation. The Endocrine Society. San Francisco, 2002.
6. Mansfield R, Galea R, Brincat M, Hole D, Mason H. Metformin has direct effects on human ovarian steroidogenesis. Fertil Steril 2003;79, 956-62.
7. Gjonnaess H. Polycystic ovarian syndrome treated by ovarian electrocautery through the laparoscope. Fertil Steril 1984;41:20.
8. Amer SAK, Li T-C, Coole ID. Repeated laparoscopic ovarian diathermy is effective in women with anovulatory infertility due to polycystic ovary syndrome. Fertil Steril 2003;79:1211-5.
9. Knochenhauer ES, Sanchez LA, Azziz R. The different phenotypes of the polycystic ovary syndrome (PCOS) [abstract]. Fertil Steril 2001;76:S208.
10. Rickenlund A, Carlström K, Ekblom B, Brismar TB, von Schoultz B, Hirschberg AL. Hyperandrogenicity is an alternative mechanism underlying oligomenorrhea or amenorrhea in female athletes and may improve physical performance. Fertil Steril 2003;79:947-55.
11. Webber LJ, Stubbs S, Stark J, Trew GH, Margara R, Hardy K, Franks S. Formation and early development of follicles in the polycystic ovary. The Lancet 2003;362:1017-21.
12. Ajoss S, Guerriero S, Paoletti AM, Orrừ M, Melis, GB. The antiandrogenic effect of flutamide improves uterine perfusion in women with polycystic ovary syndrome. Fertil Steril 2002;77:1136-40.
13. Colacurci N, Zullo F, De Franciscis P, Mollo A, De Placido G. In vitro fertilization following laparoscopic ovarian diathermy in patients with polycystic ovarian syndrome. Acta Obstet Gynecol Scand 1997;76:555-558.
© 2005 Jarrett Fertility Group
http://www.jarrettfertility.com/pcds.html
Fat distribution affects PCOS metabolism regardless of body weight
Fat distribution affects PCOS metabolism regardless of body weight
Source: Fertility and Sterility 2003; 79: 1358-64
Intra-abdominal fat distribution may be important in women with PCOS regardless of whether they are obese.
Women with polycystic ovary syndrome (PCOS) tend to exhibit abnormal fat distribution even if they are not obese, perhaps indicating an increased risk of metabolic disorders, research indicates.
"Visceral fat accumulation has been reported to be closely related to the development of metabolic disorders, such as glucose intolerance, insulin resistance, and abnormal lipid metabolism associated with obesity," explain Dr. Basak Yildirim (Pamukkale University Hospital, Denizli, Turkey) and colleagues.
They used ultrasound to measure subcutaneous and intra-abdominal visceral and preperitoneal fat thickness in 30 nonobese women with PCOS, and a control group of lean women with regular menstrual cycles. Glucose tolerance, insulin sensitivity, serum hormones, and lipid profiles were also assessed.
The average preperitoneal and visceral fat thickness was significantly greater in the women with PCOS than the controls, and PCOS was associated with glucose intolerance, hyperinsulinemia, and dyslipidemia. Furthermore, preperitoneal and visceral fat thickness correlated positively with triglyceride levels and hyperinsulinemia, and negatively with high-density lipoprotein levels in the women with PCOS.
"These results suggest that visceral fat accumulation may be an early marker of metabolic disorders in nonobese patients with PCOS," Yildirim et al conclude. They propose that ultrasonographic measurement of visceral adipose tissue be added to metabolic screening in such patients.
Source: Fertility and Sterility 2003; 79: 1358-64
Intra-abdominal fat distribution may be important in women with PCOS regardless of whether they are obese.
Women with polycystic ovary syndrome (PCOS) tend to exhibit abnormal fat distribution even if they are not obese, perhaps indicating an increased risk of metabolic disorders, research indicates.
"Visceral fat accumulation has been reported to be closely related to the development of metabolic disorders, such as glucose intolerance, insulin resistance, and abnormal lipid metabolism associated with obesity," explain Dr. Basak Yildirim (Pamukkale University Hospital, Denizli, Turkey) and colleagues.
They used ultrasound to measure subcutaneous and intra-abdominal visceral and preperitoneal fat thickness in 30 nonobese women with PCOS, and a control group of lean women with regular menstrual cycles. Glucose tolerance, insulin sensitivity, serum hormones, and lipid profiles were also assessed.
The average preperitoneal and visceral fat thickness was significantly greater in the women with PCOS than the controls, and PCOS was associated with glucose intolerance, hyperinsulinemia, and dyslipidemia. Furthermore, preperitoneal and visceral fat thickness correlated positively with triglyceride levels and hyperinsulinemia, and negatively with high-density lipoprotein levels in the women with PCOS.
"These results suggest that visceral fat accumulation may be an early marker of metabolic disorders in nonobese patients with PCOS," Yildirim et al conclude. They propose that ultrasonographic measurement of visceral adipose tissue be added to metabolic screening in such patients.
How to Cope with PCOS
How to Cope With Polycystic Ovary Syndrome:-
Experts estimate that as many as 10 percent of women may have polycystic ovary syndrome (PCOS). In spite of this, very little information is provided to the general public about PCOS, so when a woman receives a diagnosis she can feel very lost and isolated. Knowing how to cope with PCOS is an important step in dealing with this life-altering condition.
InstructionsDifficulty: Moderately Challenging
Step 1:
Realize that PCOS isn't the end of the world. When you are first diagnosed and are still experiencing all of your symptoms with no treatment, you may feel overwhelmed. However, PCOS can be dealt with and most women reach the point that the condition is an annoyance rather than a constant source of stress.
Step 2:
Know that most women with PCOS are able to obtain relief from their most distressing symptoms and find ways of managing the others, but it does take time. Be patient while your medications or other therapies are starting to work. It can take several months before you really begin to feel better.
Step 3:
Be active in seeking out the best treatments for you. Take the time to find a doctor who listens to your concerns and takes your condition seriously.
Step 4:
Do things that help you feel pretty and feminine, such as taking special care with your makeup or wearing clothes that make you feel attractive and confident. Many women with PCOS report that they feel like they're not really women because of distressing symptoms such as weight gain, facial hair and irregular or nonexistent cycles. Combating these emotions with positive actions can help a great deal.
Step 5:
Work hard to improve your self esteem. Eat healthy foods and get exercise whenever possible; both of these will greatly contribute to feelings of well-being and a positive mood.
Step 6:
Seek counseling if you need help dealing with your feelings about having PCOS. Remember that depression is often a symptom of PCOS, and you may need therapy or medication to help regulate your emotions. Be proactive in getting the help you need to feel your best.
Step 7:
Visit message boards and websites to connect with other women who have PCOS. They provide a great support system, and these resources are good ways to learn more about alternative treatments, get referrals to the best doctors and keep up with the latest research.
http://www.ehow.com/how_2066293_cope-pcos.html
PCOS Awareness - Context for Disruption and how PCOSAA will make Change!
AUTHOR: Ashley Levinson-Sells
February 1, 2014
on Twitter: @jerzgurlie
The complexity of PCOS (Polycystic Ovary Syndrome), coupled with poorly designed healthcare delivery systems, has made it difficult for clinicians to provide high-quality care for patients with this syndrome on a consistent basis and has resulted in a healthcare system building unnecessary costs, inappropriate practice variation, and suboptimal care.
February 1, 2014
on Twitter: @jerzgurlie
The complexity of PCOS (Polycystic Ovary Syndrome), coupled with poorly designed healthcare delivery systems, has made it difficult for clinicians to provide high-quality care for patients with this syndrome on a consistent basis and has resulted in a healthcare system building unnecessary costs, inappropriate practice variation, and suboptimal care.
Often unrecognized PCOS (Polycystic Ovary Syndrome) can cause many physical and emotional manifestations and for the up to 10% of women and girls with Polycystic Ovary Syndrome Worldwide, it is estimated less than half know what it is or that they have it. Therefore, the PCOS Community is charged with identifying strategies for achieving substantial improvement in the quality of health care and education for all patients living with the syndrome.
Organizations such as PCOS Awareness Association, (PCOSAA) must keep up with the current demands for information by supporting an organizational structure and programs capable of handling and satisfying the mass inquiries received and the need for reliable resources for consumers.
PCOSAA has been responding to these inadequacies with an emphasis on PCOS related research and the needs of educational instruction, clinical teaching, and delivery of education via distance learning, support services and use of educational technology.
Although there have been various resources available with regards to PCOS and PCOS support, none of these resources have been able to bridge the gaps between patients and healthcare providers, often leaving the patient at a loss trying to comprehend the mountains of data about the syndrome, without the tools to implement this information in to their healthcare.
By using technology, support and volunteerism, PCOSAA will be able to provide comprehensive and accessible resources about PCOS for all who seek it and will lower the cost of healthcare for providers, as an initial diagnosis of PCOS and treatment options will save millions of dollars in the treatment of this syndrome!
An interview with founder of PCOSAA, Megan Domino will be available on this blog shortly!
Raising Awareness for Medical Conditions Through Online Technologies and Social Media
AUTHOR: Ashley Levinson-Sells
February 1, 2014
Mantua, NJ
On twitter: @jerzgurlie
It has become painfully obvious that there is one thing limiting raising awareness for your cause, mine in particular for Polycystic Ovary Syndrome (PCOS) is not having one centralized cohesive place or plan for all resources to come together. Its time to revolutionize this theory and create a coalition for your campaign, in which you all work together to have one voice.. It is my belief that as separate entities your message can become diluted. As a united front your voices will be louder, your talents utilized properly and your message will be stronger!
By improving access to online information, resources, support and services, your coalition will provide links to the full range of patient and healthcare services for the consumer and provider. Through Education and partnership with the medical community, patients and organizations, A Coalition will be able to collaborate in providing easy integration of information, in support of users’ needs.
You want to do more to exploit the educational potential of online technologies and use social media as a platform. Therefore, we need to do all we can to accelerate the move to the next generation of e-learning activities and resources within the health/social/business communities.
There needs to be better digital resources, more widely available and more flexible learning packages that incases of a medical cause, healthcare providers can adapt to their patients’ needs. You must support innovation in the market by improving our knowledge of where e-learning works and you must keep information and resources moving, to take advantage of new methods in all areas, and to keep demanding a better response from the technology with utilize.
By engaging technology, you will be able to provide an immediate response to the needs of patients and the healthcare industry through a comprehensive set of online resources and will increase awareness of this syndrome, its symptoms and the risks associated with it.
Additionally, by effectively promoting and implementing research and education, the condition you're advocating for will be more recognizable among various medical disciplines. This will allow for earlier detection and better patient care!
Online educational materials and programs (Forums, chats, blogs, podcasts, seminars) will also allow you to empower those you serve to take control of their health and live healthier lives, while researchers continue to identify the causes of the condition and ultimately find a cure or more effective treatments to control the condition.
February 1, 2014
Mantua, NJ
On twitter: @jerzgurlie
It has become painfully obvious that there is one thing limiting raising awareness for your cause, mine in particular for Polycystic Ovary Syndrome (PCOS) is not having one centralized cohesive place or plan for all resources to come together. Its time to revolutionize this theory and create a coalition for your campaign, in which you all work together to have one voice.. It is my belief that as separate entities your message can become diluted. As a united front your voices will be louder, your talents utilized properly and your message will be stronger!
By improving access to online information, resources, support and services, your coalition will provide links to the full range of patient and healthcare services for the consumer and provider. Through Education and partnership with the medical community, patients and organizations, A Coalition will be able to collaborate in providing easy integration of information, in support of users’ needs.
You want to do more to exploit the educational potential of online technologies and use social media as a platform. Therefore, we need to do all we can to accelerate the move to the next generation of e-learning activities and resources within the health/social/business communities.
There needs to be better digital resources, more widely available and more flexible learning packages that incases of a medical cause, healthcare providers can adapt to their patients’ needs. You must support innovation in the market by improving our knowledge of where e-learning works and you must keep information and resources moving, to take advantage of new methods in all areas, and to keep demanding a better response from the technology with utilize.
By engaging technology, you will be able to provide an immediate response to the needs of patients and the healthcare industry through a comprehensive set of online resources and will increase awareness of this syndrome, its symptoms and the risks associated with it.
Additionally, by effectively promoting and implementing research and education, the condition you're advocating for will be more recognizable among various medical disciplines. This will allow for earlier detection and better patient care!
Online educational materials and programs (Forums, chats, blogs, podcasts, seminars) will also allow you to empower those you serve to take control of their health and live healthier lives, while researchers continue to identify the causes of the condition and ultimately find a cure or more effective treatments to control the condition.
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