The PCOS Plan - Jason Fung

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prolactin levels may mimic PCOS by inhibiting estrogen and causing menstrual irregularities and difficulty with ovulation. Symptoms that may help differentiate the disease include breast enlargement and abnormal milk production.

      » Thyroid disorders

      The thyroid is a small gland at the front of the neck. It secretes thyroid hormone, which controls many aspects of metabolism. Too little thyroid in the body may cause weight gain, menstrual irregularities, infertility, and hair loss that may be confused with PCOS. The diagnosis of thyroid disorders is made by measuring the blood levels of the thyroid hormones (TSH, T3, T4) to rule out this easily treated condition.

      » Nonclassic congenital adrenal hyperplasia

      Androgens are normally produced in both the ovaries and the surface (cortex) of the adrenal glands. In rare situations, the adrenal glands overproduce androgens, resulting in a syndrome called nonclassic congenital adrenal hyperplasia (NCAH), which is reminiscent of PCOS, with irregular menstruation, hirsutism, and acne. It is a rare genetic disorder that can affect young girls and women, and there is no commonly used diagnostic test for it.

      » Cushing’s Syndrome

      Prolonged exposure to high levels of the hormone cortisol causes Cushing’s Syndrome. In some cases, tumors oversecrete cortisol. In other cases, this syndrome can be caused by synthetic cortisol (prednisone), which is used to treat autoimmune diseases (asthma, lupus) and to suppress the immune system during organ transplants. Elevated cortisol levels can cause weight gain, menstrual irregularities, and infertility, which may be confused with PCOS. While prolonged periods of stress or athletic overtraining may increase cortisol, these circumstances almost never do so to the degree that’s necessary to develop Cushing’s Syndrome.

      Cushing’s Syndrome presents with some characteristic symptoms that can help to distinguish it from PCOS. These include a pocket of fat that develops below the nape of the neck (a buffalo hump), stretch marks (striae), thinning skin, muscle weakness and atrophy, sensitivity to infections, decreases in bone density, and severe psychiatric and cognitive dysfunction. The diagnosis of high cortisol levels is made by taking a small blood sample.

      » Hyperandrogenemia

      Tumors in the adrenal glands or ovaries may oversecrete androgens causing hirsutism, clitoral enlargement, deepening of the voice, and male-pattern baldness. These tumors are extremely rare but potentially life-threatening. The average age of diagnosis is 23.4 years, which overlaps significantly with the age range for PCOS. Tumors typically produce far higher levels of androgen than are found in PCOS, leading to far more severe symptoms. The diagnosis of these tumors is usually made by looking at an image from a computerized tomography (CT) scan of the abdomen.

      Drug-induced androgen excess is usually associated with those surreptitiously taking testosterone, mostly to enhance athletic performance. Because patients may not always admit to the use of these drugs, a high index of suspicion is necessary to make the diagnosis.

      When I was diagnosed with PCOS, I checked the boxes for all three of the diagnostic criteria, even though only two out of three are necessary for the diagnosis. I had frank PCOS, the most severe phenotype, and I was devastated by this news. Today, I know there is a natural way to reverse even the worst PCOS. By understanding the underlying root cause of the syndrome, we can treat it rationally and successfully.

       Who Gets PCOS?

      .................

      THE PREVALENCE OF PCOS, using the NIH criteria, ranges from 6 to 9 percent, with a strikingly similar rate globally.1 Using the Rotterdam criteria, that rate is about 15 to 20 percent of women. This makes PCOS the most common endocrine (hormonal) disorder of young women by far. Approximately one in 15 women in the United States are affected, with similar proportions in Spain, Greece, and the United Kingdom. An estimated 105 million women of childbearing age are afflicted worldwide.

       GENETICS AND PCOS

      TO TRY TO understand why some people develop PCOS and others don’t, researchers usually begin by looking for genetic influences. A large Dutch study comparing sets of identical twins with sets of fraternal twins found that approximately 70 percent of PCOS may be attributed to genetic influences.2 A U.S. study found that sisters of patients diagnosed with PCOS are more likely to have symptoms, with an estimated 22 percent also fulfilling the full diagnostic criteria.3 A further 24 percent of sisters had hyperandrogenism but regular menstrual cycles, likely indicating that they too had mild PCOS. In a separate study, mothers of patients with PCOS had higher androgen levels, insulin resistance, and metabolic syndrome.4 First-degree relatives, male or female, are more likely to have evidence of insulin resistance. Despite these strong genetic tendencies, no single gene has been identified as the causative factor. This indicates that PCOS is a complex genetic disorder with multiple genes contributing small degrees of risk.

       HEALTH RISKS ASSOCIATED WITH PCOS

      IF PCOS WERE just about acne and a few missing periods, then it would not be so bad. Unfortunately, PCOS is associated with many health concerns, reproductive as well as general.5 The reproductive issues include

      ·anovulatory cycles,

      ·infertility,

      ·disorders of pregnancy, and

      ·fetal concerns.

      Other significant health concerns include

      ·cardiovascular disease,

      ·non-alcoholic fatty liver disease (NAFLD),

      ·sleep apnea,

      ·anxiety and depression,

      ·cancer,

      ·type 2 diabetes, and

      ·metabolic syndrome.

      These are some of the deadliest conditions in the world, including the top two causes of death in America, cardiovascular disease and cancer. PCOS is not merely a nuisance; it is an important warning of risk. For this reason, it’s worth taking a look at each of these conditions in more detail to try to understand their link with PCOS.

       Reproductive concerns

      » Anovulatory cycles

      Most women with PCOS suffer from infrequent or absent menstrual periods, mostly caused by anovulatory cycles (ovulation is missed). PCOS accounts for 80 percent of cases of anovulation leading to infertility.6

      » Infertility

      If you do not ovulate, you can’t conceive: no egg, no baby. Anovulatory cycles account for approximately 30 percent of visits to an infertility clinic, mostly due to PCOS. The Australian Longitudinal Study on Women’s Health, a community-based survey of young women, found that a heartbreaking 72 percent of women with PCOS considered themselves infertile, compared with only 15 percent without PCOS. However, women with PCOS usually have difficulty conceiving rather than being completely infertile. The use of fertility hormones in the PCOS group was almost double that of the non-PCOS group. That is, the 5.8 percent of women identified as having PCOS constituted a whopping 40 percent of those seeking fertility treatments. Obviously, PCOS contributes heavily to overall use of costly fertility treatment.7

      The financial costs of infertility are depressing. Costs in the United States range from relatively inexpensive hormonal treatments (approximately US$50 per treatment cycle) to very expensive in vitro fertilization (IVF), which in 2005 was estimated to cost upward of US$6000 to $10,000 per round of treatment. With millions of women suffering from PCOS, the total cost for infertility treatment alone in the United States is an estimated US$533 million.8

      The possibility of being unable to conceive a child can cause severe anxiety. Celebrity chef Jamie Oliver and his

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