Rogue ovaries - Health.
By Anne Woodham.
1,264 words
30 July 2002
The Times
English
(c) 2002 Times Newspapers Ltd.
Little is known about polycystic ovary syndrome, yet it is more common than diabetes and has a serious effect on sufferers' health. Anne Woodham reports
I had classic polycystic ovary syndrome (PCOS) symptoms as a teenager, but I thought that was just the way things were," says 32-year-old Gaynor Colston, of Bristol. "I put on weight whatever I ate, my periods were irregular and often absent, and facial hair was a problem."
Her symptoms got worse after her daughter Bethan, 7, was born and a blood test revealed PCO or polycystic ovaries (see panel below). A course of Clomid and Metformin helped her to conceive James, now 20 months, and she takes the oral contraceptive Yasmin as well as metformin to help her to drop below her 11 1/2st weight barrier.
But facial hair, says Colston, is still the bane of her life. "I won't let my husband Nigel touch my face. I pluck twice a day for half an hour and my hands are always around my chin and neck, checking hair growth. I've spent a fortune on different products, but nothing works."
Like many women with PCOS, her self-esteem took a battering. A dermatologist's suggestion that she shave reduced her to tears, and she was told that electrolysis could cause scarring. Although said to be effective, the cost of laser treatment at up to £2,000 for eight sessions is prohibitive for her and - unfairly, she feels - is not generally available on the NHS.
"Polycystic ovaries is the most common hormonal condition in the population," says Dr Helen Mason, senior lecturer in reproductive endocrinology at St George's Hospital Medical School, in Tooting, South London. "Nothing else, not even diabetes, runs at 20 per cent."
PCOS, which affects 75 per cent of women with PCO, is the most common hormonal disturbance among women and the most common cause of not ovulating. Yet until recently PCOS was frequently misunderstood and under-diagnosed, despite its "discovery" in 1935. Then Victoria Beckham and Jamie Oliver's wife, Jules, blamed PCOS for their problems in conceiving, and suddenly it is in the spotlight.
So what is known about the condition? Surprisingly little. "We're really just scraping the surface," says Stephen Franks, Professor of Reproductive Endocrinology at Imperial College, London. A big question is why, of two women - even sisters - diagnosed with PCOS, one will be almost symptom-free and the other will struggle with excess body hair, acne and obesity.
PCOS is known to run in families. Franks believes that the type and severity of a woman's symptoms is determined by her genetic predisposition combined with her foetal environment and her diet and lifestyle since puberty.
Franks suspects an interaction between genes involved in insulin production and those regulating androgen (male sex hormone) levels. If a woman has genes A, B and C, for example, her symptoms may be mild, but add D, E and F and the picture changes. For instance, the extent of the skin's sensitivity to androgen, which influences excess hair and acne, is determined by genetic make-up; thus Mediterranean and Asian women with PCOS tend to be more hairy than women from northern Europe.
It doesn't take a lot of androgen either. "Most have androgen levels that are within the average range or only slightly above," Franks says. His research team is trying to pinpoint the genes responsible as well as understand how eggs mature within the polycystic ovary.
Dr Lisa Webber, Franks's clinical research fellow, says: "Women with PCO not only have more eggs in their ovaries, but these grow at a faster rate. The final stages of their development may be deficient and result in failure to ovulate.
WellBeing, the health research charity for women and babies - whose Sunflower pin-badges to raise funds for PCOS research are available for £1 in Boots over the summer - is funding a two-year study with Franks and the Babraham Institute, Cambridge, on the effect of androgens on egg development in the ovary. Losing weight is the single most effective way of reducing PCOS symptoms, and Franks believes that a key factor is the action on ovarian hormones of insulin, a metabolic hormone that reflects nutritional status. Weight loss also helps the body to produce greater amounts of a binding protein which mops up androgens that affect the skin.
But this is easier said than done. "For some reason women with PCOS don't burn off calories as most people do," says Mason. "To lose weight they have to eat far fewer calories than women with normal ovaries. It may be because they tend to be apple-shaped and weight in the upper body insulates the liver, and partly as a survival factor from the past. When everyone else starved to death they got away with eating less."
High-protein, low-carbohydrate diets are widely recommended, but two studies presented at the American Endocrine Society meeting in San Francisco in June suggest that it is cutting calories that matters, not the type of diet. The good news is that you don't have to be sylph-like before you improve. "Losing 1 1/2 to 2st can make a big difference just to the way you ovulate," Franks says.
PCOS
LINKS
www.verity-pcos.org.uk
Verity (PCOS self-help group) 52-54 Featherstone Street, London EC1Y 8RT.
www.wellbeing.org.uk
WellBeing, the health research charity for women and babies: 020-7772 6400; PCOS: A Woman's Guide to Dealing with Polycystic Ovary Syndrome, by Colette Harris with Dr Adam Carey (Thorsons, £9.99); PCOS Diet Book, by Colette Harris with Theresa Francis-Cheung (HarperCollins, £12.99, publication July 22).
COMPLEX CAUSES, VARIED TREATMENTS
What is PCOS?
As many as one woman in five has a number of small cysts, between 2mm to 8mm, on their ovaries. These are egg follicles that have not developed properly because of hormonal imbalances. About 23 per cent of cases have no symptoms; this is known simply as PCO (polycystic ovaries). The rest experience polycystic ovary syndrome (PCOS).
Symptoms
Usually start in adolescence, though sometimes the mid-twenties, and include: irregular or no periods; facial or body hair (hirsutism); hair loss (alopecia) from the scalp; acne and oily skin; weight gain that is difficult to lose; difficulty in conceiving and recurrent miscarriage.
Causes
Imbalances in the hormones that control the menstrual cycle. Progesterone levels tend to be below normal, oestrogen and androgen (male hormone) levels above. Many women with PCOS are also resistant to insulin.
Diagnosis
Blood tests to detect hormone imbalances and ultrasound scans of the ovaries.
Long-term health risks
Type-2 diabetes and heart disease. Endometrial cancer in women with infrequent periods and heavy bleeding as the womb lining thickens.
Treatment
No cure as yet, but losing weight with a healthy low-calorie diet and exercise reduces symptoms.
Metformin is an insulin-sensitising drug that may help those with PCOS.
The oral contraceptive Pill or progestogen-only pills are prescribed to regulate periods. Dianette, an oral contraceptive containing a low-dose anti-androgen, may help acne or unwanted hair. Yasmin is a new combined oral contraceptive that contains an antiandrogen form of progestogen and seems to prevent weight gain.
Clomiphene citrate (Clomid) stimulates ovulation in 80 per cent of women with fertility problems. Injections of a follicle-stimulating hormone may work if this fails. "Ovarian drilling", or laparoscopic ovarian diathermy, lasers holes in the ovaries and may induce ovulation.
(c) Times Newspapers Ltd, 2002.
Rogue ovaries - (The Times - UK) 
