Doctors are calling it an epidemic, and there's still so much we have to learn about what leads to a PCOS diagnosis. 

June 04, 2018

You may have heard that polycystic ovary syndrome (PCOS) is a leading cause of infertility (that impacts up to 10 percent of reproductive-age women) but you may not realize the medical community has a lot left to discover about the disorder.

Millions of women struggle daily with a PCOS diagnosis; symptoms typically range from abnormal menstrual cycles and irregular ovulation to ovarian cysts, skin problems, excess hair growth, and even mood disorders. But recent research sheds fresh light on the issue, including theories about its cause and a new approach to treatment. Here's what you need to know about PCOS today.

1. PCOS may start before you're even born

Noting that some pregnant women with PCOS have above-average anti-Müllerian hormone levels, and that the syndrome is known to be hereditary, a group of French researchers theorized that the hormonal imbalance in pregnant women might cause the same condition in their daughters. In testing the idea, they found that pregnant mice that were injected with anti-Müllerian hormone had female offspring that displayed many of the symptoms of PCOS, including delayed puberty, infrequent ovulation, and difficulty getting pregnant. According to the researchers, this suggests that PCOS starts in the womb.

While some tout this as a breakthrough discovery, other medical experts caution against drawing conclusions too quickly. Felice Gersh, M.D., an OB-GYN who specializes in PCOS, notes that the mice were injected with extremely high levels of AMH that are not comparable to the levels found in some women diagnosed with PCOS.

"The fact that it created an effect is not surprising," Dr. Gersh says. "It's very clear that when you do anything in pregnancy and upset the hormonal balance, you're going to have an impact…Every bit of information we acquire is wonderful, but it's misleading to say this is a breakthrough."

2. Anti-Müllerian hormone is just one piece of the puzzle

If anti-Müllerian hormone sounds familiar, that's because it's often used as an indicator of a woman's fertility. Anna Burgansky, M.D., director of obstetrics and gynecology at New York-Presbyterian Lawrence Hospital, explains that it's produced by ovarian follicles—a.k.a. stored eggs. "AMH level reflects the number of potential eggs and may be the best marker of ovarian function," she says. Low levels can mean a diminished ovarian reserve, but high levels can suggest a different problem altogether.

The correlation between AMH levels and PCOS is nothing new. "We know that AMH concentrations are generally in the upper range of normal or elevated in women with PCOS, and AMH elevation correlates with PCOS severity," Dr. Burgansky says.

But Dr. Gersh points out that that's just a fraction of the issue. "AMH is the trendy PCOS topic right now, but really, it is just one of the many hormones which are malfunctioning in this group," she says. "It's a complex interaction between all of the hormones—testosterone, AMH, luteinizing hormone (LH), follicle-stimulating hormone (FSH)—all working together in a really complex synergy to create ovulation. We need to understand how each hormone is a part of the whole amazing process of ovulation, and fertilization, and pregnancy."

3. There is still no known cure for PCOS

The French study suggests that IVF drug cetrorelix may help manage the symptoms of PCOS. After seeing success with the mice, they are planning a clinical trial of cetrorelix in women with PCOS. But experts caution against labeling that a "cure."

"It's an injectable, not a cure," says Dr. Gersh. "'Cure' means a reversed condition and a return to a normal state. It's dangerous because it's changing the way women produce hormones."

Currently, treatment for a PCOS diagnosis depends on the patient's desire to conceive; options include oral contraceptive pills, insulin-sensitizing agents, and medications that restore ovulation. For obese women with PCOS, weight loss can also correct hormone abnormalities. These approaches can help manage symptoms and restore hormone imbalances, but none provide a true cure for PCOS.

4. Medical experts are calling PCOS an epidemic

Despite the serious health consequences of the disorder, PCOS is still relatively unknown in many parts of the world, and 50 percent of women living with PCOS go undiagnosed, according to the National Polycystic Ovary Syndrome Association. And it may be getting worse. "There is a general consensus that the incidence is rising, as is the incidence of overall population obesity and metabolic dysfunction," Dr. Gersh says. "And it is present everywhere in the world."

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