Polycystic ovarian syndrome (PCOS) is a complex condition in which a woman’s ovary has small fluid filled cysts in 2 to 9mm size range causing sex hormones androgen, estrogen and progesterone out of balance. This leads to abnormal menstrual pattern, abnormal carbohydrate metabolism, obesity, abnormal growth of hair, acne, infertility, etc. The condition affects about 10 to 15% of women in child bearing age.
The exact cause of PCOS is unknown, it is believed that hormonal imbalances and genetics play a role. Insulin resistance, family history, lifestyle and environmental factors play a definitive role.
Genetic predisposition or Family history:
Women are more likely to develop PCOS if their mother or sister also have the condition. The chances of developing PCOS are upto 50 per cent in such a case. There is no clear genetic contributor to PCOS currently identified and the link is likely to be complex and involve multiple genes.
Hormonal imbalance:
Overproduction of the androgen hormone may be another contributing factor. Androgen is a male sex hormone that women’s bodies also produce in small quantity. Women with PCOS often produce higher-than-normal levels of androgen. Excess insulin (a hormone that helps convert sugar and starch into energy) may also cause high androgen levels. Imbalances in levels of Luetinizing hormone (LH), sex hormone binding globulin ( SHBG) and prolactin may also cause or contribute to PCOS.
Insulin resistance
Insulin is the hormone which utilizes glucose and converts it into energy. If there is abnormal sensitivity to insulin ( insulin resistance may be because of genetic predisposition), more and more insulin is produced in the body for utilization of glucose. This insulin resistance leads to increased production of androgens which causes PCOS. Insulin resistance is present in up to 80 per cent of women with PCOS and this can contribute to an increased risk of developing type 2 diabetes and cardiovascular disease.
Lifestlye factors
Insulin resistance is caused in part by lifestyle factors including being overweight because of a diet or physical inactivity. Being above a healthy weight worsens insulin resistance and the symptoms of PCOS
Low-grade inflammation.
Our body’s white blood cells produce substances to fight infection in a response called inflammation. Research has shown that women with PCOS have low-grade inflammation and that this type of low-grade inflammation stimulates polycystic ovaries to produce androgens.
PCOS is still an enigma involving multiple factors. Although, the pathophysiology of PCOS is still complex, the basic pathology is understood to be due to insulin resistance causing cascade of events related to PCOS.
