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Polycystic Ovarian Syndrome

February 10, 2021

Polycystic Ovarian Syndrome (PCOS) and Obesity

One out of three women is experiencing hormonal imbalances, irregular periods and trouble conceiving. Most of these symptoms leads to infertility and affects the ability to get pregnant. Though there are multi-factorial reasons for women infertility, studies have established obesity as a serious risk factor for reproductive issues in women. The prevalence of obesity in infertile women is high. Studies have also associated obesity in women with polycystic ovary syndrome (PCOS) as one of the most common causes of infertility in women.

What is polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS) is a common hormonal condition that affects one in 10 women of reproductive age. Women with PCOS have higher levels of androgens (male hormones that is also present in female), which interrupt normal ovulation and results in irregular periods, acne, excess facial and body hair, and male-pattern baldness. In addition to these characteristic, it increases the risk of infertility and type-2 diabetes.

Though the exact cause of PCOS is unknown, experts believe that a combination of genetic and environmental factors contributes to the condition.  Some clinical evidence indicates that there is a close link between obesity and PCOS.

Obesity as a risk factor for the development of PCOS

Obesity and PCOS are interlinked and shares a complex connection. According to studies, 40–80% of women with PCOS are reported to be obese. Women with PCOS have insulin resistance, which worsens with obesity and other lifestyle related factors. Being obese, especially in the abdominal region increases the risk of insulin resistance for up to 50%.

Insulin Action in PCOS:Relation with Obesity

Insulin is a peptide hormone produced by beta cells of the pancreas. It plays an important role in controlling blood sugar levels. It control blood glucose by signaling the liver, muscle and fat cells to take in glucose from the blood.

In obese individuals, the cells in muscles, fat, and liver don’t respond well to insulin and fail to take in glucose from the blood. Thus, it result in high blood glucose levels. In order to control blood glucose levels, the pancreas produce large amount of insulin. Excess insulin leads to insulin resistance which in turn decreases the body’s ability to use insulin effectively and thus results in hyperinsulinemia. According studies, about 50–70% of women with PCOS are highly obese and have detectable insulin resistance and hyperinsulinemia [12]. Obesity-associated insulin resistance can alter the function of the hypothalamus and the pituitary gland in the brain, thereby increasing the production of androgens. Additionally, elevated insulin level increases the secretion of luteinizing hormone which inturn promotes androgen production. Increased production of androgens in women will leads to hyperandrogenism.

Hyperinsulinaemia and hyperandrogenaemia changes the ovarian function and results in follicular arrest and anovulation (absence of ovulation). Studies showed that high androgen level is an independent risk factor for PCOS resulting in female infertility and ovarian dysfunction. [12,13]

Hypothyroidism in PCOS: Relation with Obesity

Obese women have slightly high levels of thyroid stimulating hormone (TSH) than normal weight individual. Excess body weight slows down the thyroid function and results in hypothyroidism (underactive thyroid), which have a negative impact on the ovaries. Several studies demonstrated that approximately 43% of women with PCOS suffer from subclinical hypothyroidism. [14]

PCOS: Treatment and control measures

No simple cure for PCOS exists. But the symptoms can be managed to improve the fertility and decrease the risk of long-term complications. Engaging in regular exercise, keeping a healthy diet, losing excess weight, smoking cessation and taking the prescribed medications all plays an important role in the treatment of PCOS.

Lifestyle changes: Studies show that, weight loss of just 5% can lead to a significant improvement in PCOS symptoms. Changes in the quantity, type, and quality of dietary products, also change in the degree and type of physical activity have significant role in reducing body weight. Fibre-rich and low carbohydrate foods, such as whole-grain breads, cereals, whole-wheat pasta, brown rice, barley and beans can be included in the diet.  Routine exercise for at least 30 minutes may have significant influence in obesity among PCOS women.

Medications:  Certain medicines are prescribed to regulate menstrual cycle, reduce excessive hair growth and promote normal ovulation. Additionally, if diet and exercise doesn’t reduce weight certain weight-loss medications are prescribed.

Outlook

Reducing weight can be a great challenge for obese women. But, weight loss and lifestyle changes are the effective ways that offer a beneficial effect on the ovulatory and metabolic dysfunction of obese women with PCOS.

References :

  1. Polycystic ovary syndrome (PCOS). https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439. Accessed on: 02-08-2020.
  2. Polycystic ovary syndrome. https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome . Accessed on: 02-08-2020.
  3. Polycystic ovary syndrome. https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/. Accessed on: 02-08-2020.
  4. Sam S. Obesity and Polycystic Ovary Syndrome. Obes Manag. 2007;3(2):69-73. doi:10.1089/obe.2007.0019
  5. Kahsar-Miller MD et al. Prevalence of polycystic ovary syndrome (PCOS) in first-degree relatives of patients with PCOS.” Fertil Steril. 2000;75(1):53-58.
  6. Goodarzi M, et al. Polycystic ovary syndrome: Etiology, pathogenesis and diagnosis.”  Nat Rev Endocrinol, 2011.;7(4):219–231.
  7. Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance. Accessed on: 02-08-2020.
  8. Moghetti P. Insulin Resistance and Polycystic Ovary Syndrome. Curr Pharm Des. 2016;22(36):5526-5534. doi:10.2174/1381612822666160720155855
  9. Karavani G et al. Increases in thyrotropin within the near-normal range are associated with increased triiodothyronine but not increased thyroxine in the pediatric age group. J Clin Endocrinol Metab. May 30, 2014 [Epub ahead of print].
  10. Yildiz BO, Knochenhauer ES, Azziz R. Impact of obesity on the risk for polycystic ovary syndrome. J Clin Endocrinol Metab. 2008;93(1):162-168.
  11. Sanyal D, Raychaudhuri M. Hypothyroidism and obesity: An intriguing link. Indian J Endocrinol Metab. 2016;20(4):554-557.
  12. Marshall JC, Dunaif A. Should all women with PCOS be treated for insulin resistance?. Fertil Steril. 2012;97(1):18-22.
  13. Dahan, M.H., Reaven, G. Relationship among obesity, insulin resistance, and hyperinsulinemia in the polycystic ovary syndrome. Endocrine 64, 685–689 (2019).
  14. Singla R, Gupta Y, Khemani M, Aggarwal S. Thyroid disorders and polycystic ovary syndrome: An emerging relationship. Indian J Endocr Metab [serial online] 2015 [cited 2020 Aug 2];19:25-9.

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Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome (PCOS) and Obesity

One out of three women is experiencing hormonal imbalances, irregular periods and trouble conceiving. Most of these symptoms leads to infertility and affects the ability to get pregnant. Though there are multi-factorial reasons for women infertility, studies have established obesity as a serious risk factor for reproductive issues in women. The prevalence of obesity in infertile women is high. Studies have also associated obesity in women with polycystic ovary syndrome (PCOS) as one of the most common causes of infertility in women.

What is polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS) is a common hormonal condition that affects one in 10 women of reproductive age. Women with PCOS have higher levels of androgens (male hormones that is also present in female), which interrupt normal ovulation and results in irregular periods, acne, excess facial and body hair, and male-pattern baldness. In addition to these characteristic, it increases the risk of infertility and type-2 diabetes. Though the exact cause of PCOS is unknown, experts believe that a combination of genetic and environmental factors contributes to the condition.  Some clinical evidence indicates that there is a close link between obesity and PCOS.

Obesity as a risk factor for the development of PCOS

Obesity and PCOS are interlinked and shares a complex connection. According to studies, 40–80% of women with PCOS are reported to be obese. Women with PCOS have insulin resistance, which worsens with obesity and other lifestyle related factors. Being obese, especially in the abdominal region increases the risk of insulin resistance for up to 50%. Insulin Action in PCOS: Relation with Obesity Insulin is a peptide hormone produced by beta cells of the pancreas. It plays an important role in controlling blood sugar levels. It control blood glucose by signaling the liver, muscle and fat cells to take in glucose from the blood. In obese individuals, the cells in muscles, fat, and liver don’t respond well to insulin and fail to take in glucose from the blood. Thus, it result in high blood glucose levels. In order to control blood glucose levels, the pancreas produce large amount of insulin. Excess insulin leads to insulin resistance which in turn decreases the body’s ability to use insulin effectively and thus results in hyperinsulinemia. According studies, about 50–70% of women with PCOS are highly obese and have detectable insulin resistance and hyperinsulinemia [12]. Obesity-associated insulin resistance can alter the function of the hypothalamus and the pituitary gland in the brain, thereby increasing the production of androgens. Additionally, elevated insulin level increases the secretion of luteinizing hormone which inturn promotes androgen production. Increased production of androgens in women will leads to hyperandrogenism. Hyperinsulinaemia and hyperandrogenaemia changes the ovarian function and results in follicular arrest and anovulation (absence of ovulation). Studies showed that high androgen level is an independent risk factor for PCOS resulting in female infertility and ovarian dysfunction. [12,13] Hypothyroidism in PCOS: Relation with Obesity Obese women have slightly high levels of thyroid stimulating hormone (TSH) than normal weight individual. Excess body weight slows down the thyroid function and results in hypothyroidism (underactive thyroid), which have a negative impact on the ovaries. Several studies demonstrated that approximately 43% of women with PCOS suffer from subclinical hypothyroidism. [14]

PCOS: Treatment and control measures

No simple cure for PCOS exists. But the symptoms can be managed to improve the fertility and decrease the risk of long-term complications. Engaging in regular exercise, keeping a healthy diet, losing excess weight, smoking cessation and taking the prescribed medications all plays an important role in the treatment of PCOS. Lifestyle changes: Studies show that, weight loss of just 5% can lead to a significant improvement in PCOS symptoms. Changes in the quantity, type, and quality of dietary products, also change in the degree and type of physical activity have significant role in reducing body weight. Fibre-rich and low carbohydrate foods, such as whole-grain breads, cereals, whole-wheat pasta, brown rice, barley and beans can be included in the diet.  Routine exercise for at least 30 minutes may have significant influence in obesity among PCOS women. Medications:  Certain medicines are prescribed to regulate menstrual cycle, reduce excessive hair growth and promote normal ovulation. Additionally, if diet and exercise doesn’t reduce weight certain weight-loss medications are prescribed. Outlook Reducing weight can be a great challenge for obese women. But, weight loss and lifestyle changes are the effective ways that offer a beneficial effect on the ovulatory and metabolic dysfunction of obese women with PCOS.

References :

  1. Polycystic ovary syndrome (PCOS). https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439. Accessed on: 02-08-2020.
  2. Polycystic ovary syndrome. https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome . Accessed on: 02-08-2020.
  3. Polycystic ovary syndrome. https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/. Accessed on: 02-08-2020.
  4. Sam S. Obesity and Polycystic Ovary Syndrome. Obes Manag. 2007;3(2):69-73. doi:10.1089/obe.2007.0019
  5. Kahsar-Miller MD et al. Prevalence of polycystic ovary syndrome (PCOS) in first-degree relatives of patients with PCOS.” Fertil Steril. 2000;75(1):53-58.
  6. Goodarzi M, et al. Polycystic ovary syndrome: Etiology, pathogenesis and diagnosis.”  Nat Rev Endocrinol, 2011.;7(4):219–231.
  7. Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance. Accessed on: 02-08-2020.
  8. Moghetti P. Insulin Resistance and Polycystic Ovary Syndrome. Curr Pharm Des. 2016;22(36):5526-5534. doi:10.2174/1381612822666160720155855
  9. Karavani G et al. Increases in thyrotropin within the near-normal range are associated with increased triiodothyronine but not increased thyroxine in the pediatric age group. J Clin Endocrinol Metab. May 30, 2014 [Epub ahead of print].
  10. Yildiz BO, Knochenhauer ES, Azziz R. Impact of obesity on the risk for polycystic ovary syndrome. J Clin Endocrinol Metab. 2008;93(1):162-168.
  11. Sanyal D, Raychaudhuri M. Hypothyroidism and obesity: An intriguing link. Indian J Endocrinol Metab. 2016;20(4):554-557.
  12. Marshall JC, Dunaif A. Should all women with PCOS be treated for insulin resistance?. Fertil Steril. 2012;97(1):18-22.
  13. Dahan, M.H., Reaven, G. Relationship among obesity, insulin resistance, and hyperinsulinemia in the polycystic ovary syndrome. Endocrine 64, 685–689 (2019).
  14. Singla R, Gupta Y, Khemani M, Aggarwal S. Thyroid disorders and polycystic ovary syndrome: An emerging relationship. Indian J Endocr Metab [serial online] 2015 [cited 2020 Aug 2];19:25-9.