Polycystic ovarian syndrome (PCOS) is a very common reproductive health problem seen in women mostly under 30 years of age. Irregular menstrual periods, on and off bloating and weight gain, and appearance of male physical characteristics can be very disturbing for a young woman. The PCOS Hypoglycemic Attacks that often result from the PCOS are also a cause of concern.
So what is PCOS? PCOS is basically a chronic disorder caused by genetic or environmental factors resulting in multiple benign cysts on the ovaries. Research suggests a familial or genetic basis in close association with obesity. It is not necessary that a woman who develops PCOS is obese, but disorders of fat metabolism do effect production of sexual hormones.
PCOS is caused by increased production of LH and decreased FSH in the body. This imbalance prevents the ovaries from releasing an egg every month. Small cysts develop in the ovaries as a result.
These cysts are not harmful but lead to enlarged painful ovaries that cause further hormonal imbalances. Some symptoms of PCOS can be really alarming.
Role Of Female Hormones During Menstrual Cycle
1. The pituitary gland produces FSH (follicle stimulating hormone)and LH (leutenizing hormone) which has an effect on the ovaries. The normal ratio of LH:FSH in the body is 1.5:1
- FSH stimulates follicular development and maturation in the ovaries (as the name suggests)
- LH causes the release of the mature egg from one of the follicles (LH surge is detected in positive ovulation tests)
2. Estrogen, progesterone and testosterone (in small amounts) are produced by ovaries
- Estrogen causes growth of endometrial tissue of uterus in preparation for a future implantation
- The ruptured follicle that released the egg, now called corpus luteum, produces progesterone which is responsible for shedding of uterine lining in case the egg is not fertilized
- If the egg released gets fertilized by a sperm and implants into the uterus, the placenta produces HcG which can be detected in urine pregnancy test
Hormonal Imbalance of PCOS
- PCOS and obesity (deranged lipid profile) together cause insulin resistance which results in high insulin levels (hyperinsulinemia) in the blood. This can cause PCO hypoglycemic attacks
- The high insulin levels drive the ovaries to convert progesterone to testosterone
- The high insulin also decreases production of sexual hormone binding globulin (SHBG) by the liver
- Low FSH prevents releasing of the egg from the follicle, causing an anovulatory cycle. This results in multiple cysts on ovaries and no corpus luteum to produce progesterone. As a result, ovaries produce estrogen and excess testosterone but no progesterone.
Symptoms of PCOS
The important triad which is responsible for the symptoms of PCOS, is hyperandrogenism (HA), insulin resistance (IR) and acanthosis nigricans (AN). If all these are present together, it is sometimes called HAIRAN Syndrome.
Symptoms of PCOS include:
- Pelvic pain due to enlarged, cystic ovaries
- Irregular or Missed periods (long cycles, little bleeding, many may have normal periods for 1-2 years before becoming irregular and infrequent)
- Acne and oily skin
- Skin pigmentation around neck, armpits, knees and elbows. Also called acanthosis nigricans
- Male pattern baldness (alopecia) or male pattern hair growth on the body (hirsutism)
- PCOS Hypoglycemic attacks
- Mid section weight gain (waist >35″)
- Fluid retention
- Increased carbohydrate cravings
- Increased or decreased sex drive
- Breast tenderness
- Psychological effects like anxiety, depression and panic attacks
- Sleep apnea, poor sleep
- PCOS and nausea, bloating and esophageal reflux
- Chest pain and palpitation
- High blood pressure and increased clot formation also associated with high insulin levels, a major risk factor for development of heart disease and stroke
1. Pelvic ultrasound
- Both ovaries enlarged with multiple cysts (20-100 cystic follicles)
2. Hormone Assay
- LH raised levels
- Testosterone level mildly elevated
- LH:FSH ratio 3:1
3. Other Blood tests
- abnormal lipid profile – high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol
- abnormal fasting blood glucose and glucose tolerance test
- SHBG is decreased
Associations of PCOS
- Type 2 Diabetes manifested as PCOS hypoglycemic attacks (50% women diabetic before age 40)
- Infertility due to disrupting hormone balance preventing follicles from maturing and releasing a viable egg
- Obesity often strongly influenced by stress
- Endometriosis and uterine fibroids
- The Metabolic Syndrome leading to fatty liver
- Heart disease is usually late stage event and cause of death in women with PCOS
- Ovarian cancer often missed till it has reached an advanced stage
- Uterine cancer, mostly a result of chronic endometriosis
- In Vitro Fertilization is the main type of assisted reproductive technology for infertility by PCOS
PCOS Hypoglycemic Attacks – Can PCOS Cause Hypoglycemia?
Hypoglycemia is when blood sugar level falls below 3.9 mmol/L or 70 mg/dl. It can be a life threatening condition leading to coma and death.
Hypoglycemia polycystic ovarian syndrome is a result of high insulin levels in the blood. Most times, people do not suspect younger women of having type 2 diabetes. This is usually caused by insulin resistance, as the pancreas are doing their job of producing insulin.
Such women also don’t suffer from the usual form of hyperglycemia (increased blood sugar levels) which is a feature of diabetes. The presence of the disease is only discovered after the occurrence of PCOS hypoglycemic attacks caused by the high insulin levels in the blood.
PCOS Hypoglycemic attacks occur when the blood glucose level suddenly drops and becomes abnormally low. Low blood sugar and PCOS will usually happen due to the excess glucose in the blood being removed by excessive levels of insulin. It can also happen when not enough glucose is secreted into the blood such as if there is liver damage.
- Increased pulse rate, tachycardia
- Increased blood pressure
- Sweating and anxiety
- PCOS and Nausea
- Lightheaded feeling
- Extreme Hunger
- Tingling and numbness of skin
- Trouble sleeping
- Unclear thinking
The best way to treat PCOS hypoglycemic attacks is to treat its symptoms. Eating small amounts of carbohydrates and a little bit of protein at short 3-5 hour intervals can help.
We suggest cheese and crackers, a slice of whole wheat toast with peanut butter, or an egg sandwich.
PCOS At Menopause
Many symptoms of PCOS persist even when a woman is nearing menopause. Although hormone levels change during this time but the PCOS symptoms continue. For instance excessive hair growth continues, and male-pattern baldness or thinning hair gets even worse after menopause. PCO hypoglycemic attacks could also be more frequent. The risks of health problems associated with PCOS such as heart attack, stroke and diabetes also increase as a woman nears and reaches menopause.
Treatment of PCOS
- Oral contraceptive pills (progesterone alone or in combination with estrogen) are used to treat irregular menstrual cycle, effects of hyperandrogenism and severe menstrual cramps. These lower free testosterone by opposing estrogen, suppressing LH stimulation and increasing sex hormone binding globulin (SHBC)
- Metformin is a diabetes medicine used to lower testosterone effects and lower insulin resistance
- Progestin will oppose estrogen related hyperplasia in uterus
- Anti-androgens like spironolactone can control hirsutism
- Clomiphene citrate pills (clomid) and gonadotropin shots are used to induce ovulation
If a patient is not responding to medical treatments, surgery might be needed. Laparoscopic ovarian drilling might be needed to find out the extent of the PCOS. There are three techniques used to treat PCOS surgically; laser diathermy, cautery and multiple biopsies.
Carol Foster, a Nutrition Specialist and Author, who battled PCOS herself has come up with a decent formula to combat PCOS, PCOS Hypoglycemic Attacks, PCOS and nausea and many other symptoms naturally. You can check it out right here. In case your condition makes you unable to use oral contraceptive pills or other medicines, this could well be your ticket to some relief.