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Articles and research studies related to PCOS. This forum is open to the public. PCOS is an autoimmune condition.
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TOPIC: PCOS and Metabolic Syndrome

PCOS and Metabolic Syndrome 04 Dec 2007 14:02 #772

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Many women with PCOS are significantly at risk for diabetes and metabolic syndrome. If you're unsure what designates metabolic syndrome please see the following:
From DOC NEWS, a publication of the American Diabetes Association:

According to the third report of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III), adults who are diagnosed with metabolic syndrome must have three or more of the following:

-Waist circumference >102cm (40.2") in men and >88 cm (35.6") in women

-Serum triglycerides >/=150 mg/dl

-Blood pressure >/= 130/85 mmHg

-HDL cholesterol < 40 mg/dl in men and <50 mg/dl in women

-Serum glucose >/= 110mg/dl (>/=100 mg/dl may be applicable)

-The definition of metabolic syndrome put forth by the World Health Organization (WHO), on the other hand, begins with poor glucose metabolism-diabetes, impaired fasting glucose, impaired glucose tolerance, or insulin resistance- and at least two of the following:

-waist-to-hip ratio > 0.90 in men or >0.80 in women

-Serum triglycerides >/= 150mg/dl or HDL cholesterol <35 mg/dl in men and <39 mg/dl in women

-Blood pressure>/= 140/90 mmhg
-Urinary albumin excretion rate >20 mg/min or albumin -to-creatine ratio >/= 30 mg/g

PCOS and Metabolic Syndrome 04 Dec 2007 14:19 #771

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POLYCYSTIC OVARY SYNDROME (PCOS) AND THE METABOLIC SYNDROME: VERY COMMON (AND UNDERTREATED)

04/21/07
Polycystic ovary syndrome (PCOS) is the most common endocrine pathology of women of reproductive age, with a prevalence of 10% to 15%. The etiology is unknown and probably heterogenous. By definition, PCOS is characterized by chronic anovulation, menstrual irregularities, and clinical or biochemical signs of hyperandrogenism after exclusion of other diseases (eg, congenital adrenal hyperplasia, Cushing’s syndrome, hyperprolactinemia, and androgen-producing tumors). There is increasing consensus on the following diagnostic criteria; two of three must be fulfilled: (I) polycystic ovaries on ultrasound, (II) clinical or biochemical hyperandrogenism, and (III) secondary amenorrhea or oligomenorrhea. Biochemically, patients display elevated androgen (testosterone) levels, and ultrasound reveals enlarged polycystic ovaries. The syndrome may not cause significant clinical symptoms, and some women live their whole lives unaware of this abnormality.1

However, many patients do develop symptoms related to increased concentrations of male hormones and/or fewer ovulations. The excessive androgen levels may cause hirsutism, acne, or male-pattern balding. These symptoms often cause the patient to present to the doctor.2

There may also be menstrual dysfunction and subfertility.3

This will often lead to biochemical evaluation and ultrasound examination, revealing PCOS. Apart from subfertility, there are other problems that have become increasingly apparent in recent years.

Quite often, PCOS patients have increased body weight and obesity with a male upper-body pattern. In addition, abnormalities characteristic of the metabolic syndrome with insulin resistance are frequently present. Finally, PCOS is associated with an increased risk of endometrial cancer.

Therapeutic measures include lifestyle intervention with more physical activity, and weight loss should be encouraged in almost all patients. Maintenance of normal body weight is essential.

Additional medical treatment is quite often warranted. As far as diabetes and the metabolic syndrome are concerned, metformin is the drug of choice. With pregnancy, metformin is considered contraindicated, but only limited data are available.4 Oral contraceptive agents may be beneficial in both lean and obese5-6 individuals.

In addition, antiandrogens, such as spironolactone or flutamide, may improve the outcome. These drugs may be used in combination with metformin7 and estrogens both in obese and non-obese patients. Nevertheless, weight loss8 and increased physical activity remain a mainstay of treatment. Antihypertensive treatment is important with elevated blood pressure, and drugs that block the renin-angiotensin-aldosterone system are the treatment of choice. Reference 4 provides us with a careful review of this important topic.
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