What has gone wrong in polycystic ovary syndrome (PCOS) ?

Polycystic ovary syndrome, PCOS for short, boils down to the body going through the motions to produce an egg each month, but when all is said and done, the egg does not actually hop out of the ovary and move down the fallopian tube.

Since the egg stays tucked away in the ovarian palace, falling pregnant is a major challenge. The poor old sperm arrive in the tube, after a long arduous swim to find no princess.

PCOS is the number one reason for infertility.

So why is the body going through the motions, but not actually delivering the goods.

Male hormone acting as a bully

The fundamental problem in polycystic ovary syndrome (PCOS) is too much male hormone.

It is politically incorrect to talk about testosterone in females, so this excess male hormone is usually referred to as an androgen. The official medical description for the problem is hyperandrogenism.

The male hormones are acting like the “gentlemen” who control the door at a night club.

Flexing their over-sized muscle, they exert their authority at the door to the fallopian tube. They intimidate the poor little egg princess, so she doesn’t actually leave the palace, ensuring that male competition in the form of handsome sperm, can only look at the princess from a distance.

Trapped eggs cause lumpy ovaries

Each month, the androgen bully, blocks the passage of the princess out of the ovary so she cannot get out an about and attract the sperm’s attention.

These trapped eggs waste away in the ovary, eventually dying, the only evidence of their tortured existence, the little bump on the surface of the ovary.

These are the bumps that are picked up when the ovary is scanned using an ultrasound. It is those “bumps” that are the cysts, the fact that there are lots of them, is where the name comes from – poly (many) cysts.

The male heavy, can also cause pimples and whiskers

Too many androgens can also cause outbreaks of acne, because the male hormones increase the production of sebum. Pools filled with oil are the perfect party venue for Propionoibacterium acnes, the bacteria which causes spots.

High androgen levels can also cause more freakish problems such as facial hair and a deepening of the voice, as well as extra big muscles and baldness. The medical name for these problems is hirsuitism.

Who hires the male bouncer ?

So the androgens are causing the trouble because they’re strutting around, flexing their oversized muscles. But you only have to talk to a testosterone loaded jock, to know that they are all brawn and no brains. Whose orders are they executing ?

The brains behind the PCOS operation is another hormone, a character usually associated with metabolic problems related to sugar, NOT testosterone. The guy behind PCOS is none other than insulin.

Insulin drives androgen production

Insulin’s sticky fingers are pulling the strings in this hormone mayhem.

Insulin is encouraging the ovary to produce these androgens directly

Insulin is blocking the ability of the liver to produce a protein known as sex hormone binding globulin (SHBG). Less SHBG, means that the androgens that are being produced are not able to travel round the body in an inactive state, tucked away in their special transport protein, instead they’re out on a power crazy spree.

Insulin also gives the pituitary gland, the master gland, a rather big headache, so it doesn’t get the production of luitenizing hormone right. Luitenizing hormone is the chemical that controls egg development.

So it’s three strikes and you’re out for the egg.

Eliminate the bouncer to beat PCOS

To beat PCOS you need to bring down the levels of androgens.

One way to do this is to re-set all the sex hormones – this is the thinking behind using oral contraceptives, which is often suggested when a women is suffering from menstrual irregularities. A more specific approach is to administer drugs that oppose the androgens (anti-androgens) such as cyproterone acetate or flutamide.

But a better way to stop the bouncer is to simply not pay him. No one works for nothing these days, not even bullies. Insulin is doing the hiring, so the most effective way to stop the androgens is to decrease insulin levels.

Rein in insulin

Insulin levels can be decreased pharmacologically using drugs which are classified as insulin sensitizers, such as metformin or thiazolidinediones.

But you don’t need drugs to rein in insulin. Cut down on the carbohydrates, this will bring the insulin levels down and improve insulin sensitivity.

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