What causes polycystic ovary syndrome?

Although a great deal is now known about the polycystic ovary syndrome, the exact cause has yet to be found. Polycystic ovary syndrome is probably an inherited condition. There has been one specific gene implicated and two others also seem to be involved. Premature balding in men is often a manifestation of the same gene that results in PCOS in women. The hormone chemistry of polycystic ovaries is often deranged. This may result in period problems, particularly reduced or absent periods. Polycystic ovaries tend not to release their eggs regularly and, without treatment, there may be problems with fertility.

In recent years it has become recognised that many of the metabolic (body chemical) changes seen in PCOS may be related to insulin resistance.^{0301, 9901}

Insulin is produced by the pancreas, which is a gland found in the abdomen. This gland has two functions, both related to the way the body deals with food. It secretes enzymes (chemical catalysts) into the small bowel allowing food to be broken down into the basic components that can be absorbed. The pancreas also secretes insulin into the blood stream. Insulin is a hormone (hormones) that reduces the blood sugar level, mainly by converting sugar into fat. Diabetes occurs when the pancreas can no longer produced sufficient insulin to prevent the blood sugar level rising too high. It turns out that most women with PCOS are resistant to insulin. Hormones work like a key in a lock. Insulin resistance means that the insulin hormone receptors are defective and a stronger key is required. The result is an increased output of insulin and it is the higher levels of insulin that seems to result in the typical problems of PCOS. Women with PCOS are not diabetic and so there is no difference in their response to a glucose (sugar) load(Figure 7.2). Typically, women with PCOS require greater output of insulin from the pancreas to prevent their sugar rising too high (Figure 7.3).

It is becoming recognised that some patients have symptoms and blood chemistry (hormone levels) typical of polycystic ovary syndrome, although their ovaries do not have a typical PCO picture. The latest definition of PCOS allows for this.⁰⁴⁰¹

Figure 7.2 Glucose Tolerance Test - Normal and PCOS women

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Figure 7.3 Insulin Response to Glucose Load - Normal and PCOS

Related Medical Abstracts - Click on the paper title:-

See Also:

PCOS - Polycystic Ovary Syndrome

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London.

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