Q I am a 35-year-old woman, and I've not had a regular period since my teens. I have also been infertile since then, and suffer from hirsutism and a disfiguring skin condition. Recently, I was diagnosed with polycystic ovarian syndrome (PCOS). Could this syndrome be responsible for my skin condition and hirsutism? Does anyone know the cause of the syndrome, and can anything be done about it? - ON, London
A Polcystic ovarian syndrome or PCOS is one of the most common causes of infertility in women - affecting up to 10 per cent of the female population - but it often goes undetected even when the sufferer displays one or more of its symptoms. These include hirsutism (excessive hair growth in a normal or abnormal distribution on the body), male-pattern baldness (alopecia), irregular periods, infertility and weight problems such as obesity. Other symptoms are acne, raised insulin levels, insulin resistance, diabetes and high blood pressure.
The syndrome is caused by abnormal hormone levels - usually of luteinising hormone (LH) or follicle-stimulating hormone (FSH) - which together make ovulation possible. Its name comes from the numerous cysts that usually form on the ovaries, although this is not always the case. In one study, the ovaries of sufferers were of a normal size and had no abnormalities ((Dunaif A, Polycystic Ovary Syndrome, Onhealth Network Co, 1998: 1-4).
Although the cause of the condition is not known, there appears to be a definite link between PCOS and weight problems. Most sufferers have difficulty in controlling their weight, and two-thirds of women with bulimia also have PCOS. Overweight women in general also tend to have far lower levels of sex hormone-binding globulin (SHBG) in their blood, a deficiency that can lead to raised testosterone levels which, in turn, can cause some of the distressing symptoms of PCOS, such as excessive facial hair and balding.
Losing weight is one of the most important non-drug approaches to counter the worst effects of PCOS and may improve ovulation (Clin Endocrinol, 1992; 36: 105-11). This finding was supported by another study where all but one of the women with PCOS who lost weight went on to conceive (Hum Reprod, 1995; 10: 2705-12).
A low-carbohydrate diet that also eliminates all refined carbohydrates - one version of this is the fashionable Atkins diet, although we always recommend the Montignac diet as a safer approach - offers the double benefit of losing weight and lowering insulin levels which, in turn, will reduce the ovaries' production of testosterone, according to the University of Chicago's Center for Polycystic Ovarian Syndrome.
The Center has also found that one in three women with PCOS has an abnormal glucose tolerance, and that one in 10 will be diabetic by age 40 (http://centerforpcos.bsd.uchicago.edu/). Studies suggest that 30 per cent of PCOS sufferers are also insulin resistant, and some researchers believe the rate is even greater than that (International Council on Infertility, http://www.inciid.org).
In addition to weight, the Center's findings suggest that nutritional deficiencies may also play a part in causing the syndrome. Supplemental chromium can help with glucose tolerance (Metabolism, 1992; 41: 768), so you may wish to include chromium in your general nutritional programme. Your supplemental regime should also include a high-quality multivitamin/mineral combination, plus extra zinc (a total of 30 mg/day) and essential fatty acids. Make sure you get adequate B vitamins, which help the liver in its central role of detoxifying hormones that will eventually be excreted from your body.
Exercise can also minimise body fat and raise levels of SHBG, which will counteract the effect of the high levels of testosterone. Exercise also lowers high levels of oestrogen. In one study, women who exercised for four hours a week more than halved their risk of breast cancer (J Natl Cancer Inst, 1994; 137: 18).
Besides dietary problems, constant stress could account for your condition. According to Colette Harris, author of PCOS: A Woman's Guide to Dealing With Polycystic Ovary Syndrome (Thorsons, 2000), stress will trigger stress hormones, especially cortisol, which places your glucose stores on red alert for the 'fight-or-flight' response
When excess amounts of these stress hormones are constantly being released, you can develop Cushing's syndrome, which causes weight gain, mood swings, excess body hair, irregular periods, acne and diabetes, many of which are the same symptoms seen in PCOS. Furthermore, the artificially high levels of insulin in most women with PCOS tend to increase cortisol levels so such women are flooded with cortisol in times of stress.