Tag Archives: PCOS

PCOS Rebranded as PMOS: A Major Update in Women’s Health

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Misidentified ‘Cysts’ in PCOS are Not True Cysts

Steve Gschmeisner/Science Photo Library

Polycystic ovarian syndrome (PCOS) has undergone a significant rebranding. At the recent European Endocrine Society congress in Prague, renowned endocrinologist Helena Teed announced that it will now be referred to as polyendocrine metabolic ovary syndrome (PMOS).

This new terminology is more than just semantics; it corrects prevalent misconceptions about the condition. It highlights the crucial metabolic and hormonal features of PMOS that extend beyond the ovaries.

Reflecting on my diagnosis of PCOS over 20 years ago, I recall suffering from severe acne and irregular periods—common symptoms that prompted a distressing ultrasound. I was shocked to see what were labeled “cysts” on my ovaries. The fear of infertility and potential emergency surgeries left me feeling confused and devastated.

My journey led me to explore recent PCOS/PMOS research through New Scientist, unveiling the extensive misinformation surrounding the condition. After publishing an article on my findings in 2018, I discovered my story resonated with many others seeking clarity.

The major revelation is that the “cysts” associated with PCOS are misidentified; they are not cysts but rather underdeveloped eggs that remain trapped due to an excess of immature follicles in the ovaries. This shift in understanding allows for a more accurate perspective on ovarian health.

This overabundance can disrupt normal ovulation and menstrual cycles, potentially delaying pregnancy due to infrequent egg release. However, studies show that women with this condition are still likely to achieve their desired family size: 80% conceive without medication or IVF. Despite my challenges, including five miscarriages, I eventually had the three children I had always wanted.

Moreover, researchers now recognize that PMOS impacts the entire body, characterized by elevated male hormone levels like testosterone. This can lead to symptoms such as acne, excessive body hair, and thinning scalp hair. Insulin resistance is also prevalent, increasing the risk of weight gain, type 2 diabetes, hypertension, and cardiovascular issues. Mental health challenges, including anxiety and depression, are also common.

On a positive note, recent findings suggest that individuals with PMOS may have enhanced egg reserves, potentially delaying the onset of perimenopause and menopause, which could enhance reproductive options even in later years.

According to Tehi Piltonen, president of the International Society for Androgen Excess and Polycystic Ovary Syndrome and professor at Oulu University Hospital in Finland, the prevalence of this condition—affecting one in eight women—might have been advantageous for our ancestors, allowing them to store energy during times of food scarcity, thus prolonging pregnancy and reproductive viability.

While today’s environment of plentiful high-calorie foods presents challenges for those with PMOS, effective symptom management is available. Historically, attention was only given to ovarian health, particularly fertility concerns, but this new classification aims to broaden the approach.

Teed, who has campaigned for over a decade to reclassify PCOS, collaborated with 56 patient and professional organizations to establish a name that accurately reflects the science. If this change alleviates confusion and anxiety linked to former diagnoses, then the effort will have been well worth it.

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Source: www.newscientist.com

How PCOS Can Delay Perimenopause and Enable Later-Age Pregnancy

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MRI scan of polycystic ovaries

MRI Scan of Polycystic Ovaries (Green)

Gusto Image/Science Photo Library

Polycystic Ovarian Syndrome (PCOS) is well-known for disrupting hormonal balance and fertility, but surprisingly, its effects often shift as women age past 40. Research suggests that as these women age, their ovaries may naturally reshape. This change can lead to more regular menstruation, a delay in perimenopause, and even better fertility prospects.

According to Tehi Piltonen, a researcher at Oulu University Hospital in Finland, “Many women with PCOS had initially believed they would need assisted reproductive technology (ART) to conceive. They were shocked to discover they could conceive naturally in their 40s. We refer to these unexpected pregnancies as ‘evening stars.’”

As part of the Northern Finland Birth Cohort Study, Piltonen and her team examined how PCOS impacts the menopausal transition by analyzing data from 1,849 women born in Finland in 1966, all of whom have regularly participated in health check-ups.

At the age of 31, 380 women met the criteria for PCOS, defined by exhibiting at least two of three characteristics: irregular periods or amenorrhea, elevated testosterone levels, and increased anti-Müllerian hormone levels, a marker produced by ovarian follicles.

Remarkably, only 3% of women with PCOS reached late menopause or menopause by age 46, in contrast to 18% of women without the condition. This delayed transition aligns with findings from a smaller study conducted in Sweden, where women with PCOS tend to experience menopause four years later on average.

Piltonen theorizes that this delayed menopausal transition is linked to women with PCOS having a greater initial reserve of eggs, thus prolonging their fertile years.

During their younger years, having an excess of eggs may pose challenges. “It causes the ovaries to become ‘crowded,’” Piltonen explains. Often, multiple eggs attempt to mature simultaneously but stall midway due to this crowding, leading to the misnomer “polycystic ovary syndrome.” This misdiagnosis arises because these poorly developed eggs manifest as dark spots on an ultrasound, resembling cysts. Consequently, ovulation becomes infrequent or non-existent, resulting in irregular menstruation and diminished chances of conception.

Additionally, the hormonal imbalances associated with PCOS can lead to weight gain, metabolic issues, acne, and excessive body hair.

However, as the natural decline of egg count occurs with age, the ovaries of women with PCOS may become less congested. This change can facilitate proper egg maturation and release. “This is why women with PCOS often enjoy more regular menstrual cycles as they age,” Piltonen states. It may also elucidate why women who previously struggled with fertility find it easier to conceive later in life.

Piltonen posits that the delayed onset of menopause due to PCOS might carry health benefits. The estrogen drop during menopause has been tied to weaker bones, thinner skin, and heightened risks of heart disease and other complications. Research indicates that women who experience menopause after age 55 tend to live two years longer on average compared to those who undergo menopause before 40.

Piltonen also mentions that PCOS may have conferred evolutionary advantages in our ancestors. When food resources were scarce and childbirth posed risks, the ability to retain extra energy by carrying weight and effectively extending the time between births could have been beneficial. “Given how common PCOS is, I believe it must have provided some form of advantage,” she concludes.

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Source: www.newscientist.com

Unraveling Polycystic Ovary Syndrome: New Insights into the Genetic Causes of PCOS

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Visual representation of polycystic ovary syndrome showing enlarged ovaries

Science Photo Library / Alamy

Recent research has begun to shed light on the genetics behind polycystic ovary syndrome (PCOS), paving the way for potential new therapies.

PCOS affects up to 20% of women, leading to disrupted ovarian function characterized by at least two of the following: irregular or absent periods, elevated male hormones like testosterone, and the accumulation of immature eggs within cyst-like ovaries. Consequently, it can result in fertility challenges.

While the exact causes remain unclear, PCOS is believed to correlate with changes in the gut microbiome and hormonal imbalances during prenatal development. The condition also appears to have a hereditary component, with studies indicating that 70% of the risk is genetic. However, researchers have only pinpointed about 25 genetic mutations impacting sex hormone production and ovarian function, explaining roughly 10% of an individual’s risk.

To address this knowledge gap, Qiao Shigang and colleagues at Shandong University in Jinan, China, conducted a genomic study involving over 440,000 women from China and Europe, out of which 25,000 were diagnosed with PCOS, marking the largest gene analysis related to the condition to date.

The researchers discovered 94 genetic variants that appear to contribute to PCOS risk, with 73 being previously unrecognized. Notably, one mutation affects the gene responsible for the mitochondrial ribosomal protein S22, essential for mitochondrial function, an area that Zhao points out has connections in earlier studies discussing the link between PCOS and mitochondrial dysfunction.

Another newly identified variant impacts sex hormone-binding globulin, a protein that moderates the activity of sex hormones and is often found at reduced levels in women with PCOS.

Several of the remaining variants influence the function of granulosa cells in the ovaries, responsible for producing estrogen and progesterone and aiding in egg development during the menstrual cycle. This supports the hypothesis that PCOS is genetically influenced by fluctuations in sex hormone levels, according to Zhao.

In summary, the research indicated that these 94 mutations account for around 27% of the risk variation in PCOS among European participants and about 34% in the Chinese cohort.

“This study is significant because it enhances our understanding of the genetic factors associated with this condition,” remarks Elisabeth Stenner-Victorin from Karolinska Institutet, Sweden. Furthermore, it underscores the necessity of including diverse ancestral backgrounds in PCOS genetic research, according to Zhao.

Ultimately, the team identified medications that could modify the pathways affected by the recognized mutations. Some of these, like clomiphene, are already used for PCOS treatment; they stimulate ovulation which is often hampered by the syndrome. Additionally, the team discovered that betaine—sometimes utilized for homocystinuria treatment—might also benefit PCOS patients. Future studies using mice exhibiting PCOS-like symptoms could explore this treatment potential.

“Current treatments focus on alleviating symptoms, as there aren’t any medications that can cure PCOS,” states Stenner-Victorin. Typical interventions include clomiphene, contraceptive pills to manage periods, and metformin, a type 2 diabetes medication that may enhance fertility. However, effectiveness varies among individuals. “Identifying genetic clusters that affect PCOS risk will be essential for developing more targeted treatment strategies for these women,” she adds.

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Source: www.newscientist.com

Gut Microbiota Alterations Associated with Fertility Challenges in PCOS Patients

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Restoring the levels of specific intestinal microorganisms may help treat fertility problems in people with PCOS

Science Photo Library / Alamy Stock Photo

Women diagnosed with polycystic ovarian syndrome (PCOS) seem to face a heightened risk of pregnancy complications linked to lower levels of gut microorganisms.

PCOS stands as the most prevalent hormonal disorder among women of reproductive age and is a leading cause of infertility. Yet, the underlying causes and effective management remain somewhat elusive. For instance, it remains unclear why women with PCOS who do conceive are more susceptible to complications such as miscarriage, premature birth, and gestational diabetes.

Aixia Liu from Z Jiang University in China and her research team tracked the pregnancy outcomes of 220 women across 44 cities, half of whom had PCOS. All were younger than 35 and provided blood samples as well as stool and tissue samples from the endometrial (internal lining of the uterus).

Despite having comparable pregnancy rates, women with PCOS exhibited nearly double the likelihood of facing pregnancy complications, including miscarriage, premature birth, gestational diabetes, and delivering babies with low birth weight. Furthermore, researchers determined that women with PCOS have roughly half the quantity of gut bacteria, particularly Parabacteroides merdae, which was more closely linked to pregnancy outcomes than in those without the condition.

P. merdae aids in converting specific nutrients, like the amino acid isoleucine, into beneficial compounds known as short-chain fatty acids, which are crucial for reproductive health. This likely accounts for the 39% higher average isoleucine levels in the blood samples of PCOS participants and their 10% lower levels of short-chain fatty acids. Additionally, high isoleucine concentrations were noted in the endometrial tissue.

In laboratory settings, when researchers cultured the participants’ endometrial cells and introduced isoleucine, they observed increased markers of cell senescence, indicating wear or damage in the cells that compromised their function. Isoleucine seemed to disrupt the processes endometrial cells typically undergo during pregnancy.

“These findings suggest age-related changes within the uterus,” Li remarked in a statement from the annual meeting of the European Breeding Association, where the data was revealed. “Our research points to high levels of isoleucine from P. merdae potentially impairing endometrial health, even in women under 35.”

Such results suggest that alterations in the gut microbiome could play a role in PCOS-related fertility challenges; however, Andrea Dunaif at the Icahn School of Medicine at Mount Sinai, New York, expresses skepticism. Her studies indicate that reproductive aging in PCOS is more delayed than accelerated. “Reproductive issues often improve in your 30s,” Dunaif notes. “This leads me to doubt the significance of endometrial findings and their true responsibility for pregnancy outcomes.”

Nonetheless, these insights could pave the way for enhanced fertility treatments for women with PCOS. “Where might we intervene in the microbiome and adjust with various probiotics?” Dunaif suggests.

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Source: www.newscientist.com