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PATHOLOGY PERSPECTIVES WHAT IS PCOS? Here is an amazing thought: every baby girl is born with ovaries that are already equipped with a lifetime supply of cells that will eventually mature into ova when she reaches puberty. In addition to being the site of egg maturation, normal ovaries also produce several hormones, including testosterone, and a variety of subtypes of estrogen and progesterone. These chemicals work with pituitary secretions (especially follicle-stimulating hormone and luteinizing hormone) to establish a menstrual cycle. If a woman has PCOS, then her testosterone and luteinizing hormone levels are high, but follicle-stimulating hormone levels are low. Consequently, ovulation becomes irregular and infrequent, and menstruation is disrupted. While not all experts agree on the diagnostic criteria for PCOS, a recent consensus of opinion suggests that at least two out of these three features be present in the post- adolescent female: oligo-ovulation (ovulation is irregular and reduced); hyperandrogenism (excessive levels of free testosterone are found in blood tests); and cysts form on the ovaries.4 Signs and symptoms of PCOS are directly linked to hormonal disruption. Further, changes in how hormones manage blood sugar leads to a high incidence of obesity among women with PCOS, although this phenomenon is more frequent in the United States than in other countries.5 PCOS is treated mainly by Other causative factors must be ruled out for a credible diagnosis: these include Cushing syndrome and congenital adrenal hyperplasia, which can affect testosterone secretion. Signs and symptoms of PCOS are directly linked to hormonal disruption. Menstruation is irregular and infertility is typical. Excessive testosterone leads to two irritating symptoms: acne and changes in hair growth patterns. Male-pattern baldness (androgenetic alopecia), along with excessive facial or body hair (hirsutism) is a common indicator of PCOS. (Interestingly, the brothers of women with PCOS often report premature balding: another sign of testosterone predominance.) managing symptoms. Because it leads to irregular periods, women who don't wish to become pregnant are frequently prescribed oral contraceptives to smooth out hormone secretion. This can be problematic, because oral contraceptives can have an adverse effect on other hormonal issues.6 Women who want to get pregnant may be prescribed fertility drugs. Medication to limit the growth of body hair and interventions to control acne may also be recommended. If a woman with PCOS is overweight, she is encouraged to fi nd strategies to control this issue; for some, this is a particularly diffi cult challenge. If no other options are satisfactory, a woman with PCOS may undergo surgical ovary "drilling": a laparascopic procedure that is thought to destroy testosterone-producing cells and thereby reduce symptoms. WHAT IS METABOLIC SYNDROME? Metabolic syndrome is a collection of features that, when they occur individually, are not cause for excessive worry, but when they occur in combinations with each other, they statistically boost the risk of developing some potentially life-threatening conditions. Several diagnostic criteria for metabolic syndrome have been developed, but a widely accepted one proposes that metabolic syndrome can be identifi ed when at least three of these fi ve risk factors are simultaneously present: • High fasting blood glucose (over 100 mg/dL after nine hours of fasting). • Abdominal obesity (a waist measurement exceeding 35" for women or 40" for men); this is somewhat fl exible to allow for individual variations. • Elevated triglyceride levels (over 150 mg/dL). • Low levels of high-density lipoproteins (under 40 mg/dL for men; under 50 mg/dL for women). • Hypertension (systolic over 130; diastolic over 85).7 Other possible features in metabolic syndrome include a high risk of blood clotting and high levels of C-reactive protein (an indicator of infl ammation). When these factors appear in combinations of three or more, they set the stage for an extremely elevated risk of type 2 diabetes, atherosclerosis, heart attack, heart failure, aneurysm, and stroke. Studies show that people with metabolic syndrome have a twofold risk of atherosclerotic cardiovascular disease, and a fi vefold risk of type 2 diabetes (which itself raises the risk for cardiovascular disease).8 visit massageandbodywork.com to access your digital magazine 113