Syndrome affects hair, menstruation, fertility

On Call

March 26, 1996|By Dr. Simeon Margolis | Dr. Simeon Margolis,SPECIAL TO THE SUN

Since age 19, my menstrual periods have occurred only every three to four months, and my efforts to become pregnant during three years of marriage have been unsuccessful. I have also noticed an increased growth of hair on my face.

Do you have any ideas about what might be causing these problems?

The difficulties you describe sound like you may have polycystic ovary (PCO) syndrome. Some of the manifestations of this syndrome are menstrual abnormalities and infertility due to lack of regular ovulation, acne, and excessive growth of hair (hirsutism). Obesity accompanies the PCO syndrome in 30 percent to 40 percent of women.

PCO syndrome derives its name from the presence of many large cysts in the ovaries. Why this happens is obscure, but in each case, the ovaries produce excessive amounts of male sex hormones, which cause the hirsutism and acne, and predispose women to male pattern baldness later in life.

The diagnosis can be established by identifying polycystic ovaries by ultrasound and measuring elevated levels of male sex hormones in the blood.

PCO syndrome is common. In some studies, the diagnosis was made in over half the women who have no menstrual periods or infrequent periods and in about half the women with hirsutism but normal periods. Some studies indicate that PCO syndrome is even present in 10 percent to 20 percent of women with normal periods and no hirsutism.

Another worrisome feature of PCO syndrome in women with menstrual irregularities is resistance to the action of insulin, with resulting increases in blood levels of insulin (hyperinsulinism). Although hyperinsulinism is common in obesity, it is more frequent in women with PCO syndrome than in equal weight women who do not have it.

Hyperinsulinism is often associated with elevated levels of blood triglycerides, reduced levels of protective HDL cholesterol, a greater risk or coronary artery disease, and as much as a seven-fold higher risk of developing diabetes.

Weight loss is an important first step in efforts to improve fertility in obese women with PCO syndrome.

In some, weight loss alone may trigger spontaneous ovulation and pregnancy.

Weight loss in obese women and prevention of weight gain in normal weight women with PCO syndrome are essential to overcome the insulin resistance and associated risks of diabetes and coronary disease.

Drug treatment with clomiphene citrate to induce ovulation is effective in about 75% of women with PCO syndrome.

Treatment of hirsutism is often not effective, but spironolactone, which blocks the action of male sex hormones by binding to their receptors in hair follicles and various other tissues, may work for some.

Its main side effect, erratic vaginal bleeding, requires that spironolactone be taken along with a low dose oral contraceptive.

Patience is essential during spironolactone treatment, because its effect on hair growth takes considerable time -- about five months for any obvious change and 18 months or longer for a maximum effect.

Dr. Margolis is professor of medicine and biological chemistry at Johns Hopkins School of Medicine.

Pub Date: 3/26/96

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