March 17, 2016
The Skinny on PCOS:
PCOS in Non-Obese Women

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of reproductive age women, affecting approximately 4-6% of women in the US alone. While we typically think of women with PCOS as being overweight or obese, women of all shapes and sizes can present with this disorder.

According to the Rotterdam criteria a diagnosis of PCOS can be made if two of the following are present; oligo- or anovulation, hyperandrogenism (acne, hirtsutism, male-pattern hair growth) or polycystic ovaries on ultrasound. Note that BMI is not a part of PCOS diagnosis, leading to the question: When did body habitus come into the clinical thought process surrounding PCOS?

This is easily explained by the degree of insulin resistance and comorbid conditions seen in clinical practices. It is well documented that obesity and PCOS go hand in hand. In fact, elevations in blood insulin levels have been shown to act directly by increasing ovarian production of androgens and indirectly by causing a disordered release of FSH and LH leading to many of the physiologic implications of PCOS.

The “typical” insulin resistance patient will present with central adiposity as well as a BMI > 30, but this doesn’t mean thin or non-obese women don’t suffer from the insulin resistance seen in PCOS, but instead demonstrate a range of insulin resistance. This makes sense as obesity takes time to develop, so will insulin resistance. In fact, Dunaif et al, suggest beta-cell dysfunction as well as insulin sensitivity plays a role in PCOS in both the obese and non-obese population, with the obese population experiencing less insulin sensitivity than the non-obese women studied with PCOS . Women with PCOS “most commonly have postprandial dysglycemia” which is a reflection of peripheral, mainly skeletal muscle, insulin resistance rather than fasting dysglycemia that corresponds with increased endogenous glucose production. Because of this, an oral glucose tolerance test may be used to determine the degree of post prandial glucose tolerance seen in PCOS.

Hormone testing of a patient with suspected PCOS or metabolic syndrome commonly demonstrates elevations in one or more androgens (testosterone and DHEA). Elevations in androgens are detectable in salivary hormone testing well before serum will detect frank pathology. This simple and non-invasive test offers the potential to catch PCOS/metabolic syndrome in its infancy and promptly initiate treatment approaches that will profound impacts on patients’ health.

References:
  • ACOG. (2011). 2011 Women's Health Stats and Facts [Brochure]. Author. Retrieved March 15, 2016, from https://www.acog.org/-/media/NewsRoom/MediaKit.pdf
  • Dunaif A, Finegood DT. Beta-cell dysfunction independent of obesity and glucose intolerance in the polycystic ovary syndrome.
  • Legro RS, Kunselman AR, Dodson WC, Dunaif A 1999 Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 women. J Clin endocrinol Metab 84:165-169.
  • Rizza RA 2010 Pathogenesis of fasting and postprandial hyperglycemia in type 2 diabetes: implications for therapy. Diabetes 59:2697-2707.

Labrix Clinical Spotlight Series:
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Labrix Director of Clinical Services Robyn Kutka ND discusses common symptoms associated with menopause, and outlines an effective and straightforward testing and treatment approach for female patients.




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