In the past, I never used to ask a woman whether her mother had problems with infertility, irregular menstrual cycles, or excess facial or body hair. But with the most recent research findings published in Fertility and Sterility®,* I will now add to my list of questions: "Did your mom have problems getting pregnant?" and "Did your mom have irregular menstrual cycles?"
If you are the mother of an adolescent girl, it is important to schedule her first reproductive health visit if she:
- has irregular menstrual cycles
- is more than two years from her first menstrual period
- has experienced two or more years of intermittent or absent menstrual cycles.
She may have PCOS, Polycystic (pah-lee-SIS-tik) Ovary Syndrome, a condition in which women have many small cysts (fluid-filled sacs) in their ovaries.
PCOS is a common disorder that increases a woman's lifetime risk of infertility, type 2 diabetes and cardiovascular disease. PCOS can also affect a woman's menstrual cycle, hormones (especially testosterone), blood vessels and appearance.
Currently, the diagnosis of polycystic ovary syndrome is made based on testosterone excess, intermittent or absent menstrual cycles and polycystic ovaries. Most women will schedule a visit based on the intermittence or absence of menstrual cycles. A blood sample is required to determine the presence of excess testosterone. Polycystic ovaries are diagnosed with ultrasound.
The impact of PCOS is experienced more acutely in young women when they have problems becoming pregnant. If your menstrual cycles are intermittent or absent then your ability to ovulate is compromised. It is important to diagnose PCOS early in adolescents. Research shows menstrual irregularities can be improved with dietary and lifestyle changes. Studies also indicate that symptoms of PCOS can be detected early in young women and that obesity plus PCOS is strongly associated with insulin resistance.
What is insulin resistance?**
Insulin is a hormone that is produced by the beta cells of the pancreas. These cells are scattered throughout the pancreas in small clusters known as the islets of Langerhans. The insulin produced is released into the blood stream and travels throughout the body. Insulin is an essential hormone that has many functions within the body. Most functions of insulin are directed at metabolism (control) of carbohydrates (sugars and starches), lipids (fats), and proteins. Insulin also regulates the functions of the body's cells, including their growth. Insulin is critical for the body's use of glucose as energy.
With insulin resistance, the pancreas produces more and more insulin until the pancreas can no longer produce sufficient insulin for the body's demands, then blood sugar rises. Insulin resistance is a risk factor for development of diabetes and heart disease.
PCOS moms and their daughters
Recent evidence suggests that PCOS is a genetically inheritable disorder and that mothers with PCOS contribute increased levels of testosterone to the environment of the growing fetus. This excess testosterone can affect their fetal daughters. Furthermore, the fetal ovary can also be a source of excess testosterone.
Change your PCOS by changing your environment
Have you or your daughter received a diagnosis of PCOS? If your lifestyle includes conflicts in nutrition and inactivity and you have been diagnosed with PCOS, you may be able to change the symptoms of PCOS by engaging in dietary habits that result in weight loss. You'll have to combine exercise with weight loss to achieve an overall improvement in your symptoms.
The combination of weight loss and exercise will significantly decrease the risks for onset of type 2 diabetes, hypertension and heart disease in both young and older women.
I look forward to your feedback in regards to these issues. Let me know how your mother-daughter conversations go.
*David H. Abbott, PhD, and Fida Bacha, MD, authored the article: "Ontogeny of Polycystic Ovary Syndrome and Insulin Resistance in Utero and Early Childhood," published in the July issue of Fertility and Sterility, Vol. 100 No. 1, pages 2-7. Fertility and Sterility® is the official Journal of the American Society for Reproductive Medicine.