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Victoria Beckham is pregnant with her fourth child. The former Spice Girl and fashion designer already has three sons with soccer legend David Beckham. Getting pregnant has not been easy for Posh Spice, as she suffers from a disease called Polycystic Ovarian Syndrome, an endocrine disorder which can affect fertility.
Today we have a guest blog fromNancy Onyett, FNP-C a board certified family nurse practitioner about Polycystic Ovarian Syndrome.
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome (PCOS) is a reproductive metabolic disorder in young women that is often missed in a primary care office. A common complaint by a young woman is “I can’t lose weight” or “my weight keeps going up and I barely eat anything”. Other signs/symptoms such as irregular periods, inability to conceive, facial hair, persistent skin rash, acne, oily skin, and a darkened neck ring is specific and common to this disorder. About fifty percent of women are obese with insulin resistance and fifty percent are thin without insulin resistance. In PCOS affected women phenotype variability exists with a caveat of the above symptoms.
Researchers are still uncertain to the exact cause of PCOS but believe environmental and genetic influences play a role in it. Another contributing factor that could be related is chronic body inflammation from the environment and fetal exposure to male hormones. It is believed hormonal imbalances are triggered by excess secretion of insulin from the pancreas. This leads to the ovaries to secreting more estrogen and testosterone and less progesterone which causes abnormal menstrual cycles, often skipping months at a time.
Laboratory markers correlating with this syndrome include the LH/FSH ratio 1:1 along with high values for free testosterone, estradiol, and a low value for progesterone. PCOS that is more advanced have LH/FSH ratios up to 4: 1 and sometimes much higher. Insulin levels are usually greater than or equal to 15 depending how advanced the syndrome is which also affects both metabolism and weight gain. Other metabolic findings include hypothyroidism, abnormal glucose metabolism, and elevated cholesterol triglycerides. The fasting sugars may be elevated indicative of impaired fasting glucose or the two hour postprandial blood sugar is elevated indicative of impaired glucose tolerance. Slowly, the hemoglobin A1C elevates along with FBS till diabetes is diagnosed.
The first goal in treatment is lifestyle change to a structured regimen of calculated macronutrients, and exercise involving both cardiovascular and strength training. The weight must be lost to help reverse this syndrome and restore normal ovulatory menstrual cycles. Patients who become partners in their management have the best success in weight loss and reversing their syndrome to normal cycles of menses. Pharmacological treatment consists of metformin, spirolactone, natural progesterone, and armour thyroid if T3 is low. These medications help with unwanted hair growth, energy, and metabolism, insulin lowering, and balancing estrogen. Once, approximately 10% of the weight is lost and progesterone is consistently taken the menstrual cycles resume and insulin levels start to lower. In thin patients without insulin resistance treatment is symptomatic with spirolactone, progesterone and T3 if needed. Some providers do use the birth control pill but I find it more of a problem withweight gain with this population.
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