PCOS is often looked at and talked about as if it were a disease, but IMO classifying PCOS as a disease is not accurate. This is because PCOS is actually a syndrome. A syndrome is basically a bunch of simultaneously occuring related manifesting symptoms, not a disease. A syndrome is something that results from disease-causing agents, it isn't a disease but it is caused by a disease (sort of how to have HIV is to be diseased, but AIDS is the syndrome that results).

A woman is said to have PCOS when she exhibits symptoms of androgenization, in absence of any obvious cause (say endocrine disease like cushing's, or steroid abuse, something like that). The androgenization has to impair fertility, which is why the emphasis is mainly on ovulation (the cysts on the ovaries are caused by failed/incomplete ovulation), however other symptoms of androgenization are usually required present before diagnosis is made, such as excess hair growth, acne, hair loss on the head, etc.

I harp on the disease/syndrome distinction for a reason. I fully believe that the label PCOS is entirely inadequate. The diagnosis of PCOS is made exclusively on a bunch of symptoms, but not on any pathological disease. Naturally this can cause lots of confusion for patients and researchers.
I think PCOS is much like diabetes. Up until suprisingly recently doctors didn't know the difference between type 2 diabetes and type 1 diabetes... all diabetics were diagnosed soley by their symptoms of having high blood sugar and general inability to use sugar. Doctors soon discovered that there were actually two types of diabetes, and they were completely unrelated to each other in pathology. Type 2 is caused by IRS. Type 1 is much less common and caused most commonly by auto-immune disorder/disease which causes the body to destroy its insulin producing beta cells. Type 1 usually occurs in early childhood (but not always) whereas type 2 takes longer to set in and occurs in adulthood (again, but not always especially now that carb consumption is way up). Type 1 diabetics have no IRS, they merely lack insulin because they can't make it. Type 2 diabetics on the other hand were born with relatively "normal" capacity to make insulin, but because of a biological susceptability or poor/uninformed dietary choices this results in their body to be unable to respond to insulin due to IRS, thus causing type 2 diabetes. Sometimes type 2s can overwork their insulin producing capabilities and become insulin dependent like type 1's, but it's not by or for the same cause.

PCOS, like diabetes, is a disease defined by symptoms but not any disease causing agent. Just as in the example of diabetics above, classifying a syndromes as diseases is going to have problems. I don't think all PCOS women have it for the same reason, and I believe in the future there will be different "types" of PCOS as there are different types of diabetes. The most common type of PCOS is probably caused by IRS due to the number of women who improve on LC diets. Though most women who have PCOS symptoms are insulin reistant, curiously not all women who have PCOS symptoms are. It also seems that not all PCOS women respond to any particular type of diet or insulin-sensitizing medication better than the other. This tells me there is strong evidence supporting the potential for as yet unidentified diseases that can result in PCOS, which may be totally unrelated to IRS.

However, because of the nature of our diets (they are VERY poor in composition and replete with disease-causing agents), it is unsurprising that most PCOS women are actually suffering from IRS... the PCOS is merely a symptom of uncontrolled insulin resistance. There seems to be an especially strong link between PCOS and tendancy towards hypoglycemia. It seems that whatever results in the high insulin levels causes both the hypoglycemia and the PCOS. The disease causing agent is actually high glycemic load carbohydrate food. To resolve IRS-related PCOS, total carbohydrate intake should be minimized, especially higher glycemic index carbohydrates.

Excellent post!! I just want to add some info about the different variants of PCOS:

If I were doing a research study on PCOS, I would have to stick to the strict definition of PCOS which requires that the woman have menstrual cycles longer than 35 days in conjunction with either clinical and/or laboratory evidence of increased androgen production. Women who have this constellation of signs and symptoms would be defined as having "Classic Poly-Cystic Ovary Syndrome". According to some recent data, only about one-third of all women with PCOS have the full-blown classic syndrome. The other two-thirds have only one or two features but still, when looked at appropriately, do fit the criteria.

There are, however, a number of women who do not fit the classic textbook definition of PCOS but who have many features which makes the diagnosis of PCOS the most appropriate one for them. We would term these women as having "Non-Classic PCOS".

For instance, instead of having very infrequent cycles, some women will have totally irregular bleeding with periods coming every two weeks, sometimes alternating with much longer cycles.

Other women with non-classic PCOS will have fairly normal cycles and increased androgen production will have a typical "poly-cystic" appearance of the ovary on ultrasound. A number of studies have shown that the presence of a poly-cystic appearing ovary is frequently associated with many of the other features of classical PCOS even though the women may not fit the true definition.

Another study has shown that there may be at least two different disorders associated with PCOS that, again, we would term "non-classic PCOS". The first of these (which I am not sure really falls under the category of PCOS) are women who are obese and hyperinsulinemic but not hyperandrogenic. Since we know that obesity produces insulin resistance by a different mechanism than classic PCOS, these women probably represent a totally different syndrome, although there may be considerable overlap.

The second type of non-classic PCOS would be those women who appear to be hyperandrogenic but are not insulin resistant and/or hyperinsulinemic.

Approximately two-thirds of all women with classic PCOS are overweight and, in this group of women, the majority are insulin resistant.

Approximately one-third of women with classic PCOS are of normal body weight but only about one-third of these women are insulin resistant. However, for reasons that have yet to be explained, most of these women will still respond to insulin sensitizing therapy. This probably means that our criteria for insulin resistance and the ways we have of measuring it are not sensitive enough.

It has also been shown in various studies that women with the clinical features of PCOS who also have the ultrasound manifestations of PCOS will show more severe abnormalities than women whose ultrasounds are "normal".

A study published in 1988 in the British Journal "The Lancet" looked at the ovaries of "normal women". Of those women studied, 22% had "poly-cystic" ovaries on ultrasound and, of those women, 76% had irregular menstrual cycles and 6 of 8 women with regular menstrual cycles had significant hirsutism.

Turning the numbers around, 26% of women with no menstrual periods (amenorrhea) and 87% of women with oligomenorrhea (infrequent menstrual periods) will have poly-cystic ovaries on ultrasound. In this particular study, 92% of women with hirsutism and regular menstrual cycles also had poly-cystic ovaries.

Also, as has been mentioned elsewhere in this pamphlet, it is important to consider the ethnic background of the woman who is being evaluated. Your genetic make-up will determine how sensitive you are to the effects of increased androgen or whether you are in fact sensitive at all. It is well-known that hirsutism does not develop in Japanese women unless their testosterone is severely elevated. Similarly, women of northern European extraction (such as Scandinavia) will often show a much lesser response to testosterone; women of Mediterranean ancestry will often show a significant response to rather minimal elevations in their testosterone.

Another common variant which I see involves women who may have regular menstrual cycles but who are insulin resistant in association with evidence of increased androgen production.

While textbook definitions are important, it has always been my philosophy that the most important thing is to treat your patient properly. By widening the definition to include these other women, who I believe are in fact PCOS variants, it allows me the opportunity to offer them more effective therapies than would be possible if I were to insist upon a strict definition.

http://www.soulcysters.net/showthre...&threadid=65636

Linda

my hat is off to the both of u are u assumptions of PCOS