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Polycystic ovarian syndrome (PCOS):

In this condition the ovarian follicles do not develop properly. The ovary becomes enlargedwith four or more unruptured follicles (cysts). The condition is associated with weight gain,oligomenorrhoea or amenorrhoea, excessive body hair in a male distribution andinfertility. The underlying cause of PCOS is not fully understood. Recent theories proposethat over-secretion of insulin might be the fundamental problem. This is believed to affectthe LH surge from the pituitary (so preventing rupture of the ovarian follicles and causinginfertility) as well as leading to excessive formation of male sex hormones (which causeexcessive body hair and also acne). This theory fits with the observation that PCOS is morecommon in people with chaotic eating patterns, and in particular in those with bulimianervosa (sees Stage 6).

In fact, some degree of PCOS is very common. Ultrasound studies have shown that up to20% of women have evidence of PCOS. However, only a few will exhibit the more severemanifestations of the syndrome.

In PCOS ultrasound examination of the ovaries shows unruptured ovarian follicles, and ablood test reveals an imbalance in the levels of FSH and LH.

Women with established PCOS are at increased risk of developing Type II diabetes, and soshould be followed up on a long term basis. There is also a small increased risk of cancer ofthe womb in this condition.

Tests for secondary amenorrhoea include blood tests for FSH and LH and the sexhormones. If PCOS is suspected, an ultrasound of the ovaries will also be performed.

Treatment is primarily directed at the cause. If the amenorrhoea persists in the non-structuraland endocrine cases, despite treatment of the cause, then HRT may also be prescribed. Inprimary ovarian failure, HRT is always prescribed. This should be maintained at least untilthe normal age of the menopause.

In PCOS women are advised to lose weight and to increase participation in gentle exercise,as these changes can normalise insulin levels. Excessive male pattern body hair can betreated by means of medication. The oral contraceptive may be effective in reducing thehairiness. Alternatively, a drug called cyproterone acetate may be prescribed. This has theeffect of opposing the action of male sex hormones. See Lesson 5.2f for the treatment ofinfertility caused by PCOS.

In Chinese medicine amenorrhoea ("no periods") may be an empty or a full condition.Empty causes include Jing Deficiency, Blood deficiency, Spleen and KidneyDeficiency and Liver and Kidney deficiency. Full causes are Cold in the Uterus, Phlegm or Qi/Blood Stagnation. Oligomenorrhoea ("late periods") might indicate Blood Deficiency, Cold in the Uterus, Kidney Yang Deficiency or Qi Deficiency

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