New Hope for PCOS Treatment, Prevention

July 1, 2002 WNPRC News

Contact: David Abbott: 608-263-3583

MADISON-Millions of women with polycystic ovary sydrome (PCOS), a complex and dangerous disease, may soon see better diagnosis and treatment.

Researchers in the U.S. and United Kingdom believe they have pinned down when and how PCOS originates. Reporting in today's issue of Journal of Endocrinology, the researchers explain how prenatal genetic, biochemical and environmental factors combine to produce PCOS later in life. The disorder affects at least 4 million women of childbearing age in the U.S. It is a common, but complex reproductive disorder and a major cause of infertility. PCOS is also the leading cause of Type 2 diabetes in women in their 20s and 30s and puts women at high risk for cancer in the uterus.

PCOS can originate during puberty or much earlier, during the first and second trimester of pregnancy, according to lead author David Abbott, Ph.D., of the Wisconsin National Primate Center at the University of Wisconsin-Madison. By developing a rhesus monkey model for PCOS, Abbott and his colleagues have shown that the disease may arise in humans due to excess androgen levels during critical developmental periods.

"It's a major step," Abbott said. "We now have a unifying mechanism in the rhesus monkey, the sheep and the human. The phenotype of the disorder is nearly identical in women and in these animals."

PCOS arises as a consequence of genetically or environmentally determined oversecretion of androgens by the ovaries or adrenal glands. This "hyperandrogenism" causes the body to secrete excess hormones that can wreak havoc with metabolism. Single or combined disorders can include high insulin, obesity and high rates of miscarriage. Many women also have abnormally high levels of body hair, stomach fat, and acne.

Until recently, doctors tried to identify and treat the myriad of symptoms as separate ailments. The PCOS diagnosis is becoming more frequent, resulting in better patient care and treatment, commonly involving prescription of insulin sensitizing drugs. Before too long, through early intervention, the researchers hope to prevent the disease altogether. "It's too early to tell whether gene therapy would be an effective cure", said Abbott. But other preventions, such as well-timed and controlled anti-androgens during pregnancies at risk, could be realistically considered over the next few decades.

"The time is also coming when women will not have to wait for the myriad of symptoms to manifest themselves," he said. "We may well be able to test newborns and pre-teens who appear to be at risk for PCOS to see if they show one or more symptoms early on and then provide early treatment to minimize PCOS symptoms at puberty and beyond."

Study co-authors are Daniel Dumesic, M.D., of the Mayo Clinic in Rochester, Minnesota, and Stephen Franks, M.D., of Imperial College, London, UK.

Reference:

Abbott DH, Dumesic DA, Franks S. Developmental origin of Polycystic Ovary Syndrome-A Hypothesis. Journal of Endocrinology. 174, 1-5. 2002.

-J. Lenon