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