DEAR DOCTOR K:
I have polycystic ovary syndrome and treatments are helping only a little. My doctor says there has been recent progress in understanding what causes it, and that I should not give up hope. What is your opinion?
For readers who don’t know about polycystic ovary syndrome (PCOS), I should explain a few things first. PCOS is pretty common: About 10 to 20 percent of women have it to some degree. The key features of this illness are multiple cysts in the ovaries, failure of the ovaries to release eggs (and resulting difficulty getting pregnant), irregular menstrual periods and high levels of androgens.
Androgens are “male” hormones that females also make, but in lower amounts than men. High levels in women can cause acne and more body hair. They also can cause loss of scalp hair in a pattern like that in men who are becoming bald.
Women with PCOS also are at higher risk for developing Type 2 diabetes, obesity, elevated levels of cholesterol and triglycerides (two types of fat), and atherosclerosis, which increases the risk of heart attack and stroke.
So a lot of very different things are going wrong in PCOS. Doctors and scientists have long sought a single abnormality that triggers all the rest. If such an abnormality were found to exist, it would become a target for treatment: Treat that single abnormality, and you might simultaneously fix all of the things that go wrong in PCOS.
That single abnormality has been elusive, perhaps until now. In early 2016, scientists from China reported that low levels of a hormone made by fat are responsible for PCOS.
Until about 20 years ago, we thought fat was simple. We knew that fat was made up of cells. We thought those fat cells were all the same. We thought they were a place where we stored energy for future use — that was right. We thought they provided insulation to keep our insides warm in cold weather — that also was right.
But it’s not that simple. First, our bodies have two main kinds of fat: white fat and brown fat. (There’s also “beige” fat, but let’s not digress.) White fat cells store fat. In contrast, brown fat cells burn fat.
Second, we now know that fat cells also are powerful little hormone factories. They make hormones that travel throughout our body, influencing our appetite, the rate of our metabolism and many other aspects of our health.
The Chinese scientists transplanted extra brown fat cells into rats with PCOS. All at once, many of the abnormalities of PCOS promptly started to improve. Then the scientists discovered that a hormone called adiponectin that is made by brown fat cells was likely responsible. When rats with PCOS were given just adiponectin, all of the features of PCOS promptly improved.
It remains to be seen if what is true in rats is true in humans, and whether the discovery will lead to improved treatment of PCOS. If so, many women stand to benefit.