Polycystic ovary syndrome: an intrinsic risk factor for diabetes compounded by obesity

Reflections

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VOLUME 115, ISSUE 6, P1449-1450

Authors:

Helena J. Teede, M.B., B.S., Ph.D., Chau Thien Tay, B.Med.Sc., M.B., B.S., Anju E. Joham, M.B., B.S., Ph.D.

Abstract:

Reflections on "Risk of type 2 diabetes is increased in nonobese women with polycystic ovary syndrome: the National Health Insurance Service-National Sample Cohort Study" by Ryu et al.

Read the full text here. 

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. 

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Go to the profile of Pandiyan  Natarajan
5 months ago

PCOS is an Epiphenomenon. (1) 

PCOS is an ancient disease. Several theories abound as to the cause of PCOS. The theory depended upon the available investigation of the time. Not surprisingly, the ovary was blamed in the initial days and until recently. Enlarged ovary, Thickened ovarian capsule, Sclerocystic ovary, Hyperthecosis ovary were all blamed. The ovaries were initially cut and with advancement of technology, the ovaries were being burnt and continue to be burnt.  

High LH hypothesis reigned for sometime to be replaced by the current trend of Insulin Resistance. Insulin Resistance is blamed for many things like Type 2 Diabetes Mellitus today.

Insulin Resistance- the Inconvenient Truth.(2) 

Insulin Resistance is a nebulous term. The primary cause of PCOS is abnormal weight gain in adolescence or adult life. Raised Insulin, if present is the consequence of abnormal weight gain and not the cause of it. All the cascade of features we encounter in PCOS is set into motion by Abnormal weight gain and Obesity.(3)

PCOS has been blamed for many other conditions too like Diabetes Mellitus, heart disease and increased risk of COVID-19. The primary pathology in all these conditions is : Overweight and Obesity and not PCOS as such. The ovary is not to be blamed. Let us not shoot/ burn the ovary/messenger.

BMI is an unreliable indicator of Weight gain, Overweight and Obesity.

Patients who have gained significant amount weight can still be in the normal BMI range.The critical determinant of the onset of anovulation, PCOS, Insulin Resistance, Type 2 Diabetes Mellitus and Metabolic syndrome is Abnormal weight gain in adolescence and adulthood. These patients may still have normal BMI, but have gained significant weight from their early adolescent post menarchal years. 

1) Puvithra.T, N.Pandiyan. Polycystic Ovary Syndrome is an Epiphenomenon - An Opinion.

Chettinad Health City Medical Journal 2016; 5(3): 106 - 107

https://www.chcmj.ac.in/pdf/vol5_no3/polycystic_ovary.pdf

2) Chockalingam A, Natarajan P, Thanikachalam P, Pandiyan R. Insulin Resistance: The Inconvenient Truth. Mo Med. 2021 Mar-Apr;118(2):119-121. PMID: 33840852; PMCID: PMC8029630.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8029630/pdf/ms118_p0119.pdf

3) Puvithra T, Pandiyan N. Is Weight Gain the Precipitating Factor for Polycystic Ovarian Syndrome? A Hypothesis Based on a Retrospective Study.

Chettinad Health City Medical Journal 2015; 4(3): 120 - 124.

https://www.chcmj.ac.in/pdf/vol4_no3/Is_Weight_Gain.pdf