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Author: Suzi Birnbaum

Hello and welcome to my biochemistry blog for the course BCM441. You may be wondering what exactly we learn in advanced, undergraduate, biochemistry courses. Hopefully my blog is a good example of how integrative and cross-sectional the subject of biochemistry is. My culminating project has been investigating the affliction, Polycystic Ovarian Syndrome (PCOS). I have been researching the molecular and cellular basis behind this issue, and its treatments.

PCOS is extremely important to understand, given that it is the most widespread and prevalent issue that faces womens’ reproductive lives. The disease is fascinating to me, because it affects 7-15% of women around the world, yet is so little researched. This is not to say that research has not been given to the its potential causes, but that it’s such an integrated syndrome that it is very hard to pinpoint what exactly causes it. Before going too far into the science, we should first establish what it is.

From its name, we can understand that it is mainly characterized by multiple (from the prefix “poly) ovarian cysts. What are ovarian cysts? A cyst is a fluid-filled sac, and ovarian cysts in particular are small fluid filled sacs on the ovary. They can cause symptoms such as bloating and/or pain in the lower abdomen, in varying degrees of severity. It is important to note that one can develop ovarian cysts without developing PCOS. This is because PCOS is defined by multiple criteria, most notable are the amount and types of ovarian cysts, and by hyperandrogenism.

Hyperandrogenism refers to the androgen hormones which both biologically-defined men and women contain. A major difference is the ratio of hormones in each body. The androgen hormones are a class of hormone that are in balance with the estrogen class of hormones. Most famously known is testosterone, which is associated with hypermasculinity. This is a common misconception of hormone balance.

When there are too many androgens in the biologically-female body, the result is not that she morphs into a man. Instead, the result is (usually) PCOS, and becomes a complex issue to understand and treat. Other characteristics of PCOS include hirsutism (male pattern facial hair on female body), and chronic anovulation (persisting lack of ovulation, resulting in prolonged lack of menstruation). There are two main criteria for diagnosing PCOS and then treating it. Either way, is considered a very prevalent issue in terms of women’s reproductive health.

Treatment for PCOS, at this point, does not treat hyperandrogenism or the cysts themselves. Instead, it is a case-by-case procedure whereby individual symptoms are treated. Treatments include drugs, lifestyle alterations, and supplementation. The most common drug treatments are combinations of hormonal birth control pills and a type-2 diabetes treatment. The hormonal birth control treatment is almost self explanatory, as one could imagine how they are used to offset the hormonal imbalance. The type-2 diabetes drug treatments are a little less intuitive.

Many sources cite the high occurrence of obesity in women with PCOS. The two are not necessarily causative of each other, but the relationship is still not well understood. Generally speaking there is an understanding that being classified as “overweight”, having insulin resistance (the precursor of diabetes), and having PCOS are commonly seen together. As stated earlier, the main issue facing the exact cause of PCOS is that it is associated with such global issues as insulin signalling and cardiovascular health. Both of these issues affect more than just the reproductive system and turn PCOS into a larger issue to understand. One clear link between PCOS and insulin signaling is the usage of insulin-sensitizer drugs to treat the symptoms of the disease – in particular anovulation. A famous insulin sensitizer that is used to treat PCOS is the drug, Metformin. Understanding what it affects at the cellular level has helped us understand a link between insulin signalling and PCOS.

For those who are more holistically inclined, the change in PCOS clinical trials seems to be tending towards different kinds of supplementation. This includes extracts of various herbs and/or plants, and common vitamins or minerals that are part of health-food fads. Sadly I just did not have the time or space to completely divulge into all the holistic treatments out there and the potentially promising or negative-outcome clinical trials, given the sheer amount of studies accessible even at a undergraduate level.

Overall, PCOS is not a syndrome to be taken lightly as it greatly affects many thousands of women’s lives around the world. It is a truly intriguing issue from the biochemical perspective as it ties in a bunch of metabolic issues and other diseases. Hopefully moving forward women’s reproductive health will become less taboo and talking about common yet powerful experiences like having ovaries and the issues associated with them will be more commonplace. I hope for a world where we can fully understand such intersectional issues. Please enjoy perusing around my blog and leave comments wherever that I will answer to my best ability!

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