Polycystic ovary syndrome, or PCOS, affects 5 percent to 10 percent of adult women. In addition to hormonal aberrations, PCOS is associated with a variety of other physiologic abnormalities and medical problems. In a study published in the February 2005 issue of "Fertility and Sterility," scientists demonstrated a link between PCOS and liver disease.
Characteristics
The signs and symptoms of PCOS are not unique to this syndrome. Excessive hair growth, acne, menstrual irregularities, elevated levels of certain hormones, infertility and mild obesity are hallmarks of PCOS, but not all of these signs will necessarily be present, and they may be caused by other conditions. Not all patients with PCOS fit the classic picture of the disorder, and treatment isn't the same for all patients. In fact, according to a 2009 article in "American Family Physician," there is debate over which criteria should even be used to diagnose PCOS.
Significance
Although PCOS has been recognized for years as a cause of infertility, the full extent of its impact on women's health is still unfolding. In recent years, PCOS has been linked to cardiovascular disease, diabetes and liver disease. These conditions are due, in part, to the higher levels of androgens -- male hormones such as testosterone -- that are characteristic of PCOS. Elevated androgen levels predispose affected women to hardening of the arteries, high blood pressure, insulin resistance, metabolic syndrome, elevated lipid levels and nonalcoholic fatty liver disease, or NAFLD.
Liver Disease
When the liver is exposed to abnormally high levels of cholesterol and triglycerides or when its ability to metabolize these molecules is impaired, the extra lipids must be temporarily stored within the liver's cells. In PCOS, both androgen excess and insulin resistance contribute to perturbations in the liver's metabolic capacity. Even though the liver can partially compensate by enhancing its metabolic machinery, its ability to store lipids is limited. Furthermore, unprocessed or partially processed lipid molecules are inflammatory. Eventually, the liver's cells are damaged.
Enzyme Testing
Enzymes are molecules that increase the rate of chemical reactions in biologic systems. Enzymes drive the myriad processes that constitute the day-to-day work of the liver, the most metabolically complex organ in the body. When liver cells are injured, their enzymes are released into the bloodstream, where they can be detected with routine blood tests. Enzyme levels are sensitive indicators of how severely the liver is damaged. In patients with NAFLD, enzymes called aminotransferases are most commonly used to evaluate the liver's status.
Implications
Most patients with NAFLD don't develop cirrhosis or other severe liver disease. However, a liver that is already injured is susceptible to further damage when it is exposed to certain drugs and toxins. Polycystic ovary syndrome and its associated conditions are frequently treated with medications that are potentially harmful to the liver, particularly one that is already compromised. Women with PCOS should undergo periodic liver testing, and those who are subsequently diagnosed with NAFLD should work with their physicians to develop treatment plans that are "liver friendly."
References
- Fertility and Sterility: Abnormal Aminotransferase Activity in Women with Polycystic Ovary Syndrome
- "American Family Physician": Drug Treatments for Polycystic Ovary Syndrome
- "The Merck Manual of Diagnosis and Therapy": Fatty Liver; Mark Beers, M.D., Editor-in-Chief; 2006
