Connecting the Dots

Polycystic ovary syndrome (PCOS) is a condition characterized by a set of symptoms which are the result of increased androgen production by the ovaries.  Androgens are hormones that contribute to the development of male characteristics.  These symptoms include irregular or infrequent menses, heavy menses, pelvic pain, fertility challenges, and excessive facial and/or body hair.  PCOS is also associated with adult onset (type two) diabetes, heart disease, obesity, sleep apnea, and endometrial cancer.  It is the most common endocrine disorder found within women aged 18-44.

Two important hormones ordinarily released by the ovaries include estrogen and progesterone.  Treatment for PCOS includes modified ovarian hormones (ex. oral contraceptives which generally contain estrogen and progesterone) to counteract the effect of the androgens.  Another approach to treating PCOS includes anti-androgen drugs.

A third and new approach being researched is modified adrenal hormones.  The adrenal hormones include adrenaline and steroids (aldosterone, cortisol, and the hot topic of the day- androgens).  What do the adrenal glands have to do with ovaries?  That is an excellent question.  The answer, which is also the reason why this approach is being explored, is because a recent study conducted by the National Institute of Health’s (NIH), results released June 27, 2016, suggests that there may be a link between PCOS and adrenal gland disorder.  Previous research has revealed that the adrenal glands of some women with PCOS produce increased amounts of androgens.  In this study, 38 women with diagnosed PCOS comprised the experimental group, and 20 women without PCOS served as the control group.  Almost 40% (15 of the 38 women in the experimental group) demonstrated increased adrenal gland hormone production.  Furthermore, on average, the size of these women’s adrenal glands were smaller than average.


These findings reminded researchers of micronodular adrenocortical hyperplasia (MAH), a condition characterized by formation of little nodules on the adrenal glands.  These nodules begin to produce adrenal hormones independent of the adrenal glands.  The new alternative hormone source “allows” the adrenal glands to get lazy, slack off in their own hormone production, and shrink.  The similarities between women with MAH and a decent number of women with PCOS, particularly smaller adrenal glands, struck the researchers.

What percentage of women who experience PCOS are actually also experiencing adrenal gland dysfunction?  Is there a connection in the pathology and etiologies of the two disorders?  Perhaps most importantly, can the population of women with PCOS who also demonstrate adrenal hormone overproduction benefit from adrenal hormone therapy?  Connecting the dots between the ovarian-adrenal connection may guide and facilitate future research and treatment.

Book Review on Conservative Medicine

Jörg Blech, author of Inventing Disease and Pushing Pills: Pharmaceutical Companies and the Medicalisation of Normal Life
Conservative medicine is supported by Jörg Blech is his book, Inventing Disease and Pushing Pills: Pharmaceutical Companies and the Medicalisation of Normal Life (2003).  In fact, I enjoyed the book so much that I have decided to blog about it and share my favorite parts with you.  Hopefully, this will pique your interest and inspire you to read the book in its entirety.  I strongly encourage you to do so, and I look forward to hearing from you about your favorite parts.

Blech, a German science journalist and nonfiction author, studied biology and biochemistry at the University of Cologne (Germany) and the University of Sussex (UK).  Currently, he is a correspondent for Der Spiegel, a German magazine.  Blech is widely known for his critique of the pharmaceutical and medical industries.  In fact, at times, his book may even feel like an expose to the reader.  Blech addresses a variety of issues within the healthcare system, especially the invention of diseases in order for pharmaceutical companies to generate profit.  For instance, natural elements of the aging process are falsely advertised to the public as ailments which must be medically addressed.  He refers to this concept as “medicalisation”, the reframing of previously viewed healthy and normal processes as disorders that must be treated.  In fact, he cites many examples of physicians performing research on behalf of pharmaceutical companies.  These companies routinely hire physicians to perform research supporting the so-called benefits of their medication, medication which the physicians may likely prescribe to their patients.  Obviously, the physicians are aware that the companies are looking for a glowing report and for their medication to be endorsed.  It is undoubtedly extremely difficult for these researchers to remain objective.  This blatant conflict of interest calls into question the ethics, or lack thereof, inherent in such a process.

As a pelvic floor physical therapist, I found Chapter Seven, The Femininity Syndrome, to be of particular interest.  Blech describes how the natural process of menopause is now viewed by many health care providers as a pseudo-diseased phase.  The price tag imposed on insurance companies for these possibly superfluous treatments is astronomical.  In fact, in Germany alone, approximately 500 million Euros are spent on hormone replacement therapies.  According to Blech, “The medicalization of the menopause is an example par excellence of the way certain physicians’ groups and pharmaceutical firms are manipulating the evidence in medical issues.  Nowadays menopausal woman is regarded as a deficient being…Women’s health seems to have vanished, washed away by unrelenting tides of disease- as one ebbs so the next advances.  One is almost inclined to believe that to be of the female sex has become a disease in itself.”  He points out that certain tell-tale menopause symptoms, such as night sweats and hot flashes, are much more frequently reported in Western countries.  In fact, in Japan, these symptoms were only reported by approximately 15% of women older than age 50 in a study led my Margaret Lock (McGill University, Montreal).  In 1960, gynecologist Robert Wilson wrote Feminine Forever, a popular book which encouraged menopausal women to initiate hormone replacement therapy in order that “they may look forward to prolonged well-being and extended youth.” It was only revealed later on that Wilson’s writing was financially supported by the pharmaceutical company Wyeth Ayerst.

There is a time and place for medication, and obviously hormone replacement therapy is more appropriate for some women than others.  I am not shouting from the rooftops that medicine and all surgeries are bad!  I have encountered many women who have been appropriately advised to take medicine and who have benefited tremendously from their usage.  However, I do encourage you to discuss all treatment options with your physician, from conservative to more invasive.  I encourage you to be your own biggest health advocate, and to obtain as much information as possible in order to make educate health related decisions.  An excellent start is by reading Blech’s book.  He has opened the door to a fascinating and important discussion, and I encourage you to join.