What is PCOS?
Polycystic Ovary Syndrome, abbreviated as PCOS, is a medical condition that can affect female members of the population from puberty to menopause. As a syndrome, this condition typically consists of many symptoms clustered together which share a common cause or causes. Though each case of PCOS will manifest in its own unique manner, it is generally characterized by hormonal dysregulation and a tendency for the ovaries to enlarge and develop many fluid-filled cysts along their inner borders.
These cysts represent an aberration of the normal process by which ovaries prepare and deliver a mature egg to the uterine tract as part of the menstrual cycle. In a healthy reproductive system, the ovaries contain thousands of tiny openings called follicles, which contain a single immature egg. Throughout each menstrual cycle, a single follicle will develop an immature egg into a fully matured one, at which point the follicle ruptures and releases the egg into the uterine tract. When this process is disrupted, as in PCOS, the immature eggs do not properly develop, and the follicles do not properly complete the cycle of egg development and rupture. Instead, they remain large and accumulate along the outer wall of the ovaries.
PCOS Symptoms
Untreated, PCOS can cause complications that can drastically impact an individual’s health and quality of life. Many of these result from the imbalanced hormonal profile that often accompanies PCOS, while others are secondary effects of some of the physical and mental changes that can be brought on by this condition. It’s important to note that not all cases of PCOS are symptomatic, and only a doctor can determine whether you do or do not have PCOS.
Superficially, PCOS can cause changes to a woman’s external presentation that some women may find undesirable. Many of these traits are classically associated with masculinity, such as the prominent growth of face and body hair, a deepening of the voice, an increase in overall muscle mass, and a reduction in breast size. While not inherently dangerous, if these presentations suggest an underlying PCOS diagnosis, then they may signify more serious but less visible health complications resulting from the same underlying cause.
Speaking of more severe complications, unfortunately for women seeking to conceive, PCOS can signify a whole host of complications throughout the conception and gestation processes. Infertility or reduced fertility, gestational diabetes, premature birth, or even miscarriage are all unfortunate risks that should be considered and evaluated in consultation with a physician by women who are, or who hope to become, pregnant.
Still further harmful complications can affect the individual outside of pregnancy. Hormonal imbalances can cause metabolic disruptions that can include type 2 diabetes and metabolic syndrome. Obesity is a common co-morbidity of these conditions, and is often associated with PCOS; it has also been known to reduce the efficacy of treatment and increase the severity of other complications. Endometrial cancer is also a possible result of hormonal excesses, and like most cancers can be life threatening.
Root Causes
PCOS exists in that category of illnesses that are both well understood in some ways, while totally mysterious in others. Much is known about the various hormonal and metabolic pathways that are altered in PCOS patients and the symptoms that are likely to occur as a result, making some forms of treatment possible. The root cause of the syndrome and the resulting changes, however, is not clear, though many theories and possible mechanisms exist.
One common explanation directs responsibility at excessive levels of male sex hormones called androgens. Ovaries, which are responsible for storing and releasing an egg with each menstrual cycle, are very sensitive to the hormonal environment of the body. Disruptions to the delicate balance of sex hormones, which include estrogen, progesterone, and androgens, can alter the ovaries’ natural function and cause them to develop a series of fluid filled cysts.
This theory seems to be supported by scientific literature,[1] but it lacks an explanation for the excessive androgen levels that disrupt the ovaries in the first place. Theoretical explanations of this excess have been advanced, chief among which is the theory that excess insulin in the bloodstream, caused by insulin resistance, triggers androgen production. When an insulin resistant person consumes sugar, their body releases insulin as expected. Their cells fail to respond appropriately to the insulin, however, causing sugar levels to build in the bloodstream. The body naturally interprets the rising sugar levels as a signal that greater insulin production is required, thereby releasing excessive amounts of insulin into the bloodstream.
Current Treatments
The first step in treating PCOS is to receive a confirmed diagnosis from a physician. This is typically accomplished through a battery of physical examinations and lab tests that evaluate the presence of external symptoms and the status of one’s hormonal and biochemical profiles.
Unfortunately, even once a diagnosis is confirmed, there is no total cure for PCOS. Because the root cause of PCOS is only speculated, attempts at treating this condition have focused primarily at alleviating specific symptoms of the condition, like menstrual abnormalities, disrupted ovulation, or excessive hair growth. Medical treatments exist for many of these symptoms, each having their own relative advantages, disadvantages, and likelihoods of success.
Beyond such symptom-specific treatment, few global approaches exist. Some lifestyle changes have been shown to have positive impacts, though, and these include maintaining a healthy weight, reducing the intake of carbs, and maintaining a physically active lifestyle. Together, these may regulate blood sugar and insulin levels to some degree, ultimately reducing the amount of androgen produced by the body.
Ozempic
How it’s Typically Used
Ozempic is the brand name for a medication called semaglutide. Semaglutide is currently marketed in various forms, including Wegovy, Ozempic, and Rybelsus, and is FDA-approved for the treatment of type 2 diabetes and weight loss (note that not all forms of semaglutide are FDA approved for both use cases).
Semaglutide functions by binding to receptors for a naturally occurring hormone called GLP-1, causing them to respond as though GLP-1 concentrations were higher than they are. This binding has several effects, which are primarily to increase insulin secretion by the pancreas, decrease the release of sugar into the bloodstream, and to suppress the appetite.
Together, these effects of semaglutide help regulate blood sugar and improve the body’s sensitivity to insulin. This has clear benefits for individuals with type 2 diabetes but can also help people control their appetites and lose weight.
Could Ozempic be useful in treating PCOS?
Arguably, the current state of PCOS treatment leaves something to be desired. A cure for the root cause of the syndrome would carry clear benefits over the current piecemeal approach at treating individual symptoms. Could the properties of Ozempic be leveraged to turn the tides in favor of those struggling with PCOS?
At first, using Ozempic to fight PCOS may seem counterintuitive. After all, stimulating the release of insulin in the body seems counter productive when PCOS itself may be a result of excess androgen caused by excess insulin levels. However, some experts speculate that the combined effects of the various mechanisms of action of Ozempic lead to an overall increase in insulin sensitivity and a decrease in appetite causing individuals to lose weight, eat less, and respond more to the insulin circulating in their blood stream. By reducing the presence of blood sugar in this way, the body does not need to produce as much insulin in response, and insulin levels return to normal (or so the theory goes).
But is this just fanciful thinking, or are these speculations supported by data?
The Literature
To be clear, Ozempic is not currently approved by the FDA for PCOS treatment. However, clinical trials are being conducted to determine whether such treatment is effective, and if successful, these could pave the way to an official FDA indication for PCOS.
For example, a study posted in 2019[2] by the University of Colorado, Denver, is exploring the efficacy of oral semaglutide (Rybelsus) as a treatment for PCOS, as well as adolescent obesity and non-alcoholic fatty liver disease (NAFLD). The authors hypothesize that altered GLP-1 activity may be to blame for the fatty liver and insulin resistance occurring in PCOS patients. Rybelsus, they explain, may therefore lower fatty liver deposits and increase insulin sensitivity. Increased insulin sensitivity might then cause a reduction in androgen production, though this study does not include androgen measurements among the data they will be collecting.
No results have been posted and the study is not estimated to conclude until 2024, but it represents exciting progress into the discovery of novel treatments for PCOS.
Research is also underway to compare the efficacy of metformin and Ozempic in fighting PCOS. Metformin is another anti-diabetic medication which purports to improve insulin sensitivity. It has therefore been speculated that metformin could be useful in treating PCOS, for similar reasons as given for the potential efficacy of Ozempic. Current clinical trials are attempting to address the effects of Ozempic as compared to metformin in aiding weight loss, reducing androgen levels, and increasing glucose tolerance.[3] The outcomes of this research should provide a clearer picture into the relative efficacy of both of these medications, and may assist doctors and the FDA in deciding whether either medication should be prescribed to PCOS patients.
Conclusion
In the meantime, the decision to use any particular medication remains one that must be made by healthcare professionals. Ozempic may prove to emerge as a decisively progressive step towards curing PCOS – or it may turn out not to be worth its own hype. Regardless, those who suffer from PCOS should not lose hope, as the many treatment options currently available leave a plethora of alternatives to explore that can help return life to a state of normalcy. And, even if Ozempic does not deliver on its potential, scientific and medical progress surely have further advancements in store.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045492/
[2] https://clinicaltrials.gov/ct2/show/NCT03919929
[3] https://clinicaltrials.gov/ct2/show/NCT05646199
