Abdominal fat: Fat that is centrally distributed between the chest cavity and pelvis. Also known as central or visceral fat.
Acanthosis nigricans: A skin change commonly associated with excess insulin and insulin resistance. The skin in affected areas has a darker pigmentation and often has a velvety feel and raised, dark plaques. The areas most commonly affected include the back of the neck, the groin, under the breasts, and over the elbows. It is frequently associated with small skin tags in the neck and under the arms.
ACTH see Adrenocorticotropic hormone.
Adenoma: A benign growth in a hormone-producing gland.
Adipocyte: Fat cell.
Adrenal gland: A triangular, walnut-shaped gland that lies on top of each kidney. The gland’s outer portion, the adrenal cortex, produces the major stress hormone cortisol and other hormones such as androgens, estrogens, and aldosterone. The latter is an important hormone that regulates salt and water metabolism.
Adrenal hyperplasia: The enlargement of the adrenal glands due to an inherited defect. Because of this defect, the adrenals enlarge in order to produce enough cortisol and aldosterone. Because adrenal hyperplasia can result also in the excess production of male hormones, women suffering from it are often mistakenly thought to have PCOS. Adrenal hyperplasia in adult women may be fatal due to a cortisol deficiency.
Adrenal stimulation test: This test of adrenal function, used to detect the presence of adrenal hyperplasia, involves obtaining blood before and one hour after the injection of purified ACTH. Also called ACTH stimulation test.
Adrenocorticotropic hormone (ACTH): This hormone, secreted by the pituitary gland, stimulates the adrenal glands to produce cortisol and androgens. In its purified form, it is used in the adrenal (ACTH) stimulation test.
Alopecia: The thinning or loss of scalp hair in women due to increased male hormone levels or increased sensitivity to male hormones. Also called androgenic or androgenetic alopecia.
Amenorrhea: A condition in which a woman does not have menstrual bleeding or cycles for six or more months.
Androgen: A male hormone secreted by the ovary, testis, or adrenal gland. Examples are testosterone, androstenedione, and dehydroepiandrosterone (DHEA), the latter being mainly produced by the adrenal glands. Androgens are part of the steroid family of hormones (along with cortisol and estrogens). Both men and women produce them, although men produce significantly more than women. Androgens are responsible for producing many of the physical traits we consider male (body hair growth, increased muscles mass, and deepening of the voice). However, androgens are also important in women since they assure healthy muscles and bones, serve as the precursor or basic hormone type necessary for the production of estrogens, and are responsible for sexual arousal.
Androstenedione: A relatively weak male hormone; in women, produced equally by the adrenal glands and ovaries.
Angina pectoris: Severe pain in the chest associated with an inadequate blood supply to the heart.
Anovulation: Absence of ovulation. Women with PCOS often have difficulty becoming pregnant because they do not ovulate regularly. Women who do not ovulate are said to be anovulatory.
Antiandrogen: A drug used to block or reduce the effect of testosterone and other androgens in those sites or organs where they exert a male hormone effect. In patients with PCOS who have acne or hirsutism, they are used to block the action of androgens on the skin. Examples of antiandrogens include spironolactone, cyproterone acetate, finasteride, and flutamide.
Aromatase: An enzyme that converts testosterone to estrogens.
ART: Assisted reproductive technologies, a group of procedures that includes intrauterine insemination and in vitro fertilization.
Atherosclerosis: The buildup of plaque containing cholesterol and lipids on the innermost lining of the walls of large and medium-sized arteries, leading to serious vascular complications such as heart attack and stroke.
Biliopancreatic diversion: One of the most complicated of the current operative procedures in obesity or bariatric surgery that sometimes involves the removal of a portion of the stomach.
Biliopancreatic diversion with duodenal switch: Bariatric surgery that restricts both food intake and the amount of calories and nutrients the body absorbs by leaving a larger portion of the stomach intact, but dividing it and the small intestine.
Blood glucose: Glucose in the bloodstream. Also known as blood sugar.
BMI see Body mass index.
Body mass index (BMI): An individual’s weight relative to his or her height. It can be calculated by multiplying weight in pounds by 703 and dividing that number by height in inches squared.
Cardiovascular disease: A disease of the heart or major blood vessels; any abnormal condition characterized by dysfunction of the heart or blood vessels.
Computed tomography (CT): A method of examining body organs by scanning them with X-rays and using a computer to construct an image. It is called a CT scan.
Congestive heart failure: A condition marked by weakness, edema (fluid retention), and shortness of breath that is caused by the inability of the heart to maintain adequate blood circulation in peripheral tissues and lungs.
Corpus luteum: A yellowish follicle that forms when the ovarian follicle has matured and expelled the egg at mid-cycle. It secretes estrogen and progesterone into the bloodstream. If no fertilization of the egg occurs, it diminishes after the menstrual cycle starts.
Cortisol: A steroid hormone produced by the adrenal glands responsible for maintaining the ability to process blood sugar, maintain blood pressure, and react to any stress and illness.
CT see Computed tomography.
Cushing’s syndrome: A syndrome caused by an increased production of the hormone cortisol from a tumor of the adrenal cortex or pituitary. Sometimes it is also caused by an “ectopic” source such as a malignancy of various organs. Cushing’s syndrome is characterized by obesity, weakening of the muscles, violet-colored stretch marks, and possible development of hypertension and diabetes.
Cyproterone acetate: A progestin that also blocks the effect of androgens on the skin. It is very useful for the treatment of hirsutism, acne, and alopecia. A rare side effect is liver abnormality. It is available outside the United States as oral contraceptive pills (Diane-35 and Dianette-35) and as Androcur.
Dehydroepiandrosterone (DHEA): An androgen produced by the adrenal glands. It is metabolized to DHEAS.
Dehydroepiandrosterone sulfate (DHEAS): An androgen produced almost exclusively by the adrenal glands.
Diabetes: Any of several metabolic disorders marked by increased blood glucose, excessive discharge of urine, persistent thirst, and elevation of blood sugar due to deficient insulin production or action. Thus, almost all type 2 diabetics are insulin resistant.
Dysfunctional uterine bleeding: A menstrual pattern when a woman has very irregular, unpredictable, and frequently heavy vaginal bleeding. Its most frequent cause is an absence of ovulation. When not shed in regular menstrual cycles, the endometrial lining tends to thicken excessively and then bleed irregularly and heavily. Because women with PCOS do not ovulate regularly, many of them suffer from dysfunctional uterine bleeding, which can be treated in most instances with hormonal medications.
Dyslipidemia: A condition marked by abnormal concentrations of lipids or lipoproteins in the blood, including lipid levels that are either higher or lower than normal, which is often but not always a result of obesity.
Electrolysis: Medically, a method of permanently destroying individual hairs by placing a needle into the hair follicle and transmitting a small amount of galvanic electricity to destroy the base of the growing hair.
Endocrinology: The study of the hormone-secreting glands and their production of hormones, including excessive or inadequate production of hormones leading to clinical abnormalities.
Endometrium: The inside lining of the uterus.
Estradiol: The active estrogen secreted by the ovaries.
Estriol: An estrogen, which may be converted from male hormones secreted by the ovaries or adrenals.
Estrogen: A large group of female hormones, including estradiol, estrone, and estriol. In women, the ovaries are the major source of estrogens, although some estrogens are produced by the adrenal glands as well. Both men and women produce estrogens, with women producing much greater quantities than men. Estrogen is responsible for the development of female characteristics and also stimulates endometrial growth.
Estrone: A weak estrogen, often converted from precursor male hormones produced outside the ovaries or adrenals.
Fatty liver disease: Inflammation of the liver due to an abnormal accumulation of fat cells, which may lead to liver dysfunction.
Fertilization: The process whereby a sperm and an egg combine to create an embryo.
Finasteride: A drug that blocks the effect of androgens on the skin and very useful for the treatment of hirsutism. Side effects are rare, although it can cause birth defects of the external genitalia in a male infant. Brand name is Proscar.
Flutamide: A drug that blocks the effect of androgens on the skin and very useful for the treatment of hirsutism. Side effects include frequent dry skin, rare serious liver toxicity, and birth defects in male fetus. Brand name is Eulexin.
Follicle: A small sac in the ovary that contains a developing egg and makes estrogens. It appears as a spherical mass of cells that usually contain a cavity. During each menstrual cycle the ovaries produce several follicles, each with its own developing egg. Through a complex process, one of these follicles is selected to continue developing to maturity and will ultimately rupture and release its egg. These follicles are the most common cause of ovarian cysts seen on an ultrasound. Since they are the result of a monthly cycle of development, these cysts resolve spontaneously over one or two months.
Follicle-stimulating hormone (FSH): Pituitary hormone essential in the regulation of ovarian function leading to ovulation.
FSH see Follicle-stimulating hormone.
Galactorrhea: A milky secretion of the breasts that may occur naturally or by pressing the breasts. It may indicate an excess of prolactin.
Gastric banding: Bariatric surgery designed to limit the amount of food the stomach can hold by sectioning it off with the placement of a band near its upper end. The band creates a small pouch, which delays the emptying of food from the pouch and causes a feeling of fullness.
Gastric bypass: Bariatric surgery that combines the creation of a small stomach pouch to restrict the intake of food and construction of a bypass of the duodenum to prevent food absorption.
Gastric glands: A group of cells that produce gastric secretions or hormones for use in the stomach or elsewhere in the body.
Gestational diabetes: The occurrence of diabetes during pregnancy.
Glucose: The most common type of sugar found in the body. The hormone insulin regulates the blood level of glucose and its use by various organs, including muscles and liver.
GnRH see Gonadotropin-releasing hormone.
Gonadotropin: Either of the pituitary hormones’ luteinizing hormone (LH) or follicle-stimulating hormone (FSH), which regulate ovarian function and facilitate ovulation. These hormones are produced commercially in a purified and concentrated form that may be injected for ovulation induction.
Gonadotropin-releasing hormone (GnRH): The hypothalamic hormone that stimulates the production of the pituitary gonadotropins LH and FSH. For ovulation to occur, GnRH has to be synchronized at a certain pulsatile rate.
Granulosa cells: A lining of cells on the periphery of the ovarian follicle. They secrete sex hormones.
HDL see High-density lipoprotein.
High-density lipoprotein (HDL): A blood particle composed of a combination of lipid and protein, with a high proportion of protein and a little triglyceride and cholesterol. Referred to as “good” cholesterol, it is associated with a reduced probability of developing atherosclerosis.
Hirsutism: Excess hair growth in a male pattern in women, for example on the face, chest, lower abdomen, thighs, back, and extremities. Commonly coarse, thick, and dark, this hair is usually caused by excess androgens.
Hormone: A chemical produced by one part of the body that travels to another part of the body, where it produces an effect. Hormones are responsible for regulating practically every body function. Examples include estrogens, androgens, DHEA, and cortisol.
Hyperandrogenemia: An excess amount of androgens in the blood that frequently results in hyperandrogenism and skin changes such as acne, hirsutism, and scalp hair loss.
Hyperandrogenism: The effects of excess male hormones (androgens) in women, which include acne, hirsutism, alopecia, and irregular menstrual cycles.
Hyperinsulinemia: Hyperinsulinism, that is, a high level of insulin in the blood, most frequently resulting from insulin resistance. This may cause episodes of hypoglycemia, particularly after eating a carbohydrate-rich meal.
Hypertension: Abnormally elevated blood pressure.
Hyperthyroidism: Overactive thyroid gland.
Hypertrichosis: Excessive hair growth. Many, however, use the word to refer to the excess growth of vellus (fine and soft) hairs, as opposed to hirsutism (the excessive growth of thick, dark hairs in a male pattern). Women with hypertrichosis due to the excess growth of vellus hair do not have androgen excess, as in PCOS and other male hormone excess disorders.
Hypoglycemia: A low blood sugar level. Hypoglycemic episodes are frequently observed in people with insulin resistance who consume excessive amounts of carbohydrates such as sugars or starches. The high insulin levels secreted by the pancreas after they eat sugars or starches lead to a rapid drop in the blood sugar level.
Hypothalamus: The brain gland that controls a number of body functions, including mood, appetite, sleep, and reproduction. The pituitary hormones LH and FSH are stimulated by its secretion of GnRH.
Hypothyroidism: Underactive thyroid gland. This may be caused by an inherent defect or by an abnormality of the pituitary hormonal stimulus of the thyroid gland.
Idiopathic hirsutism: A disorder in which women have hirsutism but ovulate normally with regular menstrual cycles, and who consistently show normal male hormone blood levels. They usually do not have insulin resistance and usually are not at risk of diabetes.
Infertility: Diminished fertility or inability to conceive, which can be caused by problems in either men or women. PCOS often is associated with infertility.
Insulin: A hormone produced by the beta cells of the pancreas, responsible for blood sugar regulation. Insulin regulates the metabolism of carbohydrates and fats, especially the conversion of glucose to glycogen, which lowers the blood sugar level. When not enough insulin is produced to maintain a normal blood sugar level, a person develops diabetes.
Insulin resistance: A subnormal response of blood sugar to a normal insulin level. With insulin resistance in muscle and fatty tissues, the pancreas compensates by producing more insulin to maintain a normal blood sugar level. Most people with type 2 diabetes mellitus are insulin resistant, as are many obese or pregnant people and those having cortisone treatment.
Insulin resistance syndrome: A combination of high blood pressure, high LDL, low HDL, high triglyceride, high insulin, or high blood sugar levels. Much of this is related to obesity and insulin resistance, and involves risk factors for cardiovascular disease and diabetes. Also known as the metabolic syndrome.
Insulin sensitizer: A drug that improves the action of insulin and generally results in a lowering of insulin and glucose blood levels in people with insulin resistance. Primarily used for the treatment of diabetes, such drugs are also promising treatments for PCOS. Insulin sensitizers include metformin, pioglitazone, and rosiglitazone.
Laparoscopic adjustable gastric banding: Bariatric surgery that places an inflatable band around the upper stomach to create a small gastric pouch, which limits food consumption and creates a feeling of fullness. The band can be adjusted over time to meet the individual’s needs.
LDL see Low-density lipoprotein.
LH see Luteinizing hormone.
Lipids: Organic substances insoluble in water that, together with proteins and carbohydrates, make up components of living cells. They include fats, phospholipids, and related compounds.
Lipoprotein: Combination of lipid and protein.
Low-carbohydrate: A common designation of food containing less than average amounts of carbohydrates. Often termed low-carb.
Low-density lipoprotein (LDL): A blood particle composed of a combination of lipids and protein, with a moderate proportion of protein, a little triglyceride, and a high proportion of cholesterol. Known as “bad” cholesterol, it is associated with an increased likelihood of developing atherosclerosis.
Luteinizing hormone (LH): Pituitary hormone essential in the regulation of ovarian function leading to ovulation.
Magnetic resonance imaging (MRI): The use of a nuclear magnetic resonance spectrometer to produce electronic images of specific atoms and molecular structures in solids, especially human cells, tissues, and organs.
Malnutrition: A condition due to an insufficient or poorly balanced diet. This may also occur due to faulty digestion or utilization of foods, and serious illnesses.
Menstrual cycle: The period of time between the beginning of one menstrual period and the next. It usually is twenty-eight to thirty days long.
Metabolic syndrome see Insulin resistance syndrome.
Metabolism: The chemical processes occurring within a living cell or organism that are necessary for the maintenance of life.
MRI see Magnetic resonance imaging.
Obesity: Excessive amount of body fat in relation to the lean body mass, or a body weight that is 30 percent over the ideal weight for a specified height.
Oligomenorrhea: Infrequent menstrual periods, at intervals greater than thirty-five to forty days, common in women affected with PCOS.
Oral contraceptive: A pill containing a mixture of an estrogen and progestin. Because they inhibit ovulation, the pills are used to prevent pregnancy. In the treatment of PCOS, they are used to control irregular uterine bleeding arising from oligomenorrhea and to decrease androgen production by the ovaries.
Ovarian cyst: A fluid-filled, balloon-like area in the ovary. Ovarian cysts measuring about an inch are usually follicles. Larger cysts may rarely be benign tumors or even cancer.
Ovary: One of a pair of glands located in the pelvis of a woman. They produce hormones, including estrogens, androgens, and progesterone, and release an egg. They are most active hormonally during the reproductive years.
Overweight: An increased body weight between 25 and 29.9 percent over an ideal weight for a specific height, as measured by the BMI. It may not only be due to an increase in body fat, but to lean muscle as well.
Ovulation: The process of releasing an egg or ovum from the ovary. Ovulation must occur in order to achieve pregnancy.
Ovulation induction: A treatment that improves the likelihood of ovulation in women seeking to become pregnant, for example, those with PCOS. Common ovulation induction agents include clomiphene citrate (Serophene and Clomid) and menotropins or gonadotropins (Pergonal, Humegon, Repronex, Follistim, and Gonal-F).
Ovum: The medical term for the egg located in one of the ovarian follicles that is normally selected to be released during ovulation.
Pancreas: A glandular organ located in the abdomen that is responsible for the production of insulin. When the pancreas is unable to provide adequate insulin to maintain a normal blood sugar level, diabetes results.
PCOS see Polycystic ovary syndrome.
Pioglitazone: A thiazolidinedione drug that improves the sensitivity of the body to insulin. It is used in the treatment of diabetes and it may be a promising treatment for the insulin resistance of PCOS. The brand name is Actos.
Pituitary: A gland located at the base of the brain that is responsible for regulation of many body functions, including ovulation, adrenal function, growth function, and thyroid function. Abnormalities in the pituitary can lead to erratic ovulation. When considering the diagnosis of PCOS, it is important to exclude a pituitary abnormality that could explain the irregular periods.
Polycystic: A term that means “many cysts.” Because women with PCOS do not ovulate normally, their ovaries usually contain many small follicles that have failed to ovulate. These cysts are located just below the surface (cortex) of the ovary. The presence of these ovarian cysts leads to the typical “polycystic” appearance of the ovaries in PCOS, as seen on an ultrasound examination. This appearance can also be seen in other disorders that may cause irregular or abnormal ovulation even in normal women.
Polycystic ovary syndrome (PCOS): The most common hormonal disorder in reproductive-age women associated with erratic menstrual cycles, infertility, and male-hormone-related skin changes.
Progesterone: A female hormone secreted by the ovary after ovulation. It creates an environment within the uterus that is receptive to a developing embryo. Progesterone also protects the endometrium from abnormal buildup and development of cancer.
Progestin: A synthetic progesterone-like hormone.
Prolactin: A pituitary hormone that, when produced in excess (hyperprolactinemia), can result in irregular or infrequent ovulation. It should be excluded as a cause before PCOS is diagnosed.
Receptor: A protein molecule on the surface or within a cell that binds to a specific factor, such as a hormone, drug, or antigen.
Rosiglitazone: A thiazolidinedione drug that improves the sensitivity of the body to insulin. It is used in the treatment of diabetes and is a promising treatment for the insulin resistance of PCOS. The brand name is Avandia.
Roux-en-Y gastric bypass: Bariatric surgery that reduces the size of the stomach and causes poor absorption of calories, vitamins, and minerals. This procedure creates a pouch out of a small portion of the stomach and attaches it directly to the small intestine, bypassing a large part of the stomach and duodenum, or the initial portion of the small intestine.
Sedentary: Having little activity or exercise as a way of life.
Sleep apnea: A temporary suspension of breathing that occurs repeatedly during sleep, often affecting overweight people. It is a potentially serious condition, which may also be caused by a respiratory obstruction, an abnormally small throat opening, or a neurological disorder.
Spironolactone: A relatively mild diuretic (a drug that increases one’s ability to urinate and lose water from the body), it has the capacity to block the effect of androgens on the skin. It is very useful for the treatment of hirsutism. Side effects include frequent urination, excess thirst, low blood pressure, feeling tired or faint, dry skin, mood disturbances, reduced libido, and heartburn. It can also cause external genital birth defects in a male infant if used during pregnancy. The brand name is Aldactone.
Sterility: A complete inability to become pregnant. Although sometimes used to mean infertility, sterility generally suggests a more permanent inability to become pregnant, such as having one’s tubes tied.
Stroke: A blockage or rupture of a blood vessel to the brain. This may be associated with atherosclerosis or the passage of a blood clot.
Stroma: The central portion of the ovary, containing connective tissue and cells that produce androgens.
Testosterone: A powerful male hormone produced, in women, by the ovaries and the adrenal glands.
Theca cells: A lining of cells surrounding the granulosa cells of the egg follicle. They have LH receptors and produce androgens.
Thyroid: A gland in the frontal portion of the neck that produces hormones designed to regulate the body’s metabolism. Over- or underfunction of this gland creates disturbances of most major organ functions. Abnormal production of thyroid hormones can lead to irregular menstrual cycles. When evaluating a woman with irregular menstrual periods or infertility, it is important to exclude the possibility of thyroid dysfunction before diagnosing PCOS. This does not usually present a difficult problem.
Triglycerides: A type of fat found in blood and food, the most common type of fat in the body, and a major source of energy. Triglycerides commonly circulate in the blood in the form of lipoproteins.
Type 2 diabetes mellitus: The most common form of diabetes mellitus, it occurs when the pancreas cannot make sufficient insulin to compensate for insulin resistance.
Underweight: Weighing less than is normal or healthy.
Uterine: Involving the uterus, as in uterine cancer or a uterine fibroid.
Uterus: A muscular organ above the vagina whose inner lining is called the endometrium, and whose function is to carry a fetus.
Vertical banded gastroplasty: Bariatric surgery that involves construction of a small pouch in the stomach, emptying through a narrow opening into the stomach and duodenum.
Virilization: Masculine appearance of a woman due to a high excess of male hormones, with voice pitch deeper, musculature prominent, significant male pattern hair loss, significant reduction in breast size, and excessive facial and body hair. The hallmark of virilization is an enlarged clitoris (clitoromegaly). Adrenal or ovarian testosterone-secreting tumors or other rare types of androgen excess disorders may cause this condition.
Waist circumference: A measurement around the waist used to assess abdominal fat.