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Robin Washington*, Langston University, Langston, OK

UNIQUE: The relationship between Polycystic Ovary Syndrome, PCOS, and type 2 diabetes is unique in that healthcare professionals tend to address the diabetes without addressing or recognizing PCOS as the primary condition. With diabetes and obesity being at epidemic proportion within the United States, it is important that proper treatment is provided. Eighteen million individuals in the United States have type 2 diabetes and 9.3 million are women over the age of 20. Within the United States, 5 million women of childbearing age have PCOS with 50% of the women diagnosed having developed type 2 diabetes. It is predicted that women with PCOS will develop type 2 diabetes by the age of 40. This condition has a significant impact on the women's quality of life and treatment should address the PCOS first while managing secondary conditions.
The purpose of this paper is to provide information to physical therapists about PCOS based on a literature review. The aim is to 1) provide background information related to PCOS; 2) identify the population of women diagnosed with PCOS and type 2 diabetes; 3) describe the relationship between PCOS and type 2 diabetes; 4) educate physical therapists on the signs and symptoms and secondary conditions related to the disorder; and 5) identify psychosocial implications of the disorder, diagnostic strategies and treatments.
PCOS was initially identified in 1935 by Drs. Stein and Leventhal who described masculine features in women displaying absent or abnormal menstrual cycles, sterility or enlarged ovaries. As a result, gynecologic treatments focused on controlling for abnormal bleeding and infertility. In the 1980s, PCOS was linked to a condition called hyperinsulinemia and impaired glucose tolerance. In the 1990s, reseachers identified a deficit in the insulin receptors of women diagnosed with PCOS. Therefore, PCOS is no longer considered solely a gynecological condition but a metabolic condition requiring early diagnosis by family physicians.
PCOS is a chronic illness of unknown etiology. Its occurrence last from puberty to menopause. This disorder is caused by hormonal imbalances resulting in the enlargement of one or both ovaries resulting in the over production of male hormones, androgen and testosterone. This overproduction interferes with the women's ability to ovulate. The enlargment of the ovaries is due to the accumulation of mature eggs within the ovaries that form fluid filled sacs (cysts) increasing the ovary's size by 1.5-2.0 times its normal size. Signs and symptoms of PCOS include male pattern baldness, excessive facial and body hair, acne, obesity, excessive abdominal fat, rashes, pelvic pain over 6 months, infertility, spontaneous abortions and water retention.
As PCOS progresses, the production of male hormones is significantly increased. Over time, women may develop insulin resistance which may lead to hyperinsulinemia. Hyperinsulinemia has been identified as a major cause of obesity and disrupts sodium metabolism leading to water retention. Secondary conditions related to PCOS include endometrial cancer, impaired glucose tolerance, type 2 diabetes, hypertension, strokes, coronary artery disease and decreased metabolic rate. Psychosocial implications for this disorder involves depression/anxiety, functional limitations, poor body image, decreased social activities and poor stress management skills. Diagnostic strategies include taking a patient history, laparascopy, ultrasound and blood work. Primary treatment for this disorder should focus on decreasing the production of male hormones through medications such as birth control pills or Spironolactone. Other treatment involves educating healthcare professionals and patients about the disorder, lifestyle changes that include diet and exercise, insulin sensitizing-medications, wedge resection of the ovary, Glucophage and counseling.
Physical therapists possess the knowledge and skills needed to enhance the quality of life for women with PCOS by addressing lifestyle changes, pain management, and psychosocial implications. Lifestyle changes are essential. Loosing weight is a challenge for women with this disorder. Further study is recommended which will identify proper exercise techniques for assisting the women in maintaining lean body mass and glycemic control when necessary. Since the development of type 2 diabetes is predicited to occur by the age 40 within this population of women, recommended studies should focus on the long-term effects of resistant exercise training in retarding the onset of type 2 diabetes.
KEY WORDS:  Polycystic Ovary Syndrome, Type 2 Diabetes, PCOS, Women and Diabetes

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