ASK: Should I be Worried about My Daughter? PCOS and Heredity

Many women with PCOS express concern about their offspring being at risk for developing PCOS. This topic is continually being researched and there does seem to be a hereditary component to PCOS.

PCOS is a condition with "multifactorial inheritance." This means that both genetics and environment play a role, and that environmental factors influence the expression of the disease. This is excellent news for those who have family members with PCOS because it means that, with the right tools, one may be able to prevent the complications and some of the symptoms of PCOS.

PCOS may be inherited from either the mother's side or the father's side or both. Males carrying the genetic information that codes for PCOS would show signs and symptoms such as low thyroid function, type 2 diabetes, abnormal lipid profile, premature balding, and more. Samuel Thatcher, MD on the website www.obgyn.net writes that "A paternal origin is equally likely, but often is overlooked. Also, various characteristic traits of PCOS may be passed down with varying degrees of severity. Doctors believe the same insulin and testosterone overload that may cause PCOS in women may also be responsible for premature male-pattern balding in men." (1)

Research conducted by Richard Legro, MD (2) confirms that daughters of mothers with PCOS are more at risk for developing PCOS and elucidates a possible early warning sign. Legro and his team looked at both male and female children of women with PCOS. They measured insulin and hormones in the children and found elevated levels of insulin in more of the girls, but only after the onset of puberty. They concluded that, not only was PCOS being passed on genetically, but more importantly, that insulin was likely the primary problem, with other hormones such as estrogen, progesterone and testosterone being a secondary problem.

With insulin resistance, the body stops responding properly to the actions of insulin and this can lead to an overproduction of insulin as the pancreas tries to compensate. This excess can cause numerous effects including borderline high blood sugar, low blood sugar, weight gain, hormonal imbalances, fatty liver, fatigue, and more. (Eventually, as insulin sensitivity further deteriorates, chronically high blood sugar can develop - the onset of diabetes.)

Fortunately, eating a healthy diet and exercising regularly can prevent weight problems and may mitigate insulin and blood sugar problems, even in those women with a genetic predisposition towards PCOS.

A healthy diet to prevent insulin resistance is one that is low in refined carbohydrates (sugar, white bread, pasta, pastries, white rice, etc.) and processed foods. Whole grains like brown rice and rye crackers are healthier than refined flours and white rice but for people with excess insulin, all carbohydrates need to be eaten in moderation, even whole grain carbohydrates. Regular exercise is also an essential component to a healthy lifestyle that may help to prevent any future diseases like PCOS and other conditions related to insulin resistance.

For now, the important message for women with PCOS is that, just because a girl may have a predisposition for PCOS, does not mean she will definitely develop this condition. Mothers with PCOS who have children of either sex should encourage their families to eat a healthy, low carbohydrate diet and engage in regular physical activity in order to prevent weight problems, insulin and blood sugar problems, and hopefully control the expression of PCOS.

Dr. Sari Cohen

References:
(1) http://www.obgyn.net/pcos/pcos.asp?page=articles/whatispcos
(2) http://www.sciencedaily.com/releases/2008/07/080728114028.htm
Kent SC et al. Hyperandrogenism and hyperinsulinism in children of women with polycystic ovary syndrome: a controlled study. J Clin Endocrinol Metab. 2008 May;93(5): 1662-9.Epub 2008 Feb 12.