One of the most common problems we see women with is polycystic ovarian syndrome, or PCOS. In fact, it’s the most common hormonal condition affecting women of reproductive age. It affects 6 to 12 percent of women of reproductive age in the US. It’s pretty frustrating for women who experience it and it often wreaks havoc on their sex lives. This is often a tough one for health care providers as well because the cause remains unclear, it’s likely multifactorial and the treatment response is variable.
What is PCOS?
Women with PCOS have higher levels of androgens (male hormones) and ovulatory dysfunction, which means ovulation is irregular or infrequent. As a result, these women may not have regular menstrual cycles each month. Between 40 and 80 percent of women with PCOS are overweight or obese. Women with PCOS are at increased risk for endometrial cancer, diabetes and heart disease.
PCOS Symptoms can include:
- Having fewer than 8 periods a year
- Growing thick, dark hair on the upper lip, chin, sideburn area, chest, or belly
- Acne (oily skin and pimples on their face)
- Hair loss from the head
- Trouble getting pregnant without medical help
- Weight gain and obesity (although not everyone with PCOS has this problem)
What’s happening inside?
Many women who are diagnosed with PCOS incorrectly assume that they have cysts on their ovaries. This is not really true. Women with PCOS do not have more cysts on their ovaries than a woman without PCOS. Rather, the term refers to the appearance of the ovaries on ultrasound. In the process of normal ovulation, multiple follicles containing ova, or eggs, develop. One of these follicles (or sometimes two in the case of twins) matures and then ruptures to release an ovum. The remainder of the follicles die and reabsorb. Follicular cysts (also referred to as physiologic cysts) arise when rupture does not occur and the follicle continues to grow. In the case of PCOS, there are more follicles than normal in the ovaries. When visualized on ultrasound they have a classic “ring of pearls” appearance. These multiple follicles look like small cysts but technically are not cysts.
PCOS makes it more difficult for the body to use the hormone insulin. Insulin helps the body convert sugars and starches from food into energy. When insulin isn’t used properly it can lead to insulin and sugar building up in the bloodstream.
High insulin levels also increase the production of male hormones. And high male hormone levels lead to symptoms such as excess hair growth, acne, irregular periods and weight gain. It's essentially a merry-go-round of hormone imbalance.
What problems can it cause?
Infertility - In people with PCOS, hormone levels become unbalanced and ovulation doesn't happen every month the way it is supposed to. We are not sure why this happens. Because women with PCOS do not ovulate regularly, PCOS is considered a leading cause of female infertility, but it has much broader health implications and should be addressed independent of pregnancy plans.
Irregular periods and/or heavy periods - Women with PCOS will often not get a period for several months. When this happens, the uterine lining (endometrium) continues to get thicker and thicker because it is not being shed regularly as in a normal menstrual cycle. It can cause heavy bleeding when it does shed off.
Endometrial hyperplasia (precancer) and cancer - In some cases, over time, this overgrowth of endometrial lining can lead to cancer or precancer. Therefore it is important to start some form of medication (like birth control pills or a progestin-secreting IUD) that will help to keep the uterine lining thin.
Type 2 diabetes - Many women with PCOS also have insulin resistance, which means their bodies make insulin but they are unable to use it effectively. Therefore, women with PCOS are at high risk for type 2 diabetes. Once a diagnosis is confirmed, women with PCOS should be screened periodically for diabetes with a glucose tolerance test and for metabolic syndrome.
How can we prevent these problems?
Exercise, weight loss- Treatment for PCOS will depend on the variety of symptoms a woman is coping with, the results of the testing, risk factors for diabetes and heart disease and pregnancy plans. One therapy that can almost always be recommended is exercise, which helps the body use insulin more effectively and can reduce the risk of diabetes. Weight loss. If you are overweight or obese, losing weight will often result in the return of a normal menstrual cycle along with many other symptoms associated with PCOS. Some studies quote 5-10% weight loss can help improve cycles.
While PCOS is a leading cause of infertility, most people with PCOS are able to get pregnant. However, it is usually easier for those who do not have difficulty with their weight. If you are overweight, losing weight can help make your periods more regular and improve your chances of getting pregnant. If you lose weight but your periods are still irregular, your doctor or fertility specialist can give you medicines to help you ovulate and improve your chances of getting pregnant.
Nutrition - The medical community is learning more about how nutrition may play into PCOS management. Reducing carbohydrate intake, eating sufficient fiber, having healthy gut bacteria as those found in probiotics and avoiding inflammatory foods (ie processed foods and refined sugars) all contribute to improved nutrition.
Hormonal contraceptive - Aside from weight loss, the most common treatment is to take birth control pills. The pills don't cure the condition, but they can improve many of its symptoms, like irregular periods, acne, and facial hair. Birth control pills also lower your risk of precancer and cancer of the uterus.
Other medications - Anti-androgen medications like Spironolactone block hormones that cause some PCOS symptoms like acne and facial hair growth. More recently Metformin has been used to treat PCOS. This medicine can help make your periods more regular and, in people with diabetes, helps to lower blood sugar levels.
Supplements - There are a number of supplements gaining attention for the management of PCOS. Inositol is a vitamin-like substance found in humans, plants and animals. Studies show it helps insulin work better and thus may be beneficial in the management of polycystic ovary syndrome. Supplements like Soul Cyster - use Myo-inositol, D-chiro-inositol, along with folic acid to improve PCOS symptoms.
What should you do?
If you are dealing with PCOS we know it can be trying, the good news is that you are not alone, there are options available to manage it and we are learning more and more about it every day. If you think you may be suffering from PCOS we encourage you to talk to your health care provider about it and see what options are best for you. Please help us expand the conversation by sharing this blog post with friends and/or loved ones who could use this information!
Disclaimer: This is not medical advice, does not take the place of medical advice from your physician, and is not intended to treat or cure any disease. Patients should see a qualified medical provider for assessment and treatment.