What’s PCOS?

SYMPTOMS

PCOS, or polycystic ovary syndrome, is an endocrine disorder that affects an estimated 5% of all women. It most commonly manifests itself through:

* menstrual irregularities

* infertility

* breastfeeding problems, such as low milk supply or oversupply [this is not on most lists, but it is very common]

* weight gain and/or trouble losing weight

* acne or other skin problems

* depression, anxiety

* insulin resistance (this is the big first issue that diet and exercise can help to correct!)

* diabetes

* loss of hair on the head, too much hair elsewhere (yes, ironic, right?). The excess hair is known as “hirsutism.”

* and something you can’t see: many small cysts on your ovaries. These are not like the painful big cysts that many women experience once in a while; they can be seen by ultrasound, though. The classic appearance is usually described as a “string of pearls” visible on the ultrasound.

DIAGNOSIS

The name “polycystic ovarian syndrome”  refers to the multiple cysts on the ovaries. Most women, when they hear the term “ovarian cyst,” think about the occasional, painful large cysts that are common for all women. The cysts that are characteristic of PCOS do not, in and of themselves, cause a problem. Indeed, not all PCOS women have these cysts, and some women with polycystic ovaries do not have PCOS. The name is not very accurate, but who’s going to change it now?

You will be diagnosed with PCOS only if you have other symptoms–not based on an ultrasound picture of a polycystic ovary alone. Tests for PCOS include [aside from the ultrasound to identify enlarged ovaries and cysts]:

* androgen levels, including testosterone. Free testosterone should be tested as well as total testosterone.

* the ratio of LH [luteinizing hormone] to FSH [follicle stimulating hormone]. If this ratio is greater than 1:1, it may suggest PCOS. It is not a very specific or accurate test, however, and would only be used to diagnose PCOS in conjunction with other clinical signs or lab results.

* levels of sex hormone binding globulin [SHBG], which may be low in PCOS sufferers.

* tests for insulin resistance or diabetes–the fasting biochemical screen or the 2-hour glucose tolerance test. [These will be familiar to many women who have been pregnant.]

Keep in mind that you should not self-diagnose PCOS. It’s so tempting to look at the list of symptoms and say, “Yes, that’s me!”, but you should consult a doctor. There are other disorders that can cause similar symptoms, including thyroid problems [hypothyroidism can cause almost exactly the same set of symptoms as PCOS]. Diagnosis may include tests to rule out thyroid disorders, hyperprolactinemia, and other diseases.

CAUSES and RISKS

Current researchers believe that PCOS is caused by excess androgens [male hormones]. Some also consider insulin resistance a cause; it is certain that IR is correlated with PCOS, although which one causes the other, or how they might be related if not causally, is unclear. So, if you have PCOS symptoms, you should be tested for insulin resistance and diabetes.

There are some other problems that are often found in PCOS sufferers–if you have PCOS or suspect it, you should also be aware of the likelihood of these comorbid disorders:

* depression and/or anxiety

* insulin resistance or Type II diabetes

* cholesterol or triglyceride problems

* high blood pressure

* heart disease and stroke

* any other problem that is caused or aggravated by obesity, as most PCOS ladies are obese

* possibly endometrial cancer, although this has not been shown for sure, and it may be caused by associated obesity and insulin problems rather than by PCOS, per se

* miscarriage

* autoimmune thyroiditis

* skin problems such as hydradenitis suppuritiva or acanthosis nigricans

TREATMENTS

Treatment for PCOS varies, partly because symptoms vary so greatly. The first and most important treatment is exercise [this is my opinion, by the way; some people believe that other treatments are more efficacious]. Exercise, even if it does not lead to weight loss, is an extremely effective treatment for PCOS. Diet is also important [again, even if it does not lead to weight loss]. Because of the link between PCOS and insulin resistance, a diet low in refined carbohydrates [sugar, white flour] is a good choice, but any balanced, heathy eating plan works well.

Weight loss can minimize symptoms. Often, women who lose weight find that their menstrual cycle regulates itself with no other treatment–even women who have struggled with infertility.

Drugs that are used to treat PCOS include:

* Metformin [brand name Glucophage], which is an insulin sensitizing agent. Doses vary between 1,000 and 2,000 mg per day, though most of the women I’ve encountered have found that a minimum of 1,500 mg is needed to see results. Met can help reduce insulin resistance, regulate menstruation, and ameliorate other symptoms of PCOS, but it is not a magic bullet; for some women it is a miracle drug, and others see no result at all. It also carries the likelihood of fairly major GI side effects, although those can often be managed by eating well. It’s available in a cheap [$4] generic in the US. There are regular and extended-release versions.

Metformin is also considered safe during pregnancy and continuing to take it for at least the first trimester can reduce the risk of miscarriage in PCOS women. Ask your OBGYN to help you figure out the risks/benefits.

* Other insulin-sensitizing drugs are also sometimes used: Actos, Avandia, etc. These are similar to Metformin, but your doctor can help you figure out the subtle differences.

* Fertility drugs. I know little about infertility, but Clomid is the first line of attack, followed by more intense reproductive medicine. FSH [follicle stimulating hormone] is also frequently used.

* Birth control pills [oral contraceptives]. These can reduce the symptoms of PCOS, although they will not really treat it. In particular, they can help with hirsutism and acne for some women [and of course they will induce a “normal” period, although it is not indicative of a normal cycle or ovulation]. Yaz is often prescribed because it contains drospironone, which can help reduce acne, or Dianette, which can help reduce hirsutism.

* Drugs to combat acne and/or hirsutism, such as spironolactone or oral and topical antibiotics.

* D-chiro-inositol, a dietary supplement, is often used; however, I know little about this. There are many women at SoulCysters [link in sidebar] who use this, and they would be a great source of information.