Polycystic Ovarian Syndrome (PCOS)
What’s in the know about PCOS?
PCOS is the most common hormonal disorder among women of reproductive age with signs and symptoms beginning soon after a woman first starts having periods (menarche). In some cases PCOS develops later during the reproductive years, for instance, in response to substantial weight gain. It occurs when a woman’s levels of estrogen, androgens, and progesterone are out of balance which leads to the growth of ovarian cysts and a multitude of symptoms.
PCOS has many signs and symptoms which include irregular periods, unwanted hair growth, weight gain, and infertility. All of these can worsen with obesity. Every woman with PCOS may be affected a little differently, and the range of symptoms can vary.
PCOS has been linked to an increased risk for developing other medical conditions such as insulin resistance, type 2 diabetes, high cholesterol, high blood pressure and heart disease.
*10% of women of childbearing age are estimated to have PCOS
*50% of women are undiagnosed
*50% will develop type 2 diabetes or pre-diabetes before the age of 40
*The risk from developing endometrial cancer is increased by 3x
*PCOS is responsible for 70% of infertility issues in women who have difficulty ovulating
What are risk factors for PCOS?
*Increased insulin levels (increased insulin levels stimulate increased male hormone production)
*Obesity, especially if it began before puberty.
What are the signs and symptoms?
*Irregular / no periods This is the most common characteristic. Examples include menstrual intervals longer than 35 days; fewer than 8 menstrual cycles a year; failure to menstruate for 4 months or longer and prolonged periods that may be scant or heavy.
*Excess facial and/or body hair: Elevated levels of male hormones (androgens) may result in physical signs, such as excess facial and body hair (hirsutism), adult acne or severe adolescent acne and male-pattern baldness(androgenic alopecia)
*Severe acne: Because women with PCOS have a hormonal imbalance that causes an over production of male hormones, acne and oily skin are typical symptoms.
*Multiple cysts on the ovaries: Polycystic Ovaries become enlarged and contain numerous small fluid filled sacs which surround the eggs
*Weight gain or obesity: Because the weight gain is triggered by male hormones, it is typically in the abdomen, where men tend to carry weight. Often, women with PCOS will have an apple shape rather than a pear shape.
Insulin Resistance: Insulin is a hormone produced in the pancreas that allows cells to use sugar (glucose) — your body’s primary energy supply. If you have insulin resistance, your ability to use insulin effectively is impaired, and your pancreas has to secrete more insulin to make glucose available to cells. Excess insulin can also affect the ovaries by increasing androgen production. Too many androgens in our body can interfere with the ovaries’ ability to ovulate.
*Anxiety / depression: PCOS can have an emotional impact on women and can affect mood, stress and body image.
HOW is PCOS diagnosed?
According to the American Society for Reproductive Medicine there must be 2 of the 3 following signs and symptoms:
- Irregular ovulation or no ovulation
- Signs of increased androgen (male hormone) levels
- Multiple small cysts on the ovaries (this alone cannot diagnose PCOS)
How is PCOS treated?
There is no cure for PCOS and the main focus in treatment is to control symptoms so that the effects of PCOS on the body are minimized.
Measures include: improving insulin sensitivity, restoring normal ovulation and decreasing androgen levels.
The key lifestyle factors in improving these measures boil down to diet – low glycemic index diet, exercise – increasing physical activity and emotional well-being.
With PCOS, correcting abnormal hormone levels, losing weight and managing cosmetic concerns are key for those not planning on pregnancy. If pregnancy is desired, losing weight and promoting ovulation is key! Medications are often used to regulate periods, control hair loss and acne, as well as improve insulin resistance. Medications can also help decrease long term risks such as high cholesterol and heart disease.
PCOS is very complex and not always easy to understand but with a little help it can be well managed!
If you think you might be experiencing these symptoms, please schedule an appointment with one of our providers at McDowell Mountain Gynecology for further evaluation at 480-483-9011.
Jacqueline Johnstone CNM, MSN, BSN