September is PCOS Awareness Month

I know it’s the end of the month, but I wanted to repost an article that I wrote for my corporate job a few years ago. My daughter was diagnosed with PCOS as a teenager, and I saw what huge improvement she experienced with her overall health once she started treatment. Women at work reached out and thanked me for writing about PCOS because they hoped it would help someone else get diagnosed sooner than they were. I hope this post helps you or someone you know.

Polycystic Ovarian Syndrome (PCOS), also known as Stein-Leventhal syndrome and hyperandrogenic anovulation (HA), is a very common hormonal endocrine disorder but is not as well-known as other diseases and disorders affecting women. Approximately 5 million females (girls and women) in the United States and more than 10 million worldwide have PCOS (1); however, it is undiagnosed in approximately half of these women.

Females with PCOS exhibit higher levels of androgens. Androgens are actually unisex sex hormones (in that they are produced by males and females), but they are most associated with males because they make and use more androgens (such as testosterone) than females. In healthy individuals whose androgen level is within the normal range, the male body experiences the proper triggers for sexual development and physique, and the female body experiences a more subtle effect on development (2). With higher levels of androgens, the female body exhibits several symptoms, which include acne, excessive hair growth, and weight gain. The most serious symptom is hormonal imbalance which ultimately causes the disruption of the menstrual cycle and infertility (3).

PCOS typically begins with small cysts afflicting the ovaries where the follicle should release a mature egg. The imbalance of hormones affects ovulation in that the egg may be unable to fully mature; therefore no egg is released. This prevention of ovulation causes the absence of progesterone production. The absence of progesterone (another hormone) affects a woman’s menstrual cycle by making it irregular or absent.

The cause of PCOS remains unknown, but scientists, doctors and other researchers believe genetics has a role. They also think another hormone, insulin, has a link to PCOS. Insulin is used in digesting food. Its role is to help the body with the conversion of sugar, starches and other food into energy that will be used or stored. A common occurrence in women with PCOS is their bodies having issues with using insulin. This causes the patient to have too much insulin, and the excess insulin may increase androgen production.

Health problems from PCOS are not limited to reproductive issues, such as irregular menstrual cycle and infertility. PCOS may also affect a woman’s hormones, heart, blood vessels and physical appearance.

Symptoms of PCOS are not the same in every woman with PCOS but may include (3):

• Infertility (not able to get pregnant) because of not ovulating. In fact, PCOS is the most common cause of female infertility
• Infrequent, absent, and/or irregular menstrual periods
• Hirsutism (HER-suh-tiz-um) — increased hair growth on the face, chest, stomach, back, thumbs, or toes
• Cysts on the ovaries
• Acne, oily skin, or dandruff
• Weight gain or obesity, usually with extra weight around the waist
• Male-pattern baldness or thinning hair
• Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black
• Skin tags — excess flaps of skin in the armpits or neck area
• Pelvic pain
• Anxiety or depression
• Sleep apnea — when breathing stops for short periods of time while asleep
• Fatigue – Many women with PCOS report increased fatigue and low energy. Related issues such as poor sleep may contribute to the feeling of fatigue.
• Mood changes –  Having PCOS can increase the likelihood of mood swings, depression, and anxiety

Women who have a combination of symptoms may speak with their health care provider to find out if they have PCOS or another disorder/disease is the cause of the symptoms. PCOS is not diagnosed from one test. The health care provider may order blood tests, perform exams and ask about the patient’s medical history. The list below provides the steps that may be performed to diagnose PCOS (3):

• Medical history. Your doctor will ask about your menstrual periods, weight changes, and other symptoms.
• Physical exam. Your doctor will want to measure your blood pressure, body mass index (BMI), and waist size. He or she also will check the areas of increased hair growth. You should try to allow the natural hair to grow for a few days before the visit.
• Pelvic exam. Your doctor might want to check to see if your ovaries are enlarged or swollen by the increased number of small cysts.
• Blood tests. Your doctor may check the androgen hormone and glucose (sugar) levels in your blood.
• Vaginal ultrasound (sonogram). Your doctor may perform a test that uses sound waves to take pictures of the pelvic area. It might be used to examine your ovaries for cysts and check the endometrium (en-do-MEE-tree-uhm) (lining of the womb). This lining may become thicker if your periods are not regular.

PCOS currently cannot be cured (1); however, a variety of treatments exist and can help manage PCOS and help patients decrease or eliminate PCOS symptoms. Management is key in preventing other problems. PCOS patients should work with their physician in order to determine symptom-based treatment goals and which treatment or combination of treatments will help the patient accomplish her goal. Treatments include but are not limited to (3):

• Lifestyle modification to treat overweight or obese patients. Modifications such as eating healthy and exercising help patients to reach and maintain a healthy weight. Being at a healthy weight improves the balance of hormones by lowering glucose (blood sugar) levels, which improves the body’s insulin use, therefore helping the body to maintain normal levels of hormones.
• Birth control pills may be part of a treatment plan for women who are not trying to get pregnant. Using birth control pills helps to regulate menstrual cycle and balance hormone levels by reducing male hormone levels. Acne may also clear up from using birth control pills. If the woman discontinues use of birth control pills, she will return to irregular menstrual cycles. Menstrual cycles can also be regulated by progesterone-only pills, but these pills will not reduce other symptoms such as acne and hair growth which can be reduced by birth control pills.
• Diabetes medications such as metformin have been credited with helping PCOS symptoms. Metformin (or Glucophage) is used in treating type 2 diabetes, but it has not been approved by the FDA (U.S. Food and Drug Administration) for use in treating PCOS. By affecting the body’s use and levels of insulin, metformin thereby lowers androgen (specifically testosterone) production. As a result, abnormal hair growth becomes slower, and it’s also possible for ovulation to return when the patient has been taking metformin a few months.
• Fertility medications may be a treatment for women with PCOS who are trying to get pregnant. Medications to stimulate ovulation are used because it is the most common reason for infertility in women with PCOS. Before using fertility medications, the woman and man should both be examined/tested for other reasons for infertility.

Please visit the PCOS Awareness Association site for more information or read the complete fact sheet at the Office on Women’s Health, U.S. Department of Health and Human Services site.

Current television entertainment has helped in raising PCOS awareness. The TLC reality series, “My Big Fat Fab Life” stars Whitney Thore. In her early 20s, she was diagnosed with PCOS to which she attributes her weight issue which has reached obesity and pre-diabetic levels. Thore has used this opportunity to educate a mass audience on PCOS beyond its link to weight gain or difficulty losing weight. She has received feedback from medical professionals, stating that they’ve seen a rise in the number of patients who wish to be tested for PCOS based on their symptoms.

References
1. PCOS Awareness Association
2. e.hormone; your gateway to the environment and hormones
3. Office on Women’s Health, U.S. Department of Health and Human Services