by Erica Howard NP with Louise D Metz, MD
Polycystic ovarian syndrome, commonly known as PCOS, is a condition that affects approximately 10 million women worldwide. PCOS is a disorder that affects hormones, resulting in a variety of physical and metabolic symptoms. Primary hormones affected by PCOS include testosterone, progesterone, estrogen, and insulin levels. The exact cause of PCOS remains unknown, however both genetic and environmental factors are believed to contribute to its development.
Symptoms of PCOS may manifest as early as puberty, but can also develop over time into early adulthood. Many individuals with PCOS experience irregular or infrequent menstrual periods as a result of not ovulating on a regular basis. Unwanted hair growth (hirsutism) is common on the face, arms, chest, and torso due to high testosterone levels. Thinning of the hair on the scalp may also occur around middle age due to hormonal influences with PCOS. Fatigue and weight changes are also common symptoms of PCOS due to the associated insulin resistance that develops as part of the disorder. This insulin resistance also increases the risk for the development of diabetes in individuals with PCOS. Headaches, pelvic pain, and sleep difficulties are other common symptoms of the condition. Many people with PCOS also experience fertility difficulties, largely due to the irregular menstrual cycles and lack of regular ovulation. PCOS is a leading cause of female infertility, and some women requiring fertility treatments in order to become pregnant. However, many women are able to conceive naturally without any assistance.
Polycystic Ovarian Syndrome is not diagnosed with one simple test, but rather is based on a variety of clinical features and a patient’s symptoms. Hormone levels, blood sugar/insulin sensitivity testing, and a comprehensive physical examination are also helpful in the diagnosis of PCOS. Pelvic ultrasound is sometimes used to characterize the appearance of the ovaries. However, it is important to note that not all patients with PCOS will have cysts on their ovaries, so ultrasound is often of limited use in diagnosis and does not change the approach to management.
There is no “cure” or one size-fits-all approach to PCOS treatment. Instead, treatment is aimed at symptom management on an individualized basis. Hormonal birth control pills are often used to help regulate menstrual periods, hormone levels, and other physical symptoms including acne and undesirable hair growth. Birth control pills also help to protect the uterine lining from becoming thickened with PCOS, which if left unmanaged, increases the risk for endometrial (uterine) cancer. Progesterone-containing IUDs, such as Mirena and Kyleena, also offer endometrial protection, as well as good contraception. Metformin is a medication used for diabetes treatment to improve insulin sensitivity, and is commonly used in PCOS management as well. Metformin is not approved by the FDA for the indication of PCOS, but can help to reduce blood sugar levels, improve insulin sensitivity, and regulate menstrual periods (and is often used to help with fertility). Spironolactone is a diuretic that works to reduce the effects of testosterone which causes the unwanted facial/body hair and acne, and is commonly used in PCOS management. Although infertility and irregular menstrual patterns are common with PCOS, it is important to be aware that unplanned pregnancy can still result without contraceptive use.
There is a common misconception that weight gain or having a larger body causes PCOS. However, PCOS can occur in women of all body sizes, and weight gain does not cause PCOS. The opposite is actually true: the high insulin levels and inflammation that occur in women with PCOS can cause the symptom of weight gain. Due to this misconception, many women with PCOS have been instructed by health care providers to diet and lose weight as the primary treatment for this condition. This often leads to weight cycling and eating disorders in women with PCOS, does not help their PCOS symptoms, and can be harmful to their health. We instead recommend a weight-inclusive approach, and encourage working with a dietitian on intuitive eating and nutritional changes that may help insulin resistance. In addition, we recommend incorporating supplements that may be helpful for PCOS, such as inositol, vitamin D, and omega-3 fatty acids.
Polycystic Ovarian Syndrome can be a confusing condition to diagnose and manage. If you think you may have symptoms consistent with PCOS, we encourage you to discuss them with your healthcare provider at Mosaic Comprehensive Care to determine how best to approach your concerns.