By Margaret Dufreney, MD
If you have irregular periods and unwanted facial hair or acne, you may have a condition called polycystic ovary syndrome, or PCOS.
PCOS is a complex disorder that some women develop during their childbearing years. The symptoms include:
- Unwanted hair on your face, chest or abdomen
- Acne on your face
- Loss of hair at your hairline
- Irregular or skipped periods
- Heavy bleeding during periods
- Difficulty getting pregnant (infertility)
To be diagnosed with PCOS, a woman must meet at least two of the following three criteria:
- Higher than normal levels of hormones called androgens, which include testosterone
- Irregular periods
- Polycystic ovaries, meaning an increased number of fluid-filled sacs on the ovaries (called follicles)
Your doctor will most likely perform a physical exam if you have any of these criteria. Then he or she will order bloodwork to rule out other conditions, like an issue with your thyroid. An internal (transvaginal) ultrasound will enable your doctor to look at the follicles on your ovaries to determine if they are increased in number and therefore appear polycystic.
While many women have heard of polycystic ovary syndrome, not everyone understands it. Here are some common misconceptions about the disorder:
- You have to have cysts on your ovaries to have PCOS. No, in some cases, the ovaries appear normal.
- Ovarian cysts require surgery. No, the cysts aren’t large cysts that require surgery. The term actually refers to an increased number of follicles in the ovaries that appear as fluid filled sacs during an ultrasound.
- You have to be obese to have PCOS. While it’s a prevalent risk factor, 20 percent of women with PCOS are of average weight or thin.
- You won’t be able to conceive if you have PCOS. While it does hinder conception, regular ovulation/menstrual cycles can be restored with weight loss (when indicated) and/or medication. You may then able to get pregnant spontaneously. If not, many women conceive using medications to induce ovulation.
- PCOS is only an issue if you’re trying to get pregnant. Not true: Women with PCOS have an increased risk of developing diabetes, cardiovascular disease, high blood pressure, high cholesterol, and endometrial cancer. The long-term health effects of PCOS are significant, so it should be addressed with your doctor whether you are trying to conceive or not.
- All women with PCOS have unwanted hair growth and acne. Not true: Elevated androgen levels affect everyone differently, and some women don’t experience these symptoms.
While the cause of PCOS is not fully understood, there seems to be a correlation between PCOS and weight. In fact, 80 percent of women diagnosed with PCOS are clinically obese. Insulin resistance also may be a factor. This occurs when the cells in your muscles, fat, and liver don’t respond well to insulin and can’t easily take in glucose from your blood. This can cause blood glucose levels to spike, and your pancreas secretes more insulin to compensate.
If left untreated, PCOS can increase your risk of developing diabetes, cardiovascular disease, or endometrial hyperplasia, a condition that occurs when the lining of the uterus builds up. Over time, the cells of the uterus can become abnormal and cancer may develop.
The first line of treatment is making lifestyle changes, such as losing weight. Just losing 10 to 15 pounds can help alleviate the symptoms of PCOS and better regulate your menstrual cycle, as well as improve your blood pressure, cholesterol, and blood sugar. I refer patients who want to better manage their weight to nutrition and exercise services to help them make positive changes.
For women who aren’t trying to get pregnant, other treatment options include taking an oral birth control pill that includes a combination of low-dose estrogen and progestin. This can regulate the menstrual cycle and alleviate unwanted hair and acne. It also protects against the development of endometrial cancer. Another option is taking an insulin-sensitizing medication like metformin, which can improve insulin resistance, lower your insulin and glucose levels, decrease androgens, and improve ovulation.
If you’re trying to become pregnant, medication to induce ovulation, such as Clomid, can help you conceive.
While PCOS may be misunderstood, there are a variety of treatment options available. Talk with your doctor about which one is right for you.
Margaret Dufreney, MD, is board-certified in obstetrics and gynecology and is on staff at CentraState Medical Center. She can be reached by calling 866-CENTRA7.