On Your Health

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What is PCOS?

Ten to 20 percent of women have Polycystic Ovarian Syndrome (PCOS). But because PCOS manifests itself differently in every woman, you may be unfamiliar with it unless you know someone who has been diagnosed.

So, what is PCOS? Essentially, PCOS is an endocrine disorder that can affect a woman’s appearance, hormones, menstrual cycle and her ability to have children. Women with PCOS are also at higher risk for diabetes and heart disease and will usually have high levels of androgens, irregular periods or small cysts within their ovaries.

PCOS Diagnosis

Diagnosis can happen a couple of ways. Either a woman is familiar with PCOS and decides to get tested, or her physician will suspect PCOS as the cause for seemingly unrelated symptoms and will run some tests.

“Often a patient will ask about PCOS because a friend has told her she thinks she has it,” says Dr. Julie Hansen, a board certified OB/GYN who practices at INTEGRIS Health Edmond.

PCOS includes a constellation of symptoms: skipped periods, problems losing weight, excess hair growth on areas like the upper lip, chin and lower abdomen (known as “male pattern hair growth”), acne, polycystic ovaries and infertility.

Unusually long waits between cycles is also a PCOS symptom. Sometimes it’s only six to eight weeks, but some women experience anywhere from six to 12 months between periods.

To be diagnosed with PCOS, a woman should meet two out of three items listed on the Rotterdam criteria, which is a well-respected guideline for diagnosis of PCOS, Dr. Hansen says. These items include an excess of androgens exhibited by either excessive male pattern hair growth or elevated testosterone levels, the appearance of multiple small cysts on the periphery of the ovaries detected on an ultrasound exam (hence the name “polycystic ovaries”), and/or irregular periods. Women who exhibit these symptoms should have their androgen levels tested as well as a pelvic ultrasound performed to establish a diagnosis of PCOS.

“The testosterone level doesn’t have to be very highly elevated to meet the criteria,” Dr. Hansen says.  Further, Dr. Hansen says the presence of polycystic ovaries alone doesn’t meet the criteria to make a PCOS diagnosis.

Currently, the cause of PCOS is unknown, but there are ways to help get symptoms under control to prevent certain health problems and help with infertility.

Common treatment options for PCOS

Treatment is different for every woman and treatment plans vary. “Treatment is very individualized because women with PCOS are concerned about different issues,” Dr. Hansen says.

Some women worry about their appearance, with symptoms like weight gain, hair growth and acne. Other women are frustrated by irregular periods or struggle with infertility. Women with PCOS have an imbalance of their estrogen and progesterone levels, which can be a managed (but not cured) with hormonal medications like birth control pills or progesterone. If a woman isn’t trying to get pregnant, the treatment plan will be designed  to get specific symptoms under control and to regulate menstrual cycles. Cycle control is important whether or not a woman wants to conceive. It's important to protect the lining of the uterus from being overstimulated, which if allowed to go unchecked can turn into uterine cancer.

“Women don’t realize there are health implications with PCOS related to abnormal menstrual cycles,” Dr. Hansen says. “I’ve seen women who have PCOS who were never diagnosed when they were younger now have uterine cancer. If you don’t have periods on your own, that’s not OK in a long-term sense.”

A common drug that’s prescribed to women with PCOS is Metformin, which helps people who are insulin-resistant. “Metformin isn’t necessarily the best option,” Dr. Hansen says. "It can help some women ovulate and lose weight, but unfortunately, the weight loss caused by this medication is only temporary and not sustained.

Fertility and PCOS

Women with PCOS struggle with fertility because their bodies don’t naturally produce hormones in the correct balance for their ovaries to release eggs normally, known as ovulation. Medication can help start normal ovulation. Femara or Clomid are two medications prescribed to women with PCOS who have difficulty ovulating.

Did you know? PCOS is responsible for about 20 percent of all causes of female infertility.

“We can test women at certain times of their cycle to see if they’re ovulating,” Dr. Hansen says. “Getting pregnant is not insurmountable. Sometimes, it is as simple as getting the correct diagnosis and a balance of medications to achieve a successful pregnancy.”

Dealing with your diagnosis

Discovering you have PCOS can feel like both a relief and a burden. On one hand, you may be relieved to finally know what’s going on with your body, but it can be easy to negatively dwell on the diagnosis.

But don’t forget: you have the power to control your symptoms with help from your doctor. One way to help minimize symptoms of PCOS, especially when it comes to trying to conceive, is to lose weight. “There’s a lot of frustration and a lot of focus on weight loss for patients who want to get pregnant,” says Dr. Hansen. “That’s one of the hardest things. Symptoms of PCOS will get better if a patient is able to drop some weight, but that’s often the most difficult task these patients face,” she says.

She continues, “I tell patients to avoid what I call the “white carbs” -- foods like pasta, tortillas, bread, pizza crust and white rice. They have a high glycemic index, which makes the body produce more insulin which, in turn, makes them store more fat.” Dr. Hansen suggests exercising and consuming more complex carbs, while still limiting your total carb intake. Cosmetic treatments, such as electrolysis and laser hair removal, may help you feel better about your appearance if you experience hirsutism.

“I caution my patients about going online and reading blogs, because they can be a hotbed of bad information,” Dr. Hansen says. Instead, try to choose your information from sites associated with major medical institutions or universities, as their information is more objective and up-to-date. “But really, the best way to deal with PCOS is to try to take care of yourself,” she says.

Symptoms sound familiar?

If you’re experiencing a few of these symptoms, talk to your gynecologist. It’s likely your OB/GYN will be well-versed in PCOS, Dr. Hansen says.

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