Polycystic Ovary Syndrome
Women often don’t learn about potential health issues until after they are diagnosed with them. One of the diseases that usually flies under the radar is polycystic ovary syndrome, or PCOS.
Women with PCOS have a hormonal imbalance that interferes with normal reproductive processes. It usually starts at puberty and is associated with irregular periods and other hormone-related symptoms. Between one in 20 women of childbearing age have PCOS. As many as five million women in the United States may be affected, and it can occur in girls as young as 11 years old.
The cause of PCOS is unknown, but research is underway to uncover its origin. There is evidence that shows a link between certain forms of PCOS and family history, suggesting a genetic basis for the condition. Women with PCOS are more likely to have a mother or a sister with PCOS. There are also environmental factors that are linked to the development of PCOS symptoms, most importantly insulin resistance.
Pay Attention to Early Symptoms
Absent menstrual periods is the most tell-tale sign of PCOS, along with weight gain in the upper body and abdominal area. Hirsutism, which is increased hair growth on the face, chest, stomach, back, thumbs or toes, also can be a leading symptom of the disease. PCOS also may be linked to other conditions such as:
Some teenage annoyances that follow you into adulthood like oily hair or persistent acne also count as symptoms too!
The Doctor or Nurse Practitioner Will See You Now
Most cases of PCOS can be diagnosed with a thorough evaluation of your medical history and symptoms, as well as a physical exam. A blood test may be required to measure the levels of various hormones. Your doctor will ask about your menstrual periods, weight changes, and other symptoms. He or she will want to measure your blood pressure, body mass index (BMI) and waist size. You should have a pelvic exam with a women’s health nurse practitioner or your gynecologist and you may need to see an endocrinologist who specializes in hormonal disorders and insulin resistance.
Because there is no cure, polycystic ovary syndrome needs to be managed to prevent problems. Treatment goals are based on your symptoms and whether or not you want to become pregnant, and focus on lowering your risk of getting heart disease and diabetes. Many women will need a combination of treatments that may include:
- Birth control pills
- Diabetes medications
- Fertility medications
- Medicine to combat the increased hair growth from extra male or “androgenic” hormones
- Medicines that lower insulin levels like Glucophage/Metformin®
Lifestyle Modifications May Help
While there are no known strategies for preventing PCOS, proper nutrition and weight management enable many women with the disorder to avoid developing diabetes and cardiovascular problems. Even a 10 percent loss in body weight can restore a normal period and make your cycle more regular. Tips for managing PCOS include:
- Low carb diet that can alleviate many of the symptoms with PCOS and may improve fertility.
- Limiting processed food and foods with added sugars
- Adding more whole-grain products, fruits, vegetables and lean meats to your diet
- Getting plenty of folic acid each day (400mcg), with a diet rich in folic acid, including leafy green vegetables, dried beans, liver and citrus fruits
- Limiting caffeine to fewer than two caffeinated beverages per day
- Weight loss is very important
- Considering ketogenic diet and/or intermittent fasting
- A ketogenic diet may restore fertility in women with PCOS
Impact on Fertility
PCOS is the most common cause of female infertility because of the body’s failure to ovulate. The ovaries, where a woman’s eggs are produced, have tiny fluid-filled sacs called follicles or cysts. As the egg grows, the follicle breaks open, the egg is released, and the egg travels through the fallopian tube to the uterus (womb) for fertilization.
In women with PCOS, the ovary doesn’t make all the hormones it needs for an egg to fully mature. The follicles may start to grow and build up fluid, but ovulation does not occur. Instead, some follicles may remain as cysts. For these reasons, ovulation does not occur and the hormone progesterone is not made.
But a diagnosis of PCOS doesn’t mean that you will never be able to conceive a child. Lifestyle changes along with oral and injected fertility drugs are often effective in women with this disorder.
Keep an Eye Out for Other Health Problems
Women with PCOS have a greater chance of developing several serious health conditions, including life-threatening diseases. According to the National Women’s Health Information Center, recent studies have shown that:
- More than 50 percent of women with PCOS will have diabetes or pre-diabetes (impaired glucose tolerance) before the age of 40.
- The risk of heart attack is four to seven times higher in women with PCOS than women of the same age without PCOS.
- Women with PCOS are at greater risk of having high blood pressure.
- Women with PCOS have high levels of LDL (bad) cholesterol and low levels of HDL (good cholesterol).
- It’s important to discuss your health concerns during your annual gynecology visit. Your physician can help you address them to ensure that PCOS is managed effectively.
Be Strong. Be Healthy. Be in Charge!
-Dana Leslie, CNP and Ula Abed Alwahab, MD
Dana Leslie CNP is a nurse practitioner in the Center for Specialized Women's Health. Call 216-445-2720 to schedule an appointment.
Ula Abed Alwahab, MD is a Internal Medicine physician who specializes in endocrinology, diabetes and metabolism at Cleveland Clinic and sees patients in the Center for Specialized Women's Health.
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