Polycystic Ovarian Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age in which levels of estrogen and progesterone hormones are out of balance. This imbalance causes the growth of cysts on a woman’s ovaries which can lead to issues with her menstrual cycle, fertility, outward appearance and even cardiac function. Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age in which levels of estrogen and progesterone hormones are out of balance. This imbalance causes the growth of cysts on a woman’s ovaries which can lead to issues with her menstrual cycle, fertility, outward appearance and even cardiac function.

Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs.

The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications such as type 2 diabetes and heart disease

Signs and Symptoms:

Signs and symptoms of PCOS often develop around the time of the first menstrual period during puberty. Sometimes PCOS develops later, for example, in response to substantial weight gain. Signs and symptoms of PCOS vary. A diagnosis of PCOS is made when you experience at least two of these signs:

  • Irregular periods: Infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS. For example, you might have fewer than nine periods a year, more than 35 days between periods and abnormally heavy periods.
  • Excess androgen: Elevated levels of male hormone may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne and male-pattern baldness.
  • Polycystic ovaries: Your ovaries might be enlarged and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly.

PCOS signs and symptoms are typically more severe if you’re obese.

Causes:

A vast amount of research on PCOS has revealed that genetic, epigenetic, endocrine, metabolic and environmental factors may all be contributing to the development of this puzzling disorder. PCOS currently affects around 5 million women in the United States and although the precise cause is still unknown, medical professionals believe that women are more likely to develop the condition if their mother or sister has also suffered from it.

Although the exact cause of PCOS isn’t known, however factors that might play a role include:

  • Excess insulin: Insulin is the hormone produced in the pancreas that allows cells to use sugar, your body’s primary energy supply. If your cells become resistant to the action of insulin, then your blood sugar levels can rise and your body might produce more insulin. Excess insulin might increase androgen production, causing difficulty with ovulation.
  • Low-grade inflammation: This term is used to describe white blood cells’ production of substances to fight infection. Research has shown that women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgens, which can lead to heart and blood vessel problems.
  • Heredity: Research suggests that certain genes might be linked to PCOS.
  • Excess androgen: The ovaries produce abnormally high levels of androgen, resulting in hirsutism and acne.

Complications:

Complications of PCOS can include:

  • Infertility
  • Gestational diabetes or pregnancy-induced high blood pressure
  • Miscarriage or premature birth
  • Nonalcoholic steatohepatitis – a severe liver inflammation caused by fat accumulation in the liver
  • Metabolic syndrome – a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular disease
  • Type 2 diabetes or prediabetes
  • Sleep apnea
  • Depression, anxiety and eating disorders
  • Abnormal uterine bleeding
  • Cancer of the uterine lining (endometrial cancer)
  • Obesity is associated with PCOS and can worsen complications of the disorder.

Diagnosis:

There’s no test to definitively diagnose PCOS. Your doctor is likely to start with a discussion of your medical history, including your menstrual periods and weight changes. A physical exam will include checking for signs of excess hair growth, insulin resistance and acne.

Your doctor might then recommend:

  • A pelvic exam: The doctor visually and manually inspects your reproductive organs for masses, growths or other abnormalities. In a pelvic exam, your physician inserts two gloved fingers inside your vagina. While simultaneously pressing down on your abdomen, he or she can examine your uterus, ovaries and other organs.
  • Blood tests: Your blood may be analyzed to measure hormone levels. This testing can exclude possible causes of menstrual abnormalities or androgen excess that mimics PCOS. You might have additional blood testing to measure glucose tolerance and fasting cholesterol and triglyceride levels.
  • An ultrasound: Your doctor checks the appearance of your ovaries and the thickness of the lining of your uterus. A wandlike device (transducer) is placed in your vagina (transvaginal ultrasound). The transducer emits sound waves that are translated into images on a computer screen. During a transvaginal ultrasound, your doctor or a medical technician inserts a wandlike device (transducer) into your vagina while you lie on your back on an exam table. The transducer emits sound waves that generate images of your pelvic organs, including your ovaries. On an ultrasound image (inset), a polycystic ovary shows many follicles. Each dark circle on the ultrasound image represents a fluid-filled follicle in the ovary. Your doctor may suspect PCOS if you have 20 or more follicles in each ovary.

If you have a diagnosis of PCOS, your doctor might recommend additional tests for complications. Those tests can include:

  • Periodic checks of blood pressure, glucose tolerance, and cholesterol and triglyceride levels
  • Screening for depression and anxiety
  • Screening for obstructive sleep apnea

Treatment:

PCOS treatment focuses on managing your individual concerns, such as infertility, hirsutism, acne or obesity. Specific treatment might involve lifestyle changes or medication.

Medications

To regulate your menstrual cycle, your doctor might recommend:

  • Combination birth control pills. Pills that contain estrogen and progestin decrease androgen production and regulate estrogen. Regulating your hormones can lower your risk of endometrial cancer and correct abnormal bleeding, excess hair growth and acne. Instead of pills, you might use a skin patch or vaginal ring that contains a combination of estrogen and progestin.
  • Progestin therapy. Taking progestin for 10 to 14 days every one to two months can regulate your periods and protect against endometrial cancer. Progestin therapy doesn’t improve androgen levels and won’t prevent pregnancy. The progestin-only minipill or progestin-containing intrauterine device is a better choice if you also wish to avoid pregnancy.

To help you ovulate, your doctor might recommend:

  • Clomiphene (Clomid). This oral anti-estrogen medication is taken during the first part of your menstrual cycle.
  • Letrozole (Femara). This breast cancer treatment can work to stimulate the ovaries.
  • Metformin (Glucophage, Fortamet, others). This oral medication for type 2 diabetes improves insulin resistance and lowers insulin levels. If you don’t become pregnant using clomiphene, your doctor might recommend adding metformin. If you have prediabetes, metformin can also slow the progression to type 2 diabetes and help with weight loss.
  • Gonadotropins. These hormone medications are given by injection.

To reduce excessive hair growth, your doctor might recommend:

  • Birth control pills. These pills decrease androgen production that can cause excessive hair growth.
  • Spironolactone (Aldactone). This medication blocks the effects of androgen on the skin. Spironolactone can cause birth defect, so effective contraception is required while taking this medication. It isn’t recommended if you’re pregnant or planning to become pregnant.
  • Eflornithine (Vaniqa). This cream can slow facial hair growth in women.
  • Electrolysis. A tiny needle is inserted into each hair follicle. The needle emits a pulse of electric current to damage and eventually destroy the follicle. You might need multiple treatments.

Diet and Lifestyle Changes

While it is always important to consult your doctor about serious conditions, there are a few well recognized diet and lifestyle changes that can help reduce the severity and prevalence of PCOS symptoms.

  1. Balance Your Daily Intake Of Protein & Carbohydrates: One contributing factor to PCOS may be an overproduction of the hormone androgen. This can affect the development and release of eggs during ovulation. Excess insulin, the hormone that helps convert sugar and starch into energy, is linked to higher-than-normal androgen levels.Eating equal amounts of protein and carbohydrates assists in keeping your insulin levels even, therefore maintaining a healthy balance of hormones. The type of carbohydrates that you eat is also an important factor in this process. Try to consume only wholegrain, or sprouted grain products as they naturally contain more protein and fiber than their processed equivalents. Avoid heavily processed carbohydrates such as white flour and white rice as these cause a spike in insulin levels, while providing almost no nutrient value.Fiber is another important element that assists in managing PCOS, as it slows the digestion of sugars within the body. This reduces the severity of a spike in insulin and promotes healthy estrogen metabolism, which assists in lowering androgen levels. Some of the best sources of fiber include broccoli, celery, leafy greens, apples, and wholegrains.
  2. Eat and Drink Wisely: In balancing your protein and carbohydrate intake, it’s also important to consume only organic animal proteins whenever possible, as commercial products are high in added growth hormones (estrogens). This can be very damaging if you’re suffering from PCOS as it will disrupt the balance between estrogen and progesterone in your body. Studies have also shown that organic foods contain more vitamins, minerals and healthier proteins.Another thing to be mindful of is the potential presence of endocrine-disrupting chemicals such as BPA in your food and water. Endocrine-disrupting chemicals (EDCs) describe a combination of widespread pollutants often found in food products that have been transported in plastic containers or wraps. EDC’s are currently being investigated as possible contributors to PCOS after strong evidence from in vitro and animal studies showed them to be capable of causing ovarian symptoms similar to those that occur with PCOS.
  3. Eat Low-GI & Low-GL Foods: Low glycemic index (GI) foods are carbohydrates that are absorbed into the body slowly and therefore don’t result in such a dramatic spike and subsequent drop in insulin levels. The glycemic load (GL) refers to the amount of the food you consume and how it affects your blood sugar levels.By decreasing the amounts of high-GI foods that cause sugar spikes, such as refined sugars, white bread, simple starches and processed foods, your blood sugars will be kept in balance which will result in less extreme cravings and mood swings. Furthermore, androgens are stimulated by high blood sugar, so a low-GI diet will help to keep them in check.
  4. Stay Active & Fit: Exercise is an important component in treating PCOS as it improves insulin sensitivity, enhances metabolism and helps to shed any excess weight which might come about as a result of hormone imbalances. A variety of different exercise is recommended, ranging from resistance training to aerobic workouts. Researchers have found that people who participate in resistance training showed better improvement in insulin sensitivity than those who only took part in aerobic exercise. Having said that, be sure to avoid overdoing the intensity of your workouts, as too much exercise can overload the adrenal glands which may increase inflammation and irritate your PCOS further. Try brisk walks, gentle weight lifting, yoga, or pilates. The optimal amount of exercise to aim for is 30 minutes per day for 5 days each week.
  5. Take It Easy On The Coffee: Some health experts believe that caffeine can intensify PCOS. A study conducted by Fertility and Sterility shows that drinking two cups of coffee a day increases levels of estradiol, a natural estrogen, while drinking 4 – 5 cups of coffee a day produces 70% more estrogen in the follicular phase of a woman’s menstrual cycle. This has the potential to substantially affect hormonal balance.Polycystic ovarian syndrome can be a painful and discouraging condition to deal with, but with the right attitude, an active lifestyle and a wholesome diet, you can minimize its severity and continue to live a vibrant, happy life!