If you are looking for the stuff you “need to know” from the title, it’s further on down in the article. In observance of PCOS Awareness Month, we thought we would share the true story of a young woman living with polycystic ovary syndrome (PCOS). I know her well but interviewed her for the article anyway. She’s my super cool middle, Delaney.
Delaney grew up a very active, wonderfully gregarious kid who moved around a few times with the Navy until we exited and settled in SoCar – that’s South Carolina, for those who don’t know. A natural athlete, fast, nimble and taller than her peers, she quickly found herself to be a standout soccer player. She didn’t know she couldn’t score every time she had the ball at her feet, and so she did. Because she was quick and had incredible endurance, she also was recruited by the track coach to run the varsity 800m in seventh grade, along with a teammate who was her opposite on the field.
But soccer was her thing, and she eventually dropped the spikes to focus solely on futbol. Running upwards of 8 miles every day in practice – anywhere from trotting to full Sprint, even backwards and sideways as an outside midfielder, she was fit in all the ways a peak performing Athlete would be. To fuel it all, she would eat FOUR big meals every day – each bigger than those her 220 lbs weight Training father would consume. She ate it and burned it with a ferocity on the Field we all admired.
Attack, fight, victory was her personal motto, in everything and in all ways. Then came college. She decided to focus on her studies and didn’t go out for the team. In fact, just about every bit of working out came to a screeching halt. And then, her period stopped….for a full year.
She had gained the average “freshman fifteen”, which wasn’t surprising when considering her eating habits, if anything, were filling her with added calories, and she had stopped using those calories on the field. So, if she had always had her period as an athlete and now had even more body fat, why was she experiencing amenorrhea (the technical term for missing your period)? Stress? All the life changes in general? Purely hormonal?
Poly cystic ovarian syndrome is, at its most basic level, a hormonal imbalance, where too much of the “male” hormones are produced in a female. While the only apparent symptom she displayed at the time was amenorrhea, her ever diligent homeopathic healer in residence, aka, her mom, was convinced she had PCOS.
First stop, her old pediatrician, who told her everything was normal; but she could go on birth control to start her period again. After all, having one is important for so many other things in a young woman’s life, like the other hormones it generates that aid in creating increased bone density.
Not enough info, so on to an Ob/Gyn. There, the feedback was little more along the lines of what her mom had already assumed, but they were even skeptical. “So, let’s get an ultrasound,” my wife suggested. The physician said you couldn’t see PCOS on an ultrasound. As a DMS, my wife knew better.
On ultrasound, it was clear her ovaries were encased in cysts. They were covered in follicles too numerous to count – today, 20 on an ovary will typically be used as a clear diagnosis.
Diagnosis in hand, the physician gave her the long list of troubles she was set to endure in her life – infertility, type II diabetes, a constant struggle with weight gain, hirsutism, and skin issues to name a few. And, as if on queue, while the lack of period was the only thing she went to the physician for, she began to experience all of the negative symptoms save diabetes.
“I started to use PCOS as an excuse to eat whatever I wanted,” she says today. “I just stopped caring about what I put in my body,” and she may have even begun to somewhat celebrate the new-found freedom from lack of discipline around diet. Pictures of food became the standard in her social feed, and she did start to suffer the weight gain her MD predicted. Along with that came the added pain of body image issues.
She started taking birth control to manage her cycle, and it worked. At least, it did ensure she became regular; but deep down inside, she knew it wasn’t fixing the problem. “I knew it was a bandaid put on to cover what was really wrong, so I quit after a year. It wasn’t really doing anything. It definitely was not helping fix whatever was at the root,” she said to me this Labor Day morning.
She finished college as a star student, winning all but one of the math awards given out by the University of South Carolina. I guess I forgot to mention, she’s also brilliant, and I am very proud, of her and all of our kids. On to New York City!
Always called to serve, Delaney decided to teach in the high schools of the Bronx. She was not sure if it was the added stress or the increased disregard for dietary discipline, but she added even more weight with the move, though she began to workout more than before. And, the skin issues and extra hair growth kicked in….
“I began to understand I had to do something. Thankfully, Mom has always been a huge proponent of natural healing, so I started a few different regiments of eating more mindfully and living more intentionally,” Delaney says now. She went through a few rounds of Whole 30, and really started to stop eating when full. “I used to empty my plate, no matter what;… but now come home with leftovers routinely,” she says. “If I want to have pizza, I still have pizza. I just don’t eat a WHOLE pizza.”
The changes in diet and exercise, along with a few other healthy changes in her life, over a two-year period, have restored this vivacious young lady to the same level of health she had when she entered college in 2011. She would say her PCOS is in remission.
“I still wonder, on occasion, about my ability to have a family; but, since my cycle is normal, naturally, I am ovulating, and my health is optimized, I think that won’t be a problem, either.” We hope not! We love grandkids!
Delaney would tell anyone asking her results may not be normal. She would encourage you to seek to control PCOS in the most natural ways possible – through diet, exercise and healthy living – but she also acknowledges those methods may not be for everyone. Definitely seek medical counsel.
So, What Is PCOS, Really?
Polycystic ovary syndrome is a hormonal condition. Hormones are substances your body makes to help make different processes happen. Some are related to your ability to have a baby, and also affect your menstrual cycle. Those that are involved in PCOS include.
- Androgens: Often called “male” hormones, women have them, too. Those with PCOS tend to have higher levels, which can cause symptoms like hair loss, hair in places you don’t want it (such as on your face), and trouble getting pregnant.
- Insulin: This hormone manages your blood sugar. If you have PCOS, your body might not react to insulin the way that it should.
- Progesterone: With PCOS, your body may not have enough of this hormone. That can make you to miss your periods for a long time, or to have periods that are hard to predict.
With PCOS, your reproductive hormones are out of balance. This can lead to problems with your ovaries, such as not having your period on time, or missing it entirely. In women who have it, it can:
- Affect your ability to have a child (fertility)
- Make your periods stop or become difficult to predict
- Cause acneand unwanted hair
- Raise your chances for other health problems, including diabetesand high blood pressure
There are treatments for the symptoms, and if you want to get pregnant, that’s still possible, though you may need to try different methods. Many women who have PCOS don’t have cysts on their ovaries, so “polycystic” can be misleading. You might have cysts, and you might not.
What Are the Symptoms of PCOS?
If you have things such as oily skin, missed periods, or trouble losing weight, you may think those issues are just a normal part of your life. But those frustrations could actually be signs that you have polycystic ovary (or ovarian) syndrome, also known as PCOS.
The condition has many symptoms, and you may not have all of them. It’s pretty common for it to take women a while – even years – to find out they have this condition.
Things You Might Notice
You might be most bothered by some of the PCOS symptoms that other people can notice. These include:
- Hair growth in unwanted areas. Your doctor may call this “hirsutism” (pronounced HUR-soo-tiz-uhm). You might have unwanted hair growing in places such as on your face or chin, breasts, stomach, or thumbs and toes.
- Hair loss. Women with PCOS might see thinning hair on their head, which could worsen in middle age.
- Weight problems. About half of women with PCOS struggle with weight gain or have a tough time losing weight.
- Acne or oily skin. Because of hormone changes related to PCOS, you might develop pimples and oily skin. (You can have these PCOS, of course).
- Problems sleeping, feeling tired all the time. You could have trouble falling asleep. Or you might have a disorder known as sleep apnea. This means that even when you do sleep, you do not feel well-rested after you wake up.
- Headaches. This is because of hormone changes with PCOS.
- Trouble getting pregnant. PCOS is one of the leading causes of infertility.
- Period problems. You could have irregular periods. Or you might not have a period for several months. Or you might have very heavy bleeding during your period.
How Do I Know If I Have PCOS?
There’s no single test that, by itself, shows whether you have polycystic ovary syndrome, or PCOS. Your doctor will ask you about your symptoms and give you a physical exam and blood tests to help find out if you have this condition.
PCOS is a common hormone disorder that can cause problems with your period, fertility, weight, and skin. It can also put you at risk for other conditions, such as type 2 diabetes. If you have it, the sooner you find out, the sooner you can start treatment.
What Your Doctor Will ask
Your doctor will want to know about all the signs and symptoms you’ve noticed. This is an important step to help figure out whether you have PCOS, and to rule out other conditions that cause similar symptoms.
You’ll need to answer questions about your family’s medical history, including whether your mother or sister has PCOS or problems getting pregnant. This information is helpful — PCOS tends to run in families.
Be ready to discuss any period problems you’ve had, weight changes, and other concerns.
Your doctor may diagnose PCOS if you have at least two of these symptoms:
- Irregular periods
- Higher levels of androgen (male hormones) shown in blood tests or through symptoms like acne, male-pattern balding, or extra hair growth on your face, chin, or body
- Cysts in your ovaries as shown in an ultrasound exam
What’s the Treatment for PCOS?
Treatments can help you manage the symptoms of polycystic ovary syndrome (PCOS) and lower your odds for long-term health problems such as diabetes and heart disease.
You and your doctor should talk about what your goals are, then you can come up with a treatment plan. For example, if you want to get pregnant and are having trouble, then your treatment would focus on helping you conceive. If you want to tame PCOS-related acne, your treatment would be geared toward skin problems.
- One of the best ways to deal with PCOSis to eat well and exercise
- Many women with PCOS are overweightor obese. Losing just 5% to 10% of your body weight may ease some symptoms and help make your periods more regular. It may also help manage problems with blood sugar levels and ovulation.
- Since PCOS could lead to high blood sugar, your doctor may want you to limit starchy or sugary foods. Instead, eat foods and meals that have plenty of fiber, which raise your blood sugarlevel slowly.
- Staying active helps you control your blood sugar and insulin, too. And exercisingevery day will help you with your weight.
- Staying active helps you control your blood sugar and insulin, too. And exercisingevery day will help you with your weight.
Hormone Treatments and Medication
Birth control is the most common PCOS treatment for women who don’t want to get pregnant. Hormonal birth control — pills, a skin patch, vaginal ring, shots, or a hormonal IUD (intrauterine device) — can help restore regular periods. The hormones also treat acne and unwanted hair growth.
These birth control methods may also lower your chance of having endometrial cancer, in the inner lining of the uterus.
Taking just a hormone called progestin could help get your periods back on track. It doesn’t prevent pregnancies or treat unwanted hair growth and acne. But it can lower the chance of uterine cancer.
Metformin (Fortamet, Glucophage) lowers insulin levels. It can help with weight loss and may prevent you from getting type 2 diabetes. It may also make you more fertile.
If birth control doesn’t stop hair growth after 6 months, your doctor may prescribe spironolactone (Aldactone). It lowers the level of a type of sex hormone called androgens. But you shouldn’t take it if you’re pregnant or plan to become pregnant, because it can cause birth defects.
When a healthy diet and regular exercise aren’t enough, medications can make losing weight easier. Different drugs work in different ways. For example, orlistat (Alli, Xenical) stops your body from digesting some of the fat in your food, so it may also improve your cholesterol levels. Lorcaserin (Belviq) makes you feel less hungry. Your doctor will prescribe the medication they think will be the most successful for you.
Weight loss surgery could help if you’re severely obese and other methods haven’t worked. The change in your weight afterward can regulate your menstrual cycle and hormones and cut your odds of having diabetes.
Products called depilatories, including creams, gels, and lotions, break down the protein structure of hair so it falls out of the skin. Follow the directions on the package.
A process like electrolysis (a way to remove individual hairs by using an electric current to destroy the root) or laser therapy destroys hair follicles. You’ll need several sessions, and though some hair may come back, it should be finer and less noticeable.
Your doctor may prescribe medication to help you get pregnant. Clomiphene and letrozole encourage steps in the process that trigger ovulation. If they don’t work, you can try shots of hormones called gonadotropins.
A surgery called ovarian drilling might make your ovaries work better when ovulation medications don’t, but it’s being done less often than it used to. The doctor makes a small cut in your belly and uses a tool called a laparoscope with a needle to poke your ovary and wreck a small part of it. The procedure changes your hormone levels and may make it easier for you to ovulate.
With in vitro fertilization, or IVF, your egg is fertilized outside of your body and then placed back inside your uterus. This may be the best way to get pregnant when you have PCOS, but it can be expensive.
What Are the Complications of PCOS?
If you have polycystic ovary syndrome, your ovaries may contain many tiny cysts that cause your body to produce too many hormones called androgens.
In men, androgens are made in the testes. They’re involved in the development of male sex organs and other male characteristics, like body hair. In women, androgens are made in the ovaries, but are later turned into estrogens. These are hormones that play a vital role in the reproductive system, as well as the health of your heart, arteries, skin, hair, brain, and other body parts and systems.
If you have PCOS and your androgen levels are too high, you have higher odds for a number of possible complications. (These may differ from woman to woman):
Trouble Getting Pregnant
- Cysts in the ovaries can interfere with ovulation. That’s when one of your ovaries releases an egg each month. If a healthy egg isn’t available to be fertilized by a sperm, you can’t get pregnant.
- You may still be able to get pregnant if you have PCOS. But you might have to take medicine and work with a fertility specialist to make it happen.
Doctors aren’t sure what causes PCOS. One theory is that insulin resistance may cause your body to make too many androgens.
Insulin is a hormone that helps the cells in your body absorb sugar (glucose) from your blood to be used as energy later. If you have insulin resistance, the cells in your muscles, organs, and other tissue don’t absorb blood sugar very well. As a result, you can have too much sugar moving through your bloodstream. This is called diabetes, and it can cause problems with your cardiovascular and nervous systems.
Other Possible Problems
You might have metabolic syndrome. This is a group of symptoms that raise the risk of cardiovascular disease, such as high triglyceride and low HDL (“good”) cholesterol levels, high blood pressure, and high blood sugar levels. Other common complications of PCOS include:
- Bleeding from the uterus and higher risk of uterine cancer
- Sleep problems
- Inflammation of the liver
Some complications of PCOS may not be serious threats to your health, but they can be unwanted and embarrassing:
- Abnormal body or facial hair growth
- Thinning hair on your head
- Weight gain around your middle
- Acne, dark patches, and other skin problems
Most women at some point have to contend with weight, but for women with polycystic ovary syndrome(PCOS), losing weight can become a constant struggle.
PCOS is the most common hormonal disorder in women of childbearing age and can lead to issues with fertility. Women who have PCOS have higher levels of male hormones and are also less sensitive to insulin or are “insulin-resistant.” Many are overweight or obese. As a result, these women can be at a higher risk of diabetes, heart disease, sleep apnea, and uterine cancer.
If you have PCOS, certain lifestyle changes can help you shed pounds and reduce the disease’s severity.
Why does polycystic ovary syndrome cause weight gain?
PCOS makes it more difficult for the body to use the hormone insulin, which normally helps convert sugars and starches from foods into energy. This condition — called insulin resistance– can cause insulin and sugar — glucose — to build up in the bloodstream.
High insulin levels increase the production of male hormones called androgens. High androgen levels lead to symptoms such as body hair growth, acne, irregular periods — and weight gain. Because the weight gain is triggered by male hormones, it is typically in the abdomen. That is where men tend to carry weight. So, instead of having a pear shape, women with PCOS have more of an apple shape.
Abdominal fat is the most dangerous kind of fat. That’s because it is associated with an increased risk of heart disease and other health conditions.
What are the risks associated with PCOS-related weight gain?
No matter what the cause, weight gain can be detrimental to your health. Women with PCOS are more likely to develop many of the problems associated with weight gain and insulin resistance, including:
- Type 2 diabetes
- High cholesterol
- High blood pressure
- Sleep apnea
- Endometrial cancer
Many of these conditions can lead to heart disease. In fact, women with PCOS are four to seven times more likely to have a heart attack than women of the same age without the condition.
Experts think weight gain also helps trigger PCOS symptoms, such as menstrual abnormalities and acne.
What can I do to lose weight if I have polycystic ovary syndrome?
Losing weight not only cuts your risk for many diseases, it can also make you feel better. When you have PCOS, shedding just 10% of your body weight can bring your periods back to normal. It can also help relieve some of the symptoms of polycystic ovary syndrome.
Weight loss can improve insulin sensitivity. That will reduce your risk of diabetes, heart disease, and other PCOS complications.
To lose weight, start with a visit to your doctor. The doctor will weigh you and check your waist size and body mass index. Body mass index is also called BMI, and it is the ratio of your height to your weight.
Your doctor may also prescribe medication. Several medications are approved for PCOS, including birth control pills and anti-androgen medications. The anti-androgen medications block the effects of male hormones. A few medications are used specifically to promote weight loss in women with PCOS. These include:
- Metformin (Glucophage). Metformin is a diabetes drug that helps the body use insulin more efficiently. It also reduces testosterone production. Some research has found that it can help obese women with PCOS lose weight.
- Thiazolidinediones. These should be used with contraception. The drugs pioglitazone (Actos) and rosiglitazone (Avandia) also help the body use insulin. In studies, these drugs improved insulin resistance. But their effect on body weight is unclear. All patients using Avandia must review and fully understand the cardiovascular risks. Research has found that Flutamide (Eulexin), an anti-androgen drug, helps obese women with PCOS lose weight. It also improves their blood sugar levels. The drug can be given alone or with metformin.
In addition to taking medication, adding healthy habits into your lifestyle can help you keep your weight under control:
- Eat a high-fiber, low-sugar diet. Load up on fruits, vegetables, and whole grains. Avoid processed and fatty foods to keep your blood sugar levels in check. If you’re having trouble eating healthy on your own, talk to your doctor or a dietitian.
- Eat four to six small meals throughout the day, rather than three large meals. This will help control your blood sugar levels.
- Exercise for at least 30 minutes a day on most, if not all, days of the week.
- Work with your doctor to track your cholesterol and blood pressure levels.
- If you smoke, get involved in a program that can help you quit.
PCOS and Your Fertility — and What You Can Do About It
One of the most common reasons a woman has trouble getting pregnant is a condition called polycystic ovary syndrome (PCOS). It’s a hormone problem that interferes with the reproductive system. When you have PCOS, your ovaries are larger than normal. These bigger ovaries can have many tiny cysts that contain immature eggs.
PCOS causes a woman’s body to produce higher-than-normal levels of androgens. These are hormones that are usually thought of as male hormones, because men have much higher levels of androgens than women.
Androgens are important in the development of male sex organs and other male traits. In women, androgens are usually converted into the hormone estrogen.
Elevated levels of androgens interfere with the development of your eggs and the regular release of your eggs. This process is called ovulation.
If a healthy egg isn’t released, it can’t be fertilized by sperm, meaning you can’t get pregnant. PCOS can cause you to miss your menstrual period or have irregular periods. This can be one of the first signs that you may have a problem such as PCOS.
Regulating Your Period
Fortunately, there are some treatments that can help women with PCOS have healthy pregnancies.
Your doctor may prescribe birth control pills that contain man-made versions of the hormones estrogen and progestin. These pills can help regulate your menstrual cycle by reducing androgen production.
If you cannot tolerate a combination birth control pill, your doctor might recommend a progestin-only pill.
You take this pill for about 2 weeks a month, for about 1-2 months. It’s also designed to help regulate your period.
Medicines to Help You Ovulate
You won’t be able to get pregnant while you’re taking birth control pills for PCOS. But if you need help ovulating so that you can become pregnant, certain medicines may help:
- Clomiphene is an anti-estrogen drug that you take at the beginning of your cycle.
- If clomiphene doesn’t help with ovulation, you may be prescribed the diabetes drug metformin.
- If clomiphene and metformin don’t work, your doctor may prescribe a medication containing a follicle-stimulating hormone (FSH) and a luteinizing hormone (LH). You get this medicine in a shot.
- One other drug that helps with ovulation is letrozole. It’s sometimes used when other medications aren’t effective.
If you have PCOS and you want to get pregnant, you should work with a doctor who is a specialist in reproductive medicine. This type of doctor is also known as a fertility specialist.
A specialist will help make sure you get the right dose of medicines, help with any problems you have, and schedule regular checkups and ultrasounds to see how you’re doing. (An ultrasound is a machine that uses sound waves to create images of the inside of your body. It’s a painless procedure that can track the growth and development of your baby).
For some women, gaining a lot of weight can affect their hormones. In turn, losing weight, if you’re obese or overweight, may help get your hormones back to normal levels. Losing 10% of your body weight may help your menstrual cycle become more predictable. This should help you get pregnant.
In general, living a healthier lifestyle with a better diet, regular exercise, no smoking, less stress, and control of diabetes and other medical conditions should improve your fertility odds.
Remember, if your period isn’t happening when it should, or you’ve already been diagnosed with PCOS, work closely with your doctor to help get it under control. And if you want to get pregnant, talk with a fertility specialist.
If you’re having irregular periods or are unable to get pregnant, see your doctor. The same holds for:
- Mood changes
- Unexplained weight gain
- Changes in your hair or skin
These symptoms may might not be caused by PCOS but could signal other serious health issues.
If anything is this article sounds like something you are dealing with, get connected with a doctor in your area who can help. To find a healthcare professional, use HealthLynked. It is a first of its kind medical network built as a social ecosystem with a higher purpose – improving healthcare. Go to HealthLynked.com to learn more, sign up for free, connect with your doctor, find a new doctor, and securely store and share your health information. Download our HealthLynked app available on Apple and Android devices.
Adapted from – WebMd