Acne, weight gain, irregular periods, infertility after years on birth control pills….these are some of the symptoms associated with Polycystic Ovarian Syndrome (PCOS), one of the most common hormonal endocrine disorders in women. It impacts approximately 5 million women in the United States, with symptoms beginning as early as age 11. The cause is unknown, but genetics do play a role. PCOS cannot be cured at this point, but it can be managed. We are currently seeing more patients diagnosed with PCOS and we want to provide a brief overview.
PCOS is primarily a hormone imbalance. In healthy ovaries, there are tiny sacs of fluid called follicles (or cysts). The egg grows and the follicle builds up fluid. When the egg matures, the follicle breaks open and the egg is released and travels through the fallopian tube and into the uterus for fertilization. This process is called ovulation. With PCOS, the egg does not fully mature because the ovary is making too much testosterone. The follicles may start to grow and build up fluid, but since ovulation does not occur, the follicles remain as cysts. And since ovulation does not occur, progesterone is not made and the menstrual cycle is irregular or absent. For women who have been on birth control pills and have underlying PCOS, the condition is masked because it is managed by the hormone regulation of the birth control pills. Many women receive a diagnosis of PCOS after they stop taking birth control pills in order to get pregnant and then have difficulty conceiving. PCOS is the cause of approximately 75% of anovulatory infertility.
The second major hormone issue with PCOS is increased insulin, and this increased insulin can trigger even more male hormone production. The increased insulin exists because the body is not using insulin effectively: a condition known as insulin resistance. This is why weight gain can often be a problem with weight tending to accumulate along the midline. Experts are unsure of the reason for insulin resistance in PCOS, but about 40% of women with diabetes or glucose intolerance will have PCOS.
PCOS can be difficult to recognize because the symptoms can vary so much. Overproduction of testosterone can either spur or disrupt a growth pattern. Patients can be thin or obese, and patients can have increased hair growth on the face, chest, and other areas but thinning hair on the head. There is no specific diagnostic test for PCOS, but women will have one or more of the following: acne, weight gain, multiple small cysts in the ovaries, high testosterone levels, and irregular periods. Diagnosis can then be confirmed with ultrasound to visualize the ovaries and blood tests to measure hormone levels.
If untreated, PCOS can lead to diabetes, high blood pressure, infertility, or cardiovascular disease. This sounds frightening, but PCOS can be managed, and these women can go on to lead healthy lives and have families. The key is diagnosis and lifestyle management.
The first step of treatment is limiting sugar and processed foods and adding more whole grain, fruits, and vegetables into the diet. Exercise is a foundation as this helps with insulin resistance. The prescription drug Metformin has also been used effectively in some patients to improve the response of cells to insulin and it can even lower testosterone levels. Other options include birth control pills or hormone therapy to normalize levels, the prescription drug Aldactone to block male hormones, and managing symptoms with laser hair removal, skin lightening creams and specific vitamins. There are promising studies using magnesium, chromium, vitamin D, calcium and omega 3 fish oil to help with symptoms.
The bottom line is that PCOS can be managed. It starts with exercise and a healthy diet.
Healthy and more informed living with John Hollis Pharmacy! Submitted by Cindy Franklin, Staff Pharmacist
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