PCOS; What is it, Do I have it, What can I do?

PCOS stands for polycystic ovarian syndrome. It is a syndrome (a combination of symptoms) named for one of the main symptoms experienced by individuals affected, which is many cysts on the ovary(ies). I have a very personal experience with the condition as I was diagnosed with it about 10 years ago, and I remember the gut-wrenching moment I diagnosed by my gynecologist as she explained it is the number one reason why women have fertility issues in America. It can be a very confusing and emotional diagnosis, and it’s one that is somewhat complicated to arrive at.

How is it diagnosed?

Only women will be diagnosed with this condition. One of the following must be present for a clinical diagnosis:

1. Multiple cysts in the ovaries (this is determined via ultrasound)
2. Abnormal androgen levels in a woman (testosterone is an androgen). Specifically high levels of androgens would indicate PCOS.
3. Symptoms of high androgen levels in the presence of irregular or absent periods.

The symptoms someone might experience with PCOS are:

1. Irregular or absent periods (especially very long cycles)
2. Low blood sugar levels after eating
3. High fasting blood sugar levels
4. Excess male patterned hair growth (face, chest, stomach, neck)
5. Hair loss from top of head
6. Skin tags or dirty looking patches on parts of your body
7. Intense carbohydrate cravings
8. Difficulty losing weight even with a great diet and regular exercise
9. Acne
10. Tendency to carry weight in the abdomen region
11. Difficulty getting pregnant

Do I have PCOS?

Your physician (Primary Care or OB/GYN) will likely check your thyroid, skin, hair, breasts, and belly. They will likely check your blood pressure and order an ultrasound of your ovaries. They will also likely order some blood panels to check hormone levels, thyroid, and rule out any other conditions that could cause these same symptoms.

What causes PCOS?

This is the billion dollar question, because well, we don’t know. Most experts think that several factors play a role including genetics and diet. Women with PCOS are more likely to have a sister or mother with PCOS also. One of the main underlying problems with the condition is a hormonal imbalance. The ovaries make more testosterone than normal, high levels affect the development and release of eggs from the ovary, and also affect normal levels of estrogen and progesterone in women. There is also a metabolic issue associated with the syndrome where insulin is not as effective in the body. Insulin is a hormone that controls changes in sugar levels in the blood and if you store or burn the sugar for energy. Many people with PCOS have chronically high levels of insulin because their bodies have trouble using it, so they make more and more and more.

Why do I need to manage this syndrome if I have it?

Women with PCOS have higher risk for developing diabetes, ovarian cancer, and increased rates of infertility. It can also be an embarrassing condition with acne, being overweight or obese, abnormal hair growth, or loss of hair. It can also have psychosocial implications due to body image and confidence.

What should you do if you think you may have PCOS?

Manage controllable lifestyle factors. Even without seeing a physician there are practices you can incorporate that are important for general well-being, but in a woman with PCOS these practices are non-negotiable.

1. Sleep at least 7-8 hours per night. Women with PCOS tend to have an impaired ability to cope with stress factors. It is important for your body to get enough sleep to repair and have energy for everyday tasks and stressors.
2. Exercise regularly. This is the most important intervention with regards to the insulin/blood sugar issues that are associated with PCOS. You should be exercising 4-5 days per week. A blend of resistance activities and interval training appear to have the best effects with the PCOS population.
3. Eat a well-balanced diet. I will reserve specific suggestions to a post for another day, but in general women with PCOS do the best with 5-6 small meals per day. They need to eat complex carbs instead of simple carbs (think sweet potato instead of white potato, whole grain breads instead of white bread, brown instead of white rice, whole fruit that has the fiber packed in rather than a fruit juice). Also it is important for women with PCOS to get enough omega-3s, so getting enough servings of nuts and fish is important, or taking a high quality fish oil supplement.
4. Speak with your physician or health care provider at your next visit- let them know you think that you may have this condition, and seek a solid diagnosis.

How does western medicine treat PCOS?

Most clinicians will prescribe oral birth control pills to manage the hormone irregularities associated with the condition. They will also prescribe metformin (or it’s generic Glucophage) to help manage the insulin sensitivity factors – this is a drug developed and prescribed to individuals with diabetes. Women will also be advised by fertility experts to have minor surgical procedures called laparoscopic ovarian drilling. What takes place is the ovaries are treated with heat or a laser to destroy the tissue that is producing androgens. I would like to state that oral birth control pills are not the only option for contraceptives and educating oneself on all of your options is important before starting the pill. I wish someone had told me some of the side effects of the pill and downsides to coming off of the pill before I was ever started on it long ago.

Are there more natural forms of treatment?

YES! The best thing you can do for yourself is diet, exercise, stress management and good sleep habits. Managing your weight will be a natural product of these efforts. Having a normal weight will be important for controlling insulin and hormone levels throughout your entire life.
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There are also natural remedies like N-acetyl cysteine, inositol, and other hormone regulating supplements like chasteberry extract (also known as vitex). Before starting any of these herbs and supplements, I recommend speaking with a practitioner or dietitian familiar with these treatment approaches who can advise and monitor you.
In terms of fertility options, before feeling destined to taking metformin and clomid, consider other options with a natural practitioners, whether it is a few of the supplements above or acupuncture, there are other ways to improve your fertility beyond pharmaceuticals. These are not hippy, wacky, close your eyes and take it on blind faith approaches either. There are scientific studies that have been performed that provide options for treatment of infertility in this population that have yielded successful pregnancies without invasive methods.
 
Let me know if you have any questions or think this may be you. I can help you develop a well balanced diet and manage the symptoms of this syndrome.