PCOS (Polycystic Ovarian Syndrome ) – What Every Woman Should Know
Jennifer Merrill never had regular menstrual cycles. Eventually, they stopped altogether. When — for no apparent reason — she began to develop skin tags, thinning hair and a weight problem, Merrill knew something was wrong. Tests for thyroid disorders came back negative, so her doctors told her she just needed to lose some weight. It wasn’t until she shared her symptoms with an Ob/Gyn that she received the correct diagnosis for her problems: Polycystic Ovarian Syndrome (PCOS).
What Is PCOS?
A hormonally based collection of symptoms, PCOS is said to affect an estimated five to ten million women, or six to ten percent of all women in their reproductive years, according to the Polycystic Ovarian Syndrome Association. This syndrome, or set of symptoms, was long considered to be simply an annoyance because of the physical manifestations by which it is often characterized: hirsutism (excess facial or body hair), obesity, acne, skin tags, infrequent or absent menstrual periods, and thinning hair. Doctors now recognize that there is more to PCOS, including difficulty conceiving.
While the medical community is not in complete agreement over the criteria for the syndrome, Daniel Dumesic, M.D. and program director for the Reproductive Endocrinology Fellowship Program at the Mayo Clinic in Rochester, MN, states that PCOS is generally defined as “Anovulation in the presence of androgen excess, in the absence of other endocrine disorders.”
A Closer Look
The crux of PCOS is that ovulation is not occurring, or is not occurring regularly, due to an excess of androgens, which are hormones produced by the ovaries. Doctors now recognize that there is also a strong link between PCOS and insulin resistance, a condition in which the body’s tissues demonstrate a decreased sensitivity to the action of insulin. Insulin functions to bring glucose into the tissues and store it as energy, and if you are insulin resistant, the pancreas is prompted to create more insulin than it needs. These high insulin levels promote higher levels of blood lipids (cholesterol and triglycerides), and also stimulate excess androgen production.
For reasons unknown, some women are more predisposed to PCOS than others. Explains Mark Perloe, M.D., medical director of the Georgia Reproductive Specialists in Atlanta, “Many will have two or three relatives with type II diabetes. Or, if there is a relative with PCOS, there is a 50 percent chance of [the woman] getting [PCOS], too.”
While a woman of any body size can develop PCOS, overweight women seem especially prone to insulin resistance, and thus to developing the syndrome. “As the insulin level rises, it combines with the ovaries that are already making more androgens,” explains Dumesic, thus creating a “two hit hypothesis — two things driving the ovaries into anovulation.”
As was Merrill’s experience, many women who have PCOS often go undiagnosed or are misdiagnosed. Perloe notes that technically, since PCOS is a syndrome — a combination of symptoms — there is no way to actually diagnose it. “It is a diagnosis of exclusion. Tests will tell you that you don’t have something else, but not [that] you have [PCOS].”
The difficulty in deducing that a woman has PCOS lies in the fact that its symptoms are quite similar to those of several other medical problems, including, according to Perloe, pituitary gland abnormalities, enzyme defects in the adrenal glands, Cushing’s Syndrome, thyroid problems, type II diabetes and abnormal responses to some drugs. Thus, a doctor who suspects PCOS in a patient based on her physical complaints will run diagnostic tests to rule out any number of these other problems in an effort to narrow the diagnosis to PCOS.
Blood tests to check androgen levels and insulin resistance may help support a PCOS diagnosis. A pelvic sonogram to detect enlargement of or cysts on the ovaries is another test a woman might undergo when trying to establish a PCOS diagnosis. If these conditions are present, that will help support the diagnosis. It’s interesting to note, however, that not all women with cystic ovaries have PCOS, nor will every woman with PCOS evidence polycystic ovaries at the time of an ultrasound exam.
Risks Without Treatment
Undoubtedly, PCOS symptoms alone can be frustrating for women who suffer with them, especially if they go untreated. Unwanted facial hair, excess body weight and the other unkind manifestations of the syndrome can contribute to depression in some women. Along with its emotional toll, PCOS can put a woman at risk for other health problems down the road.
Due to anovulation, women with PCOS often have trouble conceiving without medical assistance. Once they do conceive, they are at a higher risk of miscarrying or of developing gestational diabetes. Aside from reproductive issues, and because of the way in which PCOS affects the body, women with untreated PCOS also appear to be at a higher risk for developing type II diabetes, heart disease and endometrial cancer.
Treatments and Hope
The medical community has made great strides in the treatment of PCOS in recent years, and there are effective medications and procedures available to help with all aspects of the syndrome.
In the past, PCOS has not always received due attention, thus doctors who are not up to date on the syndrome may be less likely to correctly diagnose or treat the problem. If you suspect you have PCOS and do not feel that your current care provider is taking your concerns seriously, don’t hesitate to get a second or third opinion.
In addition to consulting with your doctor, there are a number of support groups and resources available to those who are dealing with the symptoms of PCOS. Check with your local hospital or your health insurance company to see if there are any PCOS support groups in your area.
The information contained in or made available through This Site cannot replace or substitute for the services of trained professionals in the medical field. We do not recommend any treatment, drug, food or supplement. You should regularly consult a doctor in all matters relating to physical or mental health, particularly concerning any symptoms that may require diagnosis or medical attention.