A Cup of Coffee – Polycystic Ovary Syndrome

Welcome back! Last week, we talked about heart conditions. If you missed that blog and would like to catch up, click HERE.

Have you ever heard of a woman saying that she lives with a condition called “PCOS”? PCOS stands for Polycystic Ovary Syndrome and is a problem with hormones that happens during the reproductive years.

In a recent study, many women reported delayed diagnosis and inadequate information. These gaps in early diagnosis, education, and support are clear opportunities for improving patient experience.

So what does Polycystic mean?

It means “multiple (poly) cysts (cystic)”. Cysts are sacs, usually filled with fluid, in an ovary or on its surface. One doesn’t have to have this disorder in order to have a cyst on their ovary.

Some women with this disorder do not even have cysts, while some women without the disorder do develop cysts.

So how do you know you have PCOS if not all women get cysts?

First, let’s talk about the process of ovulation

Women ovulate about 12 to 14 days before the start of a new menstrual cycle, and typically once a month. During this time, they can get pregnant if they expose the egg to sperm.

Ovulation happens when a mature egg is released from the ovary. After it’s released, the egg moves down the fallopian tube and stays there for 12 to 24 hours, where it can be fertilized by sperm.

Under the right conditions, sperm can live inside the female reproductive tract for as long as five days after sexual intercourse. Your chance of getting pregnant is highest when live sperm are present in the fallopian tubes during ovulation.

What happens if the egg isn’t fertilized?

Then the egg continues on its path, and the woman flushes the egg out with her menstrual cycle, also known as her “period”.

So what does PCOS have to do with this?

Sometimes a woman doesn’t make enough of the hormones needed to ovulate. When ovulation doesn’t happen, the ovaries can develop many small cysts. The small fluid-filled cysts contain immature eggs. These are called follicles. The follicles fail to regularly release eggs.

The cysts also make hormones called androgens. Androgens are male sex hormones that are usually present in women, but in small amounts.

PCOS enters into this scenario because it is a condition in which the ovaries produce an abnormal amount of androgens.

It has been noted that women with PCOS often have high levels of androgens.

Is there a cause for this?

John Hopkins states that “the exact cause of PCOS is not clear. Many women with PCOS have insulin resistance. This means the body can’t use insulin well. Insulin levels build up in the body and may cause higher androgen levels. Obesity can also increase insulin levels and make PCOS symptoms worse.

“PCOS may also run in families. It’s common for sisters or a mother and daughter to have PCOS.”

The Mayo Clinic believes that PCOS signs and symptoms are typically more severe in people with obesity.

What are the symptoms?

Typically, symptoms of PCOS often start around the time of the first menstrual period, however, symptoms may also develop later after you have had periods for a while.

While symptoms vary, a diagnosis of PCOS is made when you have at least two of these:

• Irregular periods. If you don’t have very many periods, or your periods aren’t regular (every 28 days), or they last for many days or longer than is typical for a period. For example, you might have fewer than nine periods a year, and those periods may occur more than 35 days apart. You may have trouble getting pregnant. Missed periods, irregular periods, or very light periods are always something to call your doctor about.
• Too much androgen. Having too much androgen may result in excess facial and body hair. This is called hirsutism (which means excess growth of hair on a person’s face and body). Sometimes, severe acne and male-pattern baldness can happen, too. Excess body hair typically shows up on the chest, stomach, and back.
• Polycystic ovaries. The ovaries may be larger. Many follicles containing immature eggs may develop around the edge of the ovary. The ovaries might not work the way they should.
• Weight gain, especially around the belly (abdomen)
• Acne or oily skin
• Male-pattern baldness or thinning hair
• Small pieces of excess skin on the neck or armpits (skin tags)
• Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts.

Are there other potential causes of PCOS?

Yes.

• Insulin resistance. The pancreas makes a hormone called insulin. It allows cells to use sugar, your body’s primary energy supply. If cells become resistant to the action of insulin, then blood sugar levels can go up. This can cause your body to make more insulin to try to bring down the blood sugar level. Too much insulin might cause your body to make too much of the male hormone androgen. One sign of insulin resistance is dark, velvety patches of skin on the lower part of the neck, armpits, groin, or under the breasts. A bigger appetite and weight gain may be other signs.
• Low-grade inflammation. White blood cells make substances in response to infection or injury. This response is called low-grade inflammation. Research shows that people with PCOS have a type of long-term, low-grade inflammation that leads polycystic ovaries to produce androgens. This can lead to heart and blood vessel problems.

Complications

Complications of PCOS can include:

• Infertility – you are struggling to become pregnant.
• Gestational diabetes or pregnancy-induced high blood pressure
• Miscarriage or premature birth
• Nonalcoholic steatohepatitis — a severe liver inflammation caused by fat buildup in the liver
• Metabolic syndrome — a cluster of conditions including high blood pressure, high blood sugar, and unhealthy cholesterol or triglyceride levels that significantly increase your risk of heart and blood vessel (cardiovascular) disease
• Type 2 diabetes or prediabetes
• Sleep apnea
• Cancer of the uterine lining (endometrial cancer)
• Depression, anxiety, and eating disorders

How is PCOS diagnosed?

Your family or OBGyn Doctor will ask about your medical history and your symptoms. You will also have a physical exam. This will likely include a pelvic exam. This exam checks the health of your reproductive organs, both inside and outside your body

Some of the symptoms of PCOS are like those caused by other health problems. Because of this, you may also have tests such as an Ultrasound which will use sound waves and a computer to create images of your blood vessels, tissues, and organs. They will be looking at the size of your ovaries, and to see if they have cysts. The doctor may also take some blood samples to look for high levels of those androgens we talked about and other hormones. They may look at your blood glucose levels, sometimes called an A1c test. You may have your cholesterol and triglyceride levels checked as well.

What is the treatment for PCOS?

John Hopkins states, “Treatment for PCOS depends on a number of factors. These may include your age, how severe your symptoms are, and your overall health. The type of treatment may also depend on whether you want to become pregnant in the future.

“If you do plan to become pregnant, your treatment may include:

• A change in diet and activity. A healthy diet and more physical activity can help you lose weight and reduce your symptoms. They can also help your body use insulin more efficiently, lower blood glucose levels, and may help you ovulate.
• Medications to cause ovulation. Medications can help the ovaries to release eggs normally. These medications also have certain risks. They can increase the chance of multiple births (twins or more). And they can cause ovarian hyperstimulation. This is when the ovaries release too many hormones. It can cause symptoms such as abdominal bloating and pelvic pain.

“If you do not plan to become pregnant, your treatment may include:

• Birth control pills. These help to control menstrual cycles, lower androgen levels, and reduce acne.
• Diabetes medication. This is often used to lower insulin resistance in PCOS. It may also help reduce androgen levels, slow hair growth, and help you ovulate more regularly.
• A change in diet and activity. A healthy diet and more physical activity can help you lose weight and reduce your symptoms. They can also help your body use insulin more efficiently, lower blood glucose levels, and may help you ovulate.
• Medications to treat other symptoms. Some medications can help reduce hair growth or acne.”

Living with PCOS

You may struggle with the physical symptoms of PCOS, such as weight gain, hair growth, and acne. Cosmetic treatments, such as electrolysis and laser hair removal, sometimes help people feel better about their appearance. Talk with your provider about the best ways to treat the symptoms that bother you.

When should I seek medical care?

If you have missed or irregular periods, excess hair growth, acne, and weight gain, call your doctor for an evaluation.

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As always, this blog is not a replacement for sound medical advice. I am not a doctor. Please make an appointment to see your healthcare provider and put a good plan in place that works for you and the needs of your body.

That’s all I have for you this week, dear reader. I’ll see you back here next Wednesday to share another cup of coffee. Until then, be good to yourself and each other.

Mind, Body, Spirit…Osteopathic Doctors treat the whole person, not just the ailment. Is your PCP a DO? Would you like to learn more about Osteopathic Physicians? Click HERE!