As Mick Jagger was showing us his moves, my friend and I were scream-singing along with the music and taking in the spectacle. And then it happened. My hand brushed my chin, and I felt that first bristly hair. I was 14; I\u2019d barely started shaving my legs\u2026 could I really have hair growing from my face? I spent the rest of the concert fervently plucking at the quarter-inch invader while Mick lamented his inability to get satisfaction. This was my first hint that I had polycystic ovary syndrome (PCOS), a common hormonal disorder among women of childbearing age.<\/p>\n
PCOS is a hormonal condition that involves the endocrine and reproductive systems. It affects between 5% and 13% of women between 15 and 44 years of age, and can cause enlarged ovaries or small ovarian cysts. It was only after my diagnosis as an older teenager that I discovered how many other women in my life have the same condition. It\u2019s more prevalent than many women realize.<\/p>\n
PCOS symptoms can vary from person to person. Someone with PCOS may exhibit some or all of the following:<\/p>\n
\u201cThe cause of PCOS is unknown,\u201d explains Ann Peters<\/a>, MD, a gynecologist and surgeon in The Gynecology Center at Mercy Medical Center in Baltimore, Maryland. \u201cPCOS is a complex disease that is believed to be in part congenital (hereditary) and in part environmental. PCOS can run in families. Approximately one out of four patients with PCOS have a mother who had been diagnosed with PCOS as well (in some studies this number is even higher).\u201d<\/p>\n While genetic and environmental factors are suspected, Geoffrey Cly<\/a>, MD, an OB\/GYN in Fort Wayne, Indiana, points out that no studies have conclusively shown a genetic link or specific environmental substance that causes PCOS.<\/p>\n As it did for me, PCOS usually develops in adolescence, but Dr. Peters says, “the diagnosis may be delayed for a couple of years following the onset of menses, as irregular menstrual cycles are not uncommon as the communication between the brain, ovaries, and uterus matures.\u201d<\/p>\n Birth control pills can mask symptoms and cause inaccurate test results, which causes a delay between the onset of PCOS and the diagnosis. \u201cPCOS may not be diagnosed until patients stop birth control methods or notice irregular periods as they attempt to conceive,\u201d explains Dr. Peters, adding that in some cases PCOS appears later in life\u2014particularly in women who have gained weight sequentially during their teens and early 20s.<\/p>\n The Mayo Clinic<\/a> mentions high insulin levels\u2014the hormone that balances blood sugar levels, excess androgen production, and low-grade inflammation as risk factors that potentially play a role in PCOS, but to date an exact cause is not known.<\/p>\n While some symptoms of PCOS, such as excess hair or acne are cosmetic issues, PCOS is associated with other more serious health problems.<\/p>\n \u201cWomen with PCOS are at increased risk for a number of medical problems,\u201d Dr. Peters says. \u201c[These include] metabolic syndrome (a constellation of diagnoses including high blood pressure, lipid abnormalities, and obesity), insulin resistance paired with higher rates of type 2 diabetes, heart disease, infertility, and uterine\/endometrial [lining of the uterine] <\/span>cancer.\u201d<\/p>\n Other complications may include sleep apnea, nonalcoholic steatohepatitis (a severe liver inflammation caused by fat accumulation in the liver), gestational diabetes, and miscarriage or premature birth.<\/p>\n This doesn\u2019t mean that all women with PCOS will develop these conditions, but the increased health risk means treating PCOS is important. Dr. Peters points out that \u201cPCOS is a life-long disease.\u201d<\/p>\n PCOS can also affect mental health. \u201cDepression and emotional disturbances [are] significant issues that should not be left untreated by counseling, group therapy, and\/or medications when necessary,\u201d Dr. Cly says.<\/p>\n A study<\/a> supervised by\u00a0Columbia University School of Nursing professor Nancy Reame, MSN, Ph.D., and published in the\u00a0Journal of Behavioral Health Services & Research<\/em> found that menstrual irregularity was the symptom most associated with psychiatric problems.<\/p>\n The first step is seeing your healthcare provider. Your general practitioner is a good place to start. Depending on your symptoms and treatment required, your GP may send you to see a women\u2019s health doctor or other specialists such as a gynecologist, an endocrinologist, and\/or a dermatologist.<\/p>\n Your doctor may ask about your symptoms and how long they have been present, as well as which medications you are taking. They may also send you for blood tests, particularly to check for high levels of androgen, i.e. testosterone<\/span> (male hormone).<\/p>\n An ultrasound to check for ovarian cysts may also be advised. \u201cWomen who don’t have PCOS may also have cysts, but fewer than 12 don’t meet the criteria for a diagnosis,\u201d writes<\/a> Dr. Jessica Chan, an assistant professor of\u00a0Obstetrics and Gynecology\u00a0at\u00a0Cedars-Sinai and reproductive endocrinologist with a specialty in PCOS.<\/p>\n Dr. Chan also points out that some women with PCOS may have no cysts at all. I fell into this category at the time of my diagnosis and for many years after. My doctor explained to me then that because PCOS is a syndrome, ovarian cysts do not need to be present to make a PCOS diagnosis if other symptoms exist.<\/p>\n Dr. Chan lists the criteria for a PCOS diagnosis as presenting with two or more of the following:<\/p>\n A list of tests are usually ordered to rule out the presence of any other hormonal disorders. <\/span><\/p>\n Unfortunately, there is no cure for PCOS, but that doesn\u2019t mean people diagnosed with the condition must suffer. \u201cPCOS symptoms are very successfully managed with medications and lifestyle changes,\u201d Dr. Peters explains. \u201cEven infertility experienced by PCOS patients can successfully be overcome with treatments.\u201d<\/p>\n Symptoms of PCOS are treated in one or a combination of three ways: lifestyle changes, medication, and (rarely) surgery.<\/p>\n \u201cLifestyle changes and weight loss are key in the treatment of PCOS,\u201d Dr. Peters says.<\/p>\n \u201cWeight loss and healthy eating are the most effective non-medicinal treatments,\u201d echoes Dr. Cly, adding, \u201cImprovements in PCOS begin with a weight loss of [greater than] 5% of total body weight.\u00a0 The improvements of the symptoms are even larger with more weight loss.\u201d<\/p>\n In her article for Cedars-Sinai, Dr. Chan recommends patients with PCOS stay active, including 30-40 minutes of exercise three to four days a week. She also suggests adopting a low-carbohydrate diet. \u201cWomen with PCOS don’t always process carbohydrates as easily as other women. Too many refined carbohydrates like sugars can lead to insulin resistance and weight gain,\u201d she says.<\/p>\n \u201cThe most common medications are birth control hormones<\/strong> in the form of pills or a patch or ring,\u201d says Dr. Cly, \u201cbecause those control the menstrual cycles\u2026and they also decrease the amount of testosterone circulating so it will help with the hair growth as well.\u201d<\/p>\n Metformin<\/strong><\/a>, a drug primarily used to control high sugar in people with type 2 diabetes, and other diabetic medications are sometimes prescribed for PCOS because they decrease insulin resistance. It is used as an off-label drug as the Food and Drug Administration (FDA) has not approved it for PCOS treatment because the manufacturer did not seek its approval; however with positive clinical research data, it is a very commonly used medication. <\/span>Dr. Cly does not recommend them because long-term studies haven\u2019t shown significant benefit. Dr. Cly specifies one exception, \u201cHowever, when a woman is trying to get pregnant, adding metformin to Clomid or Femara<\/a> will increase her chances of pregnancy three times higher than with (ovulation stimulating medications) Clomid\/Femara alone.\u201d<\/p>\n RELATED: Using Metformin for off-label PCOS treatment<\/a><\/strong><\/p>\n Dr. Cly and Dr. Peters both mention spironolactone<\/strong><\/a> as being effective alone or in combination with other medications for reducing male hormone levels; but Dr. Cly cautions that it has a, \u201crare risk of genital abnormalities in male infants if a woman gets pregnant while taking it.\u201d Hence, patients should be on contraception and blood tests to monitor electrolytes are routinely needed. <\/span><\/p>\n For unwanted hair, Dr. Peters suggests eflornithine hydrochloride cream<\/strong> (a topical drug that can be used to inhibit hair growth) as an option in addition to hair removal methods such as waxing, shaving, or electrolysis\/laser hair removal.<\/p>\n Dr. Peters also mentions that high cholesterol issues, diabetes, sleep apnea, and fatty liver disease, conditions that often appear in people with PCOS, are treated the same way they would be in a person who does not have PCOS.<\/p>\n For fertility problems, in addition to the medications mentioned by Dr. Cly and Dr. Peters, your doctor may recommend letrozole<\/a> or gonadotropins.<\/p>\n Letrozole<\/strong> slows estrogen production and causes the body to make more follicle-stimulating hormone (FSH), a hormone needed for ovulation. While a National Institute of Child Health and Human Development\u2013supported study<\/a> found that letrozole is more effective than clomiphene in causing ovulation and improving live-birth rates, studies of letrozole in animals have shown that it causes birth defects if used during pregnancy. There have been no studies of this drug in pregnant women. It is also an off-label treatment. <\/span><\/p>\n Gonadotropins<\/strong> are hormones that cause ovulation. They are given as injections. Because this treatment has a higher risk of multiple pregnancies, your doctor may order more tests and ultrasounds to monitor your body during treatment.<\/p>\n PCOS cannot be corrected by surgery, but some surgeries can help with specific PCOS conditions.<\/p>\n \u201cObesity, diabetes, and metabolic syndrome can, in extreme cases, be managed with bariatric surgery,\u201d Dr. Peters says.<\/p>\n Dr. Cly adds, \u201cWomen who lose significant weight after a gastric bypass surgery demonstrate nearly normal periods and normalization of their symptoms.\u201d<\/p>\n Ovarian drilling is a treatment option for infertility associated with PCOS. \u201cRecent studies have shown that Laparoscopic Ovarian Drilling, LOD, (removing some of the extra cystic ovarian tissue) results in a higher pregnancy rate when trying to get pregnant compared to clomid alone,\u201d says Dr. Cly.\u00a0\u201cHowever, a very recent study<\/a> revealed that Femara (letrozole) <\/span>was just as effective as LOD surgery in achieving pregnancy.\u00a0 Additionally, surgery does not help improve symptoms or PCOS findings when a woman is not trying to get pregnant.\u201d<\/p>\n While PCOS may be with you for life, the symptoms don\u2019t have to be. \u201cThe treatments are extremely successful in suppressing the symptoms,\u201d assures Dr. Cly.<\/p>\nIs PCOS serious?<\/h2>\n
How is PCOS diagnosed?<\/h2>\n
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Can PCOS be cured?<\/h2>\n
How is PCOS treated?<\/h2>\n
Lifestyle Changes<\/h3>\n
Medication<\/h3>\n
Surgery<\/h3>\n
What\u2019s promising about PCOS?<\/h2>\n