Monday Medical: The ins and outs of PCOS
If you have irregular periods, excess facial hair and find it difficult to lose weight, you might be one of the five to 10 percent of adult women who have polycystic ovary syndrome. But the condition can be confusing and sometimes challenging to diagnose.
Below, Dr. Mary Bowman, an OB/GYN with UCHealth Women’s Care Clinics in Steamboat Springs and Craig, outlines what you need to know about PCOS.
PCOS is caused by a hormone imbalance. All women make small amounts of androgens or “male hormones,” but women with PCOS make more androgens than normal. That can prevent ovulation and can result in hirsutism, commonly referred to as excess facial hair, and acne.
“There’s a big genetic component,” Bowman said. “If someone has polycystic ovaries, their first degree relatives have a 20 to 25 percent chance of also having it.”
But often there isn’t an obvious cause.
“That’s something that’s hard for people,” Bowman said. “They want to understand, ‘Why do I have this?’ But it’s often just bad luck.”
Making a diagnosis
Women with PCOS typically have at least two of the three main symptoms: irregular periods, high levels of androgens and cysts in the ovaries. An ultrasound can show multiple small ovarian cysts, while high levels of androgens are confirmed with a blood test or physical signs such as excess hair growth or acne.
“If someone doesn’t have an elevated testosterone level, they most likely don’t have PCOS,” Bowman said.
Obesity can be another symptom of PCOS, but not all women with PCOS are overweight. Irregular periods don’t always point to PCOS but may relate to ovulatory dysfunctions.
Symptoms of PCOS often develop when menstruation begins, but the condition can be especially difficult to diagnose in teens.
“Adolescents already have irregular menses, and you can’t use ultrasound for adolescents as their ovaries can naturally look polycystic,” Bowman said. “It can take a little while to make a diagnosis. If a teen has a workup that doesn’t reflect PCOS, but still has irregular periods, or acne and weight issues, then she should be reevaluated.”
PCOS puts women at risk for additional health issues, including cardiovascular disease, obesity, diabetes, mood disorders and sleep apnea, so it’s important to treat. A healthy diet and regular exercise are the first line of treatment, and often, a doctor will recommend losing weight.
“It doesn’t take that much weight to make a difference. Losing 5 to 10 percent of your weight can help restore ovulatory function,” Bowman said. “But it can be really, really hard to do.”
Bowman recommends building a support system — a dietitian, a physical trainer or friends — to help meet weight-loss goals.
An oral contraceptive provides reliable birth control and addresses the hormonal imbalance. “It actually sops up extra testosterone, which helps with acne and excess hair growth,” Bowman said.
Women who can’t take birth control pills should take progesterone to protect the uterus from the excess estrogen that can increase risk for uterine cancer. Other medications can help address other symptoms, including insulin resistance, acne, excess hair and mood disorders.
Women with PCOS who are trying to get pregnant often run into challenges. A health care provider can advise individualized therapy, but other options, such as in vitro fertilization, may be necessary.
“The eggs that are in their ovaries are perfectly good eggs,” Bowman said. “But they just don’t mature and pop out as they should.”
When helping women navigate treatment options, Bowman emphasizes the disorder is not their fault.
“They just have it. It’s no fault, no foul,” Bowman said. “We’re given whatever we’re given, and we have to work with that and determine what we can do to be our best self, our healthiest self.”
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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