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Maybe it's PCOS

December 7, 2017

 

Polycystic Ovarian Syndrome or PCOS can be diagnosed by a specialist, here are things to discuss at your next appointment.

 

PCOS begins in your teens, thankfully some cases actually mostly resolve in one’s early 20s. PCOS teens have acne, but just having acne is not an accurate early predictor of eventually having PCOS, but any excess male hormone testosterone and the facial and other hair growth of hirsutism is predictive. The  medical criteria for PCOC includes: not ovulating (anovulation or oligoovulation), androgen excess (male hormone excess), and polycystic ovaries (two out of these things counts). Typically have greater than 10 very small (under 1 cm) cystic follicles. However, almost 25% of all young women can have the ovarian appearance of these excess follicles or little cysts without being PCOS. In the Androgen Excess and PCOS Society they feel all patients with PCOS should have excess male hormones as part of their condition to meet formal criteria.

 

PCOS is Common

 

The doctors Stein and Leventhtal in 1935 discovered why some women had big cysts on their ovaries, extra hair growth and troubles getting pregnant. And though we recognize their work as the beginning, their name long left the condition of Polycystic Ovaries. After it was called Stein and Leventhal's disease this has been called a disease, a condition and now a syndrome. The definition has been changed so that almost 1/10 women can meet the definition and in fact many women with perfectly regular menstrual periods are surprised to learn upon visiting their gynos that they are now diagnosed with an important condition that can have fertility and  life long health consequences.

 

Just Having Irregular Periods Is Not Necessarily PCOS

 

Only about 40% of women with irregular periods have PCOS. Almost1/10 women can meet the definition and in fact many women with perfectly regular menstrual periods are surprised to learn upon visiting their gynos that  they fit the definition of PCOS. But knowing your diagnosis is critically important: it can affect your weight, your skin and your fertility. So early diagnosis and close monitoring is important!

 

The Most Common Symptom

 

The most common symptom of PCOS is hyperandrogenism (too much male hormone), the next most common symptom is chronic anovulation (skipped periods due to not popping an ovarian egg), many are overweight (7 out of 10) and finally either diabetic or pre-diabetic (again 7 out of 10), insulin resistance (you have it but it won’t work like it’s supposed to with your metabolism) and compensatory hperinsulinemia (the pancreas cranks out extra) are also features.

 

Obese or Very Underweight, PCOS Can Be Either

 

Weight changes affect your hormone levels and early on in the management controlling your nutrition and weight is going to be key to successful PCOS management. Most PCOS women struggle with being overweight, but it’s the amount and extent of male hormones that controls the severity of PCOS. 

 

Controlling Unwanted Hair Growth and Hair Loss

 

If you’ve got to shave your chin regularly, find you have unwanted hair, have hair loss, your ovaries may be producing too much testosterone, or one of the other male hormones that emanate from the ovary or the adrenal gland. And many have ovaries seen on ultrasound with a “string of pearls” look…little cysts all lined up around the edge as seen when looking with the ultrasound. Not only should there be these extra cysts, but the overall ovarian volume should be greater than 10 to the 3. 

 

The insulin excess in a woman's body is probably in large part responsible of the extra hair. The insulin stimulates the cells of the ovary to produce more male hormones. These extra male hormones right in the ovary mess up ovulation. Insulin can also suppress the liver substance SHBG (sex hormone binding globulin) which is supposed to bind male hormones and keep them inactive and there for in check. So the more deranged your metabolism is, the heavier you get, the worse your PCOS gets. To the extent that you have hair loss is measured by the Savin scale. Dieting can alter hair growth patterns. Hair needs nutrition, and hair loss can occur if the diet is too rapid.

 

Controlling Heart Disease if You Have PCOS

 

Eating well, lowering your blood fats, and controlling the hormones of PCOS helps prevent heart disease. It goes without saying, you also should not compound your problems with smoking. So how to fix: well to some extent there is no cure, it’s in your genes, but it can be controlled. Control anything and everything diet: lower bad LDL cholesterol, lower the blood fat triglyceride, exercise and increase good HDL cholesterol, and changing the biology of your blood fats so you change your cholesterol particle sizes and numbers of particles. Overall weight is related to how serious your PCOS is, slim by even 5%, control the sugar and use diabetic drugs like metformin if you need to. But watch for side effects of the medications used to control insulin and blood sugar. metformin can have its negative side, it can lower vitamin B12 levels (side effects of low B12 levels might include numbness, other odd neurologic symptoms such as memory loss and behavior changes). Hormonal contraception pills can suppress the androgen male hormones of the ovary.

 

Close Management and Combine With Primary Care!

 

PCOS care is a great way for you to merge your gyno care with your primary care. The fix for PCOS is not simple, and the more we learn, the more we know that we have to follow PCOS patients closely, check their sugars, scan their gall bladders, check their hormone levels, discuss contraception carefully, help them control their weight, plan when to begin trying for pregnancy, probably get help getting pregnant and now we have discovered that menopause is a good time for help as well as women with PCOS may be at more risk for heart disease as they age.

 

If you’ve got to shave your chin regularly, you may just have that sort of genetics, and on the other hand your ovaries may be producing too much testosterone, or one of the other boy hormones that emanate from the ovary or the adrenal gland. The most common symptom of PCOS is hyperandrogenism (too much boy hormone), chronic anovulation (skipped periods due to not popping an ovarian egg), many are overweight (7 out of 10) and finally either diabetic or pre-diabetic (again 7 out of 10), insulin resistance (you have it but it won’t work like it’s supposed to with your metabolism) and compensatory hperinsulinemia (the pancreas cranks out extra) are also features. And many have ovaries with a “string of pearls” look…little cysts all lined up around the edge as seen when looking with the ultrasound.

 

 

Fix Your Heart Risks

 

PCOS patients are often diagnosed when young, begin on a treatment plan, and often not screened for their risks of glucose intolerance, high cholesterol, abnormal other blood lipids cardiovascular disease and metabolic syndrome. Because of this part of PCOS care should revolve around nutritional management. The Collaborative Ambulatory Research Network of practicing obstetricians and Gynecologists did a survey and found that screening PCOS patients, even by these specialists was lacking. Over half had never ordered a glucose tolerance test as as a work up on their PCOS patients. Their study published in the November issue 2016 of the American Journal of Obstetrics and Gynecology pointed out that based on screening results physicians intervene with nutritional and lifestyle counseling. Based on the fact that many of you are not appropriately screened, many women who need to have dietary counseling are not getting that therapy prescribed. The Androgen Excess-Polycystic Ovary Syndrome Society does risk stratify it's patients, rather than recommend universal screening, which would still mean more women should be getting screening. This society recommends repeating screening every 2 years, and the Endocrine Society recommends re-screening people every 3-5 years. 

 

Unwanted Hair, There Are Other Causes

 

Tumors of the ovary or the adrenal gland or some cases of PCOS can produce so much extra male hormone that instead of just hirsutism there is virilization with receding hair line, hair loss, and clitoral enlargement with voice deepening. Why do we get mustaches or deep voices when we become menopausal?!? We all have that ying and yang balance of male and female. Before menopause our ovaries make both estrogen and testosterone. And a bit of the boy gene along with a bit of the girl gene is just what our gyno recommended: for our personality. But when it comes to hormones: most women function best when their balance is keeping those male hormones  in check. If there you have too many male hormones relative to your female hormones just from your genetic predisposition you can exhibit these same physical effects such as unwanted hair, male baldness, acne or deepened voice, and it's more likely to be due to minor imbalances rather than massively high male hormone blood levels. Nutrition and lifestyle can put your body back in to harmony and correct many of these imbalances.

 

Acne is Caused By PCOS Hormones Out of Control

 

If the imbalance becomes even more dramatic, then the skin can show other these other male hormone effects including acne that can be the cystic type that leads to scaring, and male-pattern balding (androgenic alopecia). Most commonly the acne occurs from that place in the gland where bacteria invade. The hormonal stimulus triggers the plug that keeps bacteria in and allows a pimple to form. It is possible to have the effects of either hirsutism or virilization from medications as well, and your gyno can help you sort out the side effects of what you are taking. Medical therapies work, but over time. Hair reducing strategies like waxing or lasers work more rapidly. So to calm these medical conditions down: head both to a gynecologist and your anesthetician!

 

The Genetics and Ethnic Linkages to PCOS

 

In a study of about 100 women published in the July 2011 issue of Fertility and Sterility by Dr. Gwinnett Ladson and colleagues at the departments of Ob Gyn at different universities it has been found that there is some genetic influence. In their study black and non-black women with PCOS had about the same levels of infertility and conception, but their metabolism and hormone issues were actually very different. You couldn't tell these differences by lining them all up and taking a good physical. Levels of acne and numbers of patients with excess body hair were about the same whether you were black or non-black with PCOS. But what was very different were their hormone levels and their metabolism. This group of researchers also found that they had different liver function! The black women had lower estrogen, higher resting blood pressure, they out performed in exercise studies, had worse cholesterol, and higher insulin levels. The overall profile of hormones was actually more severely affected in their cases of PCOS. 

 

Long Term Risks of Uterine Cancer

 

The biggest factor for uterine cancer is not ovulating. In Australia it was found that if you are under the age of 50 and have PCOS , regardless of race, you have about a 4 times greater risk of endometrial cancer than in women who do not have this condition. Exactly how black women might respond differently to PCOS treatment is not known, and exactly whether we can lower risks such as that of uterine cancer by short term treatment of the PCOS is thought to be true, and this is how hormonal contraception can help control a woman with PCOS’s risks of endometrial cancer. 

 

Pregnancy and PCOS

 

The most common issue with getting pregnant is chronic anovulation which leads to patients not getting pregnant. Now it has been shown in a publication by Doherty in the journal of OBSTETRICS AND GYNECOLOGY that women with PCOS have increased risks of preeclampsia, gestational diabetes, preterm delivery, and cesarean delivery. Generally it is thought that the overall metabolism disorder leads to changes in the placenta and in term changes in the vascular system of the developing fetus in pregnancy.  there has also been increased rates of any congenital birth defect, and increased rates of hospitalization for the child that persists into adolescence. It's important to try to normalize weight and the hormonal effects of PCOS prior to pregnancy. The Treatment of PCOS Women study done by Legro and coworkers has shown that 4 months of treatment with weight loss medications, oral contraceptives, and using lifestyle factors to alter eating increases the pregnancy rate from about 10-25% all the way up to 45-60%.  Attempts to control both the metabolism: good sugar control and normalize insulin levels, the weight, and the levels of blood inflammation should help to off set those effects. 

So What to Do Next:

 

  • Track your Cycles and Your Symptoms 

  • Come for Consultation

  • Examination

  • Ultrasound

  • Blood Hormone Tests

  • Dietary Assessments including Gall Bladder Check

  • Advanced Nutritional And Lipid Testing

  • Nutrition and Exercise Regimen

  • Skin Care

  • Hair Reduction

  • Weight Management

  • Monitoring Plan

 

 

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