PCOS – Better Health Today and Tomorrow

April 9, 2015 Brigham and Women's Hospital

PCOS symptoms typically develop around puberty, but the diagnosis does not occur until early adulthood.

Today’s post is written by endocrinologist and Co-Director, Margo Hudson, MD, and Meg Kruithoff, Patient Coordinator, of the Polycystic Ovary Syndrome (PCOS) Program at the Gretchen S. and Edward A. Fish Center for Women’s Health at Brigham and Women’s Hospital. The PCOS Program at the Fish Center provides women with coordinated, individualized care from experts in endocrinology, gynecology, dermatology, and nutrition.

Polycystic ovary syndrome is one of the most common endocrine disorders of reproductive age women. PCOS is characterized by irregular menstrual periods, high levels of androgens (male hormones), and, sometimes, ovarian cysts.

Obesity also is strongly associated with PCOS. At least half of women with PCOS are obese. Excess adipose tissue, or fat, contributes to the hormone imbalance. Obesity also puts a stress on the pancreas and increases the risk of developing diabetes, high blood pressure, and high cholesterol.

The exact cause of PCOS is unknown. However, researchers believe genetics and environmental factors may play a role. Symptoms of PCOS typically develop around puberty, but the diagnosis does not occur until early adulthood.

PCOS can affect women differently, so it’s important to work with your physician to develop a treatment plan that addresses the PCOS symptoms that you are experiencing.

Irregular Menstrual Cycles

Oral contraceptives (OCs) help regulate hormone levels and regulate menstrual periods. These medications also can help reduce unwanted hair growth and acne. In addition, OCs help protect women with PCOS from uterine cancer by regulating periods.

Nutrition and Weight Loss

Weight loss, even a few pounds, can have positive effects on PCOS symptoms, such as lowering male hormones and lowering insulin levels to decrease diabetes risk and improve fertility. A nutritionist can help you to develop weight loss strategies.

Skin

In women with PCOS, high levels of male hormones can cause dark hair growth on the face, chest, and back and enlarged and overactive sebaceous (oil-producing) glands, leading to acne. Some women have darkening of the skin around their neck and underarms called acanthosis nigricans. Medications are sometimes prescribed to block the effect of male hormones on your skin. Spironolactone may be used in addition to OCs if the reduction in excess hair growth is not adequate. Laser hair removal also is an option.

Fertility

Many women with PCOS have infrequent ovulation and take longer to conceive. There are numerous treatment options, including weight loss, medications, or surgery, to address menstrual irregularities and improve fertility. A gynecologist or infertility specialist can work with you to develop an individualized treatment plan.

Diabetes (Type II) and Gestational Diabetes

Due to high levels of insulin in the blood, especially among those who are overweight, women with PCOS are at risk for developing pre-diabetes or type II diabetes. Studies have shown that one third of obese women with PCOS will develop pre-diabetes, and 10 percent will develop type II diabetes by the age of 40. Your doctor or nutritionist can suggest lifestyle modifications, including diet and exercise, to facilitate weight loss. If you develop pre-diabetes, your doctor may prescribe an oral medication called metformin, which may improve the effectiveness of insulin produced by your body.

Cardiovascular (Heart) Disease

Women with PCOS have a higher risk of developing heart disease due to elevated levels of triglycerides and low-density lipoprotein (LDL) cholesterol (“bad cholesterol”) and lower levels of  high-density lipoprotein (HDL) cholesterol (“good cholesterol”). Other risk factors, such as obesity, high blood pressure, or diabetes also contribute to this risk. It is important for women with PCOS to regularly check their blood pressure, body-mass index, and lipids, as well as practice heart-healthy habits, including maintaining a healthy diet, staying physically active, and not smoking.

Sleep Apnea

Women with PCOS have an increased risk of developing obstructive sleep apnea (OSA), a condition that causes interruptions in breathing during sleep. Women with PCOS are especially prone to OSA because they have decreased levels of progesterone, a hormone that has a protective effect of opening upper airway muscles and decreasing airway resistance. OSA is typically treated with a continuous positive airway pressure (C-PAP) machine during sleep to ensure that the person is receiving adequate, consistent air intake.

Depression and Anxiety Disorders

The multiple health impacts of PCOS can be overwhelming and, at times, emotionally distressing. There is evidence that women with PCOS may be more likely to have mood disorders, such as depression and anxiety, when compared with other women without PCOS. Approximately 10 percent of women with PCOS suffer from anxiety, depression, or eating disorders. Finding a mental health provider to speak with about your concerns around PCOS can be beneficial, especially if you feel the syndrome is greatly affecting your mood and wellbeing.

Help Is Available

PCOS is a complex, yet surprisingly common endocrine syndrome. Coordinated medical care now and in the future will allow you to successfully manage your PCOS and reduce future health risks.

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