It is likely that you or someone you know has Polycystic Ovarian Syndrome (PCOS), as it is becoming more and more prevalent among women of all ages. In fact, it is estimated that up to 20% of women (1 in 5 women) have this disorder. The sheer mention of PCOS comes hand in hand in the context of challenges that are highly distressing, such as becoming pregnant or having signs of excess male hormones (androgens), producing unwanted hair growth or acne, for instance.
Historically, PCOS was described as mostly a reproductive problem. The first mentions of this syndrome in current medical literature came from Stein and Leventhal, who described the classical triad of polycystic ovaries (or multiple cysts on the ovaries), hirsutism (signs of excess androgens) and oligo-amenorrhea (having too few or no menstrual cycles).
However, as we have made significant strides in understanding this disorder, we are understanding that PCOS is better described as an endocrine or metabolic disorder, and that PCOS is more of a harbinger of endocrine diseases like Type 2 Diabetes and metabolic syndrome, rather than the originating disease itself.
Some now consider insulin resistance as central to the origins of this condition. As a result of insulin resistance, insulin levels rise and sex hormone-binding globulin (SHBG) made by the liver decrease, resulting in an increase in bioavailable, active androgens. Insulin may also increase appetite, contributing to weight gain. This leads to a number of downstream effects, such as metabolic syndrome, nonalcoholic fatty liver disease and sleep apnea. Furthermore, PCOS sufferers are more likely to have depression and anxiety and experience miscarriages or other pregnancy complications.
Unfortunately, PCOS is to this day, highly underdiagnosed.
We are finding that PCOS can present itself clinically in a variety of ways. For instance, while phenotype A has the classical high androgen, low ovulation and polycystic morphology, other phenotypes may not include any one of these criteria. Thus, women with PCOS may endure a variety of symptoms, including, but not limited to:
- irregular periods, including more frequent periods
- long lapses between periods
- weight gain
- unwanted hair on the upper lip, chin, neck, upper chest, abdomen, back, arms and thighs
- hair loss on the temporal regions of the scalp
- thinning of hair or hair loss
- darkening of the skin around the armpits, groin or back of the neck
Further, testing results are highly variable. Testing may include a number of lab tests, such as testosterone levels, thyroid hormone levels, progesterone levels and an oral glucose challenge test; however, it is not necessary to have abnormal results of bloodwork or imaging, like ultrasounds.
That being said, all is not so grim in the world of PCOS. There are real, actionable things a woman can do, in regard to their health. As a physician who strongly believes in a holistic approach, I first encourage all PCOS patients to take their diet and lifestyle into account. Insulin resistance being central to this syndrome, it is important to work at this level.
We know that weight loss can be highly impactful. Shedding as little as 5% of the initial body weight can regulate menstrual cycles and ovulation and potentially even improve SHBG levels. Diet is critical to a holistic approach to PCOS, particularly eating a whole food, non-processed diet. Many foods can contribute to inflammation in the body, and inflammation certainly contributes to insulin resistance. It is important to eat a diet similar to a low-glycemic, Mediterranean diet that is high in fibrous vegetables, high-quality fats, legumes and whole grains. I also work with certain supplements, such as those from the inositol family or bitter melon, when extra help is needed. Lastly, we cannot talk about healthy living without talking about stress. Excess stress leads to increased cortisol levels, which also causes insulin resistance. I work with patients to find their anchor that they can do regularly as their daily exercise to stave off stress.
When all of these fail, we luckily have other options, such as hormonal methods and antiandrogen medications.
The bottom line is that there ARE solutions that work. Speak to your physician about your concerns, and together, find a plan that works best for you.