The experience of many women with PCOS, or polycystic ovarian syndrome is not a good one. Imagine you are a young woman in your 20s and feeling as if your body is turning against you. You develop acne that is worse than what you had in your teens. You start to sprout hairs on your chin, maybe peach fuzz at first, but then darker, coarser hairs. You watch your diet and exercise regularly, but your weight just keeps climbing. Your periods come whenever they would like–sometimes disappearing for months, only to return for three weeks straight. You go from doctor to doctor trying to understand what is happening to you.
Polycystic ovarian syndrome is a syndrome–that is a constellation of symptoms that often occur together–not a disease. The hallmark symptoms of PCOS are irregular periods, evidence of high male hormone levels–either in the blood or physical symptoms like acne, increased body hair growth and scalp hair loss–and cysts on the ovaries. Many women also have obesity or insulin resistance.
Irregular periods, acne and increased body hair growth are easy to see, but what is insulin resistance? Insulin is a hormone that helps our cells use glucose. We all have some and we need it to live, but you can have too much of a good thing.
The easiest way to think about it is to imagine a typical woman needs 5 units of insulin to keep their blood sugars normal, a woman with insulin resistance might need 50 units of insulin to maintain the same normal blood sugars. While insulin resistance increases the risk of developing diabetes, it is NOT diabetes or pre-diabetes.
In PCOS there is a relationship between insulin and male hormones that is not well understood. Insulin resistance results in less frequent or even completely absent ovulation. And changes in ovulation result in irregular periods. Insulin resistance can also lead to carbohydrate craving and weight gain which in turn leads to more insulin resistance.
And if that wasn’t enough, PCOS can be a common cause of fertility problems. If a woman is not ovulating regularly, or at all, conceiving can be tricky or even impossible. Additionally, when women with PCOS do conceive there is an increased rate of miscarriage.
What should you do if you suspect you may have PCOS? As always, start with your doctor. A gynecologist or general practitioner is a good place to start. At Palmetto Endocrinology we can help with your insulin resistance and hormonal imbalance.
Why is it so difficult to make a diagnosis of PCOS? First, PCOS is a clinical diagnosis, which means the doctor has to take into account the details of the woman’s symptoms and physical signs of PCOS and then use their experience and judgement to decide if the woman has PCOS.
There is no one test that confirms a woman has or does not have PCOS. It is a common misconception that a woman must have cysts in the ovaries to have PCOS, but this is not true. A woman need only have irregular periods and high male hormone levels to meet the criteria for diagnosis.
PCOS is also a “diagnosis of exclusion.” This means the doctor must rule out other potential diseases that have similar symptoms before making a diagnosis.
Women can be diagnosed with PCOS when their doctor notes that they have physical signs and symptoms, and lab results that are consistent with PCOS, and cannot find another cause. Many women meet these criteria. One woman with PCOS may look and feel one way and another may look and feel completely differently. Do they have the same disease? Or, more likely, do they have a variety of issues that cause the same symptoms?
When you see your doctor with symptoms of PCOS, you can expect your doctor to ask you about the frequency and pattern of your periods. They will examine you for signs of high male hormone levels like acne and body hair growth. And they will draw blood to look for signs of high male hormone levels and insulin resistance as well as to confirm that you do not have any other diseases.
Even once women are diagnosed with PCOS they can struggle to get adequate treatment for their symptoms. The underlying cause of PCOS is not known, and, as a result there is not a treatment or cure for PCOS. We are left to treat symptoms. I mentioned that women with PCOS often have different symptoms, so treatment should not be one-size-fits-all.
I feel it is critical to have a detailed conversation with each individual woman with PCOS about the treatment options, including the benefits and limitations of each of them. Medications can be powerful additions to healthy lifestyle changes. However, medications should be tailored to an individual’s symptoms and goals. At Palmetto Endocrinology, we have the education and expertise to help. Call us for an appointment.