PCOS

Are you frustrated with lack of proper and trust worthy information on PCOS? All most websites have to say is - the cause of PCOS is not known when we do know that the real issue is an underlying metabolic disturbance that can addressed and reversed. If you or your loved ones have polycystic ovary syndrome, and want to know what truly causes the weight gain, the excess hair growth, infertility and difficulty losing weight, you came to the right place. At W8MD, our focus is prevention rather than cure. Several studies have shown that insulin resistance is the key factor in the pathophysiology of polycystic ovaries. Although the general medical community is not well educated in addressing this issue, the good news is that physicians such as W8MD physicians that are specially trained in the field of obesity / metabolic medicine that educates them on the pathophysiology, diagnosis and treatment strategies for disorders such as PCOS, fatty liver disease, metabolic syndrome, diabetes, and obesity. If you are frustrated with PCOS, consult W8MD. In this W8MD article, we will review answers to some of the following questions from an evidenced based medicine perspective.

Overview

Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder affecting approximately 6-10% of women of reproductive age. It is characterized by the growth of multiple cysts on the ovaries, and is associated with a range of symptoms, including menstrual irregularities, infertility, hirsutism (excessive hair growth), acne, and weight gain.

Cause

The exact causes of PCOS are not well understood, but it is thought to be a combination of genetic and environmental factors. Insulin resistance, an underlying condition in which the body cannot effectively use insulin, is often present in women with PCOS and is thought to play a role in the development of the condition. Women with PCOS are also more likely to have elevated levels of androgens (male hormones), which can lead to the development of cysts on the ovaries and affect ovulation.

Diagnosis

Diagnosis of PCOS is typically made through a combination of physical examination, medical history, and laboratory testing. Common tests include ultrasound, which can reveal the presence of cysts on the ovaries, and blood tests to measure hormone levels and assess insulin resistance.

Symptoms

The symptoms of PCOS can be managed through a combination of lifestyle modifications and medical treatment. Lifestyle modifications, such as diet and exercise, can help manage insulin resistance and improve overall health. Medical treatment may include oral contraceptives to regulate menstrual cycles, anti-androgens to reduce the effects of excess male hormones, and metformin to improve insulin sensitivity.

Fertility treatments

In addition to these management strategies, women with PCOS may also benefit from fertility treatments, such as ovulation induction medications, to help them conceive. Women with PCOS are also at increased risk of developing long-term health problems, such as cardiovascular disease, type 2 diabetes, and endometrial cancer, and it is important for them to receive regular medical care and monitoring.

Transvaginal ultrasound scan of polycystic ovary
Polycystic ovary as seen on sonography

PCOS frequently asked questions

What is polycystic ovary syndrome? Polycystic ovary syndrome (PCOS) is a hormonal imbalance and metabolic issue caused by insulin resistance that may affect their overall health and appearance. PCOS is also a common and treatable cause of infertility.
What are the effects of PCOS on ovaries? PCOS can cause missed or irregular menstrual periods. Irregular periods can lead to:
Infertility (inability to get pregnant). In fact, PCOS is one of the most common causes of infertility in women.
How common is PCOS? Between 5% and 10% of women between 15 and 44, or during the years you can have children, have PCOS.
What age does PCOS usually present? Most women find out they have PCOS in their 20s and 30s, when they have problems getting pregnant and see their doctor. But PCOS can happen at any age after puberty. Women of all races and ethnicities are at risk of PCOS. Your risk of PCOS may be higher if you have obesity or if you have a mother, sister, or aunt with PCOS.
What are the symptoms of PCOS? Some of the symptoms of PCOS include:
Irregular menstrual cycle. Women with PCOS may miss periods or have fewer periods (fewer than eight in a year). Or, their periods may come every 21 days or more often. Some women with PCOS stop having menstrual periods.
Too much hair on the face, chin, or parts of the body where men usually have hair. This is called "hirsutism." Hirsutism affects up to 70% of women with PCOS.
Acne on the face, chest, and upper back
Thinning hair or hair loss on the scalp; male-pattern baldness
Weight gain or difficulty losing weight
Darkening of skin, particularly along neck creases, in the groin, and underneath breasts called acanthosis nigricans
Skin tags, which are small excess flaps of skin in the armpits or neck area

Most experts think that several factors, most importantly insulin resistance, and genetics, play a role:

High levels of androgens. Androgens are sometimes called "male hormones," although all women make small amounts of androgens. Androgens control the development of male traits, such as male-pattern baldness. Women with PCOS have more androgens than normal. Higher than normal androgen levels in women can prevent the ovaries from releasing an egg (ovulation) during each menstrual cycle, and can cause extra hair growth and acne, two signs of PCOS.
High levels of insulin. Insulin is a hormone that controls how the food you eat is changed into energy. Insulin resistance is when the body's cells do not respond normally to insulin. As a result, your insulin blood levels become higher than normal. Many women with PCOS have insulin resistance, especially those who have overweight or obesity, have unhealthy eating habits, do not get enough physical activity, and have a family history of diabetes (usually type 2 diabetes). Over time, insulin resistance can lead to type 2 diabetes.
Can I still get pregnant if I have PCOS? Yes. Having PCOS does not mean you can't get pregnant. PCOS is one of the most common, but treatable, causes of infertility in women. In women with PCOS, the hormonal imbalance interferes with the growth and release of eggs from the ovaries (ovulation). If you don't ovulate, you can't get pregnant.
Is PCOS linked to other health problems? Yes, studies have found links between PCOS and other health problems, including:
Diabetes. More than half of women with PCOS will have diabetes or prediabetes (glucose intolerance) before the age of 40.
High blood pressure. Women with PCOS are at greater risk of having high blood pressure compared with women of the same age without PCOS. High blood pressure is a leading cause of heart disease and stroke.
Unhealthy cholesterol. Women with PCOS often have higher levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol. High cholesterol raises your risk of heart disease and stroke.
Sleep apnea. This is when momentary and repeated stops in breathing interrupt sleep. Many women with PCOS have overweight or obesity, which can cause sleep apnea. Sleep apnea raises your risk of heart disease and diabetes.
Depression and anxiety. Depression and anxiety are common among women with PCOS.
Endometrial cancer. Problems with ovulation, obesity, insulin resistance, and diabetes (all common in women with PCOS) increase the risk of developing cancer of the endometrium (lining of the uterus or womb).

Will my PCOS symptoms go away at menopause? Yes and no. PCOS affects many systems in the body. Many women with PCOS find that their menstrual cycles become more regular as they get closer to menopause. However, their PCOS hormonal imbalance does not change with age, so they may continue to have symptoms of PCOS. Also, the risks of PCOS-related health problems, such as diabetes, stroke, and heart attack, increase with age. These risks may be higher in women with PCOS than those without.
How is PCOS diagnosed? There is no single test to diagnose PCOS. To help diagnose PCOS and rule out other causes of your symptoms, your doctor may talk to you about your medical history and do a physical exam and different tests:
Physical exam. Your doctor will measure your blood pressure, body mass index (BMI), and waist size. They will also look at your skin for extra hair on your face, chest or back, acne, or skin discoloration. Your doctor may look for any hair loss or signs of other health conditions (such as an enlarged thyroid gland).
Pelvic exam. Your doctor may do a pelvic exam for signs of extra male hormones (for example, an enlarged clitoris) and check to see if your ovaries are enlarged or swollen.
Pelvic ultrasound (sonogram). This test uses sound waves to examine your ovaries for cysts and check the endometrium (lining of the uterus or womb).
Blood tests. Blood tests check your androgen hormone levels, sometimes called "male hormones." Your doctor will also check for other hormones related to other common health problems that can be mistaken for PCOS, such as thyroid disease. Your doctor may also test your cholesterol levels and test you for diabetes.
Once other conditions are ruled out, you may be diagnosed with PCOS if you have at least two of the following symptoms:
Irregular periods, including periods that come too often, not often enough, or not at all
Signs that you have high levels of androgens:
Extra hair growth on your face, chin, and body (hirsutism)
Acne
Thinning of scalp hair
Higher than normal blood levels of androgens
Multiple cysts on one or both ovaries
How is PCOS treated? There is no cure for PCOS, but you can manage the symptoms of PCOS.
What steps can I take at home to improve my PCOS symptoms? You can take steps at home to help your PCOS symptoms, including:
Losing weight. Healthy eating habits and regular physical activity can help relieve PCOS-related symptoms. Losing weight may help to lower your blood glucose levels, improve the way your body uses insulin, and help your hormones reach normal levels. Even a 10% loss in body weight (for example, a 150-pound woman losing 15 pounds) can help make your menstrual cycle more regular and improve your chances of getting pregnant. Learn more about losing weight.
Removing hair. You can try facial hair removal creams, laser hair removal, or electrolysis to remove excess hair. You can find hair removal creams and products at drugstores. Procedures like laser hair removal or electrolysis must be done by a doctor and may not be covered by health insurance.
Slowing hair growth. A prescription skin treatment (eflornithine HCl cream) can help slow down the growth rate of new hair in unwanted places.
What types of medicines treat PCOS? The types of medicines that treat PCOS and its symptoms include:
Hormonal birth control, including the pill, patch, shot, vaginal ring, and hormone intrauterine device (IUD). For women who don't want to get pregnant, hormonal birth control can:
Make your menstrual cycle more regular
Lower your risk of endometrial cancer
Help improve acne and reduce extra hair on the face and body.
Anti-androgen medicines. These medicines block the effect of androgens and can help reduce scalp hair loss, facial and body hair growth, and acne. They are not approved by the Food and Drug Administration (FDA) to treat PCOS symptoms. These medicines can also cause problems during pregnancy.
Metformin. Metformin is often used to treat type 2 diabetes and may help some women with PCOS symptoms. It is not approved by the FDA to treat PCOS symptoms. Metformin improves insulin's ability to lower your blood sugar and can lower both insulin and androgen levels. After a few months of use, metformin may help restart ovulation, but it usually has little effect on acne and extra hair on the face or body. Recent research shows that metformin may have other positive effects, including lowering body mass and improving cholesterol levels.
What are my treatment options for PCOS if I want to get pregnant?
You have several options to help your chances of getting pregnant if you have PCOS:
Losing weight. If you have overweight or obesity, losing weight under careful medical supervision is recommended in a program that understands the underlying factors causing PCOS such as insulin resistance.
Medicine. After ruling out other causes of infertility in you and your partner, your doctor might prescribe medicine to help you ovulate, such as clomiphene (Clomid).
In vitro fertilization (IVF). IVF may be an option if medicine does not work. In IVF, your egg is fertilized with your partner's sperm in a laboratory and then placed in your uterus to implant and develop. Compared to medicine alone, IVF has higher pregnancy rates and better control over your risk of having twins and triplets (by allowing your doctor to transfer a single fertilized egg into your uterus).
Surgery. Surgery is also an option, usually only if the other options do not work. The outer shell (called the cortex) of ovaries is thickened in women with PCOS and thought to play a role in preventing spontaneous ovulation. Ovarian drilling is a surgery in which the doctor makes a few holes in the surface of your ovary using lasers or a fine needle heated with electricity. Surgery usually restores ovulation, but only for 6 to 8 months.
How does PCOS affect pregnancy? PCOS can cause problems during pregnancy for you and for your baby. Women with PCOS have higher rates of:
Miscarriage
Gestational diabetes
Preeclampsia
Cesarean section (C-section)

PCOS glossary of terms

PCOS Test: Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects women of reproductive age. It is diagnosed through a combination of physical exams, medical history, and laboratory tests. The most common tests used to diagnose PCOS include ultrasound, hormonal blood tests, and glucose tolerance tests. An ultrasound can detect the presence of cysts on the ovaries, while hormonal blood tests can help identify elevated levels of androgens (male hormones) and insulin resistance. Glucose tolerance tests are used to assess insulin sensitivity and glucose metabolism.
PCOS Pain: Women with PCOS may experience pain and discomfort in the lower abdomen, pelvis, and ovaries. This pain can be caused by the formation of cysts on the ovaries, which can lead to ovarian enlargement and tenderness. Some women may also experience dysmenorrhea, which is pain during menstrual periods, due to hormonal imbalances and menstrual irregularities.
PCOS Causes: The exact cause of PCOS is unknown, but it is believed to be related to a combination of genetic and environmental factors. Hormonal imbalances, insulin resistance, and obesity are some of the key factors that contribute to the development of PCOS. Other potential causes include elevated levels of androgens, chronic inflammation, and exposure to environmental toxins.
Weight Gain: Weight gain is a common symptom of PCOS, as insulin resistance and hormonal imbalances can lead to the accumulation of fat in the body. Women with PCOS are also at increased risk of obesity, which can exacerbate their symptoms and increase their risk of developing related health problems.
PCOS Infertility: Infertility is a common complication of PCOS, as the formation of cysts on the ovaries can interfere with ovulation and cause menstrual irregularities. Women with PCOS may have difficulty getting pregnant, and may require fertility treatments such as ovulation induction or in vitro fertilization (IVF) to conceive.
Genetics and PCOS: Studies have shown that PCOS has a genetic component, and that the risk of developing the condition may be inherited from one's parents. Family history, as well as specific genetic variations, may increase a woman's risk of developing PCOS.
Obesity and its link to PCOS: Obesity is a major risk factor for the development of PCOS, as excess body weight can lead to insulin resistance and hormonal imbalances. Women with PCOS who are overweight or obese may experience more severe symptoms and an increased risk of related health problems, such as cardiovascular disease, type 2 diabetes, and endometrial cancer.
Polycystic Ovarian Syndrome Diet: A balanced and nutritious diet can help manage the symptoms of PCOS and reduce the risk of related health problems. Women with PCOS should aim to eat a diet that is low in refined carbohydrates and high in fiber, as well as focus on consuming nutrient-dense foods, such as fruits, vegetables, lean proteins, and healthy fats. Additionally, limiting or avoiding processed foods and added sugars may help regulate insulin levels and improve overall health.
Polycystic Ovarian Syndrome Symptoms: Common symptoms of PCOS include irregular menstrual periods, excessive hair growth, acne, weight gain, and infertility. Other symptoms may include thinning hair, dark skin patches, and pelvic pain.
Polycystic Ovarian Syndrome Treatment: Treatment for PCOS may include lifestyle modifications, such as weight loss, dietary changes, and regular exercise, as well as medical interventions, such as hormonal therapy and insulin-sensitizing medications. Women with PCOS who are trying to conceive may also require fertility treatments.
Environmental Exposure and PCOS Risk: Exposure to environmental toxins, such as endocrine-disrupting chemicals (EDCs), has been linked to an increased risk of developing PCOS. EDCs can interfere with hormonal signaling and disrupt normal reproductive function, leading to hormonal imbalances and the formation of cysts on the ovaries. Limiting exposure to EDCs by avoiding certain products, such as plastic containers and personal care products, and choosing organic foods may help reduce the risk of developing PCOS.
Polycystic Ovarian Syndrome Weight Gain: Weight gain is a common symptom of PCOS, and can be caused by insulin resistance and hormonal imbalances. Women with PCOS who are overweight or obese are at increased risk of developing related health problems, such as cardiovascular disease, type 2 diabetes, and endometrial cancer. Lifestyle modifications, such as diet and exercise, can help manage weight gain and improve overall health.
Health Risks for Children of Women with PCOS: Women with PCOS may have an increased risk of developing pregnancy-related complications, such as gestational diabetes, hypertension, and pre-eclampsia. Children born to mothers with PCOS may also be at increased risk of obesity, type 2 diabetes, and cardiovascular disease later in life.
Medicines and Supplements to Restart Ovulation: Ovulation induction medications, such as clomiphene citrate and letrozole, may be used to help women with PCOS who are trying to conceive. Additionally, supplements, such as inositol, can help regulate insulin sensitivity and improve ovulatory function.
Ethnic and Racial Differences in PCOS Symptoms: Studies have shown that there may be differences in the prevalence and symptoms of PCOS among different ethnic and racial groups. For example, Hispanic and African American women may have a higher prevalence of obesity and insulin resistance, while Asian women may be more likely to experience menstrual irregularities. Understanding these differences may help improve diagnosis and treatment for women with PCOS.

How can W8MD Medical Weight Loss program help me with PCOS?

Frankly, not too many doctors including endocrinologists, Ob/Gyn, or primary care physicians, understand the concepts in obesity medicine such as the role insulin resistance plays, unless they are obesity medicine trained. W8MD’s insurance physician weight loss program is unique in many ways with a comprehensive multidisciplinary approach to weight loss that addresses all the complex issues leading to weight gain, both in adults and children. Since its inception in 2011, W8MD has successfully helped thousands of patients succeed in not only losing weight but also keep it off with an ongoing maintenance plan.

References

Polycystic ovary syndrome (PCOS). (2021, September 7). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439 Polycystic Ovary Syndrome (PCOS). (2021, August 10). National Institute of Child Health and Human Development. https://www.nichd.nih.gov/health/topics/pcos/conditioninfo Polycystic Ovary Syndrome (PCOS). (2021, June 2). American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/polycystic-ovary-syndrome-pcos Dunaif, A. (2017). Polycystic ovary syndrome. The Lancet, 390(10086), 2357-2368. https://doi.org/10.1016/S0140-6736(17)31151-3 Dokras, A. (2015). PCOS: Current concepts and treatment strategies. Fertility and Sterility, 103(2), 365-376. https://doi.org/10.1016/j.fertnstert.2014.10.013

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