Understanding PCOS -- March 19th, 2012 -- Dr. Kristina McCain - NewsChannel5.com | Nashville News, Weather & Sports

Understanding PCOS -- March 19th, 2012 -- Dr. Kristina McCain

Kristina McCain, MD: GYN
BAPTIST HOSPITAL

Monday, March 19, 2012
TOPIC: Understanding PCOS

News notes via www.webmd.com

What is (PCOS) Polycystic Ovarian Syndrome?

PCOS, or polycystic ovarian syndrome, is a common hormonal disorder in women that with interferes with the growth and release of eggs from the ovaries, or ovulation. It is the most common cause of infertility among women. PCOS occurs when a woman's body overproduces sex hormones, called androgens. The hormone imbalance prevents fluid-filled sacs in the ovaries from breaking open and releasing mature eggs. The fluid-filled sacs bunch together, causing many tiny cysts. Symptoms of PCOS include missed periods, abnormal facial and body hair growth, acne, and weight gain. PCOS may run in families 

PCOS: What Happens?

Polycystic ovary syndrome (PCOS) is a group of health problems linked to a woman's out-of-balance hormones. Common symptoms of PCOS include irregular periods, infertility, repeat miscarriages, male-pattern hair loss, male-type facial and body hair, acne, and obesity. PCOS raises your risks for serious health problems, including high blood pressure (hypertension), heart disease, diabetes, and uterine (endometrial) cancer.

Reproductive problems

Hormone imbalances linked to PCOS cause several types of pregnancy problems and related problems, including:

• Infertility. This happens when the ovaries are not releasing an egg every month.
• Repeat miscarriages. The cause for this is not known. These miscarriages may be linked to high insulin levels, delayed ovulation, or other problems such as the quality of the egg or how the egg attaches to the uterus.
• Gestational diabetes during pregnancy. This risk is greater in women with PCOS than in women who ovulate regularly.
• Increased blood pressure during pregnancy or delivery, having a larger than normal or smaller than normal baby, or having a premature baby.
• Precancer of the uterine lining (endometrial hyperplasia). This can happen when you don't have regular menstrual cycles, which normally build up and "clear off" the uterine lining every month. You can take birth control pills or other hormone medicines to reduce the risk of endometrial hyperplasia.
• Uterine (endometrial) cancer. Risk during the reproductive years is 3 times greater in women with PCOS than in women who ovulate monthly.³

You may have more regular menstrual cycles as you near menopause. The reason for this is not known. But your history of PCOS may still increase your long-term risk of high blood pressure (hypertension), heart disease, diabetes, or endometrial cancer.

Problems with insulin and sugar metabolism

Insulin is a hormone that helps your body's cells get the sugar they need for energy. Sometimes these cells do not fully respond to the action of insulin. This is called insulin resistance. Insulin resistance can lead to an increase in blood sugar and diabetes.

Up to 40% of women with PCOS have insulin resistance, and up to 10% get type 2 diabetes by the time they reach age 40.² Insulin levels also rise in people with insulin resistance. High insulin levels can increase the production of male hormones and make your PCOS worse.

Serious health problems linked to insulin resistance include:

• High blood pressure.
• High triglycerides.
• Low HDL ("good") cholesterol.
• High blood sugar.
• Excess body fat (particularly abdominal obesity).

Heart and blood circulation problems

It is possible that high insulin from PCOS makes heart and blood vessel problems worse.² These problems include:

• Hardening of the arteries (atherosclerosis).
• Coronary artery disease and heart attack.
• High blood pressure.
• High cholesterol.
• Stroke.

Breathing/sleep problems

Women who have PCOS have a higher risk of breathing problems while sleeping (obstructive sleep apnea). This is linked to both obesity and insulin resistance.²

What are hormones, and what happens in PCOS?

Hormones are chemical messengers that trigger many different processes, including growth and energy production. Often, the job of one hormone is to signal the release of another hormone.

For reasons that are not well understood, in PCOS the hormones get out of balance. One hormone change triggers another, which changes another. For example:

• The sex hormones get out of balance. Normally, the ovaries make a tiny amount of male sex hormones (androgens). In PCOS, they start making slightly more androgens. This may cause you to stop ovulating, get acne, and grow extra facial and body hair.
• The body may have a problem using insulin, called insulin resistance. When the body doesn't use insulin well, blood sugar levels go up. Over time, this increases your chance of getting diabetes.

What are the symptoms?

Symptoms tend to be mild at first. You may have only a few symptoms or a lot of them. The most common symptoms are:

• Acne.
• Weight gain and trouble losing weight.
• Extra hair on the face and body. Often women get thicker and darker facial hair and more hair on the chest, belly, and back.
• Thinning hair on the scalp.
• Irregular periods. Often women with PCOS have fewer than nine periods a year. Some women have no periods. Others have very heavy bleeding.
• Fertility problems. Many women who have PCOS have trouble getting pregnant (infertility).
• Depression.

Most women with PCOS grow many small cysts on their ovaries. That is why it is called polycystic ovary syndrome. The cysts are not harmful but lead to hormone imbalances.

Causes of PCOS

The cause of polycystic ovary syndrome (PCOS) is not fully understood, but genetics may be a factor. If you have PCOS, your sisters and daughters have a 50% chance of developing PCOS.¹

PCOS problems are caused by hormone changes. One hormone change triggers another, which changes another. PCOS problems may include:

• Ovary hormone imbalance. When the hormones that trigger ovulation are not at the right levels, the ovary does not release an egg every month. In some women, cysts form on the ovaries. These cysts make androgen.
• High androgen levels. High androgen in a woman causes male-type hair and acne problems and can stop ovulation.
• High insulin and blood sugar levels. About half of women with PCOS have a problem with how the body uses insulin, called insulin resistance. When the body doesn't use insulin well, blood sugar builds to high levels. If not treated, this can lead to diabetes.

How is PCOS diagnosed?

To diagnose PCOS, the doctor will:

• Ask questions about your past health, symptoms, and menstrual cycles.
• Do a physical exam to look for signs of PCOS, such as extra body hair and high blood pressure. The doctor will also check your height and weight to see if you have a healthy body mass index (BMI).
• Do a number of lab tests to check your blood sugar, insulin, and other hormone levels. Hormone tests can help rule out thyroid or other gland problems that could cause similar symptoms.

You may also have a pelvic ultrasound to look for cysts on your ovaries. Your doctor may be able to tell you that you have PCOS without an ultrasound, but this test will help him or her rule out other problems.

How is it treated?

Regular exercise, healthy foods, and weight control are key treatments for PCOS. Medicines to balance hormones may also be used. Getting treatment can reduce unpleasant symptoms and help prevent long-term health problems.

The first step in managing PCOS is to get regular exercise and eat heart-healthy foods. This can help lower blood pressure and cholesterol and reduce the risk of diabetes and heart disease. It can also help you lose weight if you need to.

• Try to fit in moderate activity and/or vigorous activity on a regular basis. Walking is a great exercise that most people can do.
• Eat a heart-healthy diet. In general, this diet has lots of vegetables, fruits, nuts, beans, and whole grains. It also limits foods that are high in saturated fat, such as meats, cheeses, and fried foods. If you have blood sugar problems, try to eat about the same amount of carbohydrate at each meal. A registered dietitian can help you make a meal plan.
• Most women who have PCOS can benefit from losing weight. Even losing 10 lb (4.5 kg) may help get your hormones in balance and regulate your menstrual cycle. PCOS can make it hard to lose weight, so work with your doctor to make a plan that can help you succeed.
• If you smoke, consider quitting. Women who smoke have higher androgen levels that may contribute to PCOS symptoms.¹Smoking also increases the risk for heart disease.

A doctor may also prescribe medicines, such as:

• Birth control pills. They can help your periods be regular and can reduce symptoms such as excess facial hair and acne. An androgen-lowering medicine, spironolactone, may be used with birth control pills to help reduce symptoms even more. These medicines are not used if you are trying to get pregnant.
• A diabetes medicine called metformin. It can help restore regular menstrual cycles and fertility.
• Fertility medicines, if you are trying to get pregnant.

It is important to see your doctor for follow-up to make sure treatment is working and to adjust it if needed. You may also need regular tests to check for diabetes, high blood pressure, and other possible problems.

It may take a while for treatments to help with symptoms such as facial hair or acne. In the meantime:

• Over-the-counter or prescription acne medicines may help with skin problems.
• Waxing, tweezing, and shaving are easy ways to get rid of unwanted hair. Electrolysis or laser treatments can permanently remove the hair but are more expensive. Your doctor can also prescribe a skin cream that slows hair growth for as long as you use it regularly.

It can be hard to deal with having PCOS. If you are feeling sad or depressed, it may help to talk to a counselor or to other women who have PCOS. Ask your doctor about local support groups, or look for an online group. It can make a big difference to know that you are not alone.