Polycystic Ovary Syndrome: The Most Common Hormonal Disorder for Women

When we hear that a woman is having trouble getting pregnant, our thoughts usually run to what we think of as the usual culprits, including: advanced age, fibroids, endometriosis or blocked fallopian tubes. But the reality is that most cases of infertility are caused by problems with ovulation. If a woman doesn't ovulate, there's no egg to be fertilized, and the most common cause of ovulatory problems is a little talked about -- and frequently undiagnosed -- health problem called polycystic ovary syndrome, or PCOS.

What Is PCOS?

PCOS is an inherited condition and is the most common hormonal disorder of women of reproductive age, affecting 5-10 percent of all women. PCOS can cause infertility by interfering with the exquisite hormonal balance needed for eggs to mature on schedule and be ready to be fertilized. Equally concerning, 60 to 70 percent of women with PCOS are obese, and are at significantly higher risk of developing diabetes (without treatment, about 50 percent of women with PCOS will be diabetic or pre-diabetic by the age of 40), heart disease and endometrial cancer.

The hallmark sign of PCOS is lack of regular menstruation, but there are also a cluster of telltale signs and symptoms that may suggest the diagnosis:

• Blood tests suggesting hormonal imbalances
• Excess hair growth on the face, back, chest or abdomen
• Acne
• Thinning hair on the crown of the head
• A tendency to accrue that much-maligned belly fat around the middle.

As you can imagine, for many women PCOS can also set the stage for a major crisis of body image and female identity.

What Causes PCOS?
The connection between PCOS and fertility has been recognized for over 100 years, but only since the 1990s have scientists begun to appreciate that "ground zero" for PCOS in most women is insulin resistance, the same hormonal problem that, in its most advanced state, causes type 2 diabetes. This finding gives us great insight into how to treat women with PCOS beyond the historic "Band-aid" approach of treating the symptoms -- birth control pills to regulate a woman's period; laser treatment or medications for hair growth; a trip to the dermatologist to manage acne; and, of course, a non-stop onslaught of recommendations to lose weight.

Like reproductive hormones, insulin is a hormone with far-reaching action. Insulin is produced by the pancreas, and its main job is to escort glucose, or blood sugar out of the blood and into the cells after we eat carbohydrates (both sweets or added sugars, and naturally occurring carbs, like grains, starchy vegetables, fruits, milk and yogurt). The amount of carbohydrate eaten dictates how much insulin is secreted to clear glucose out of the blood. In insulin resistance, the pancreas releases insulin into the blood, but the cells resist its cell-opening action, causing the pancreas to compensate by working overtime to pump out excess amounts. Over time this can lead to pancreatic "burnout" where not enough insulin is being produced to overcome the resistance, leading to a gradual rise in blood glucose levels -- and an increased risk of diabetes.

From a reproductive standpoint, excess circulating insulin also has the ability to stimulate production of the male-type hormone testosterone in the ovaries, a place where estrogen needs to dominate to trigger ovulation. It's these male hormones that can cause unsightly growth of facial hair; wreak havoc on hair follicles on the crown of the head (leading to male-pattern hair loss); stimulate inflammation and acne in the skin; and direct fat deposits to the abdomen in a male-type distribution.

Not All The News Is Bad. PCOS Is Very Treatable
Because PCOS is genetic, there is no cure, but it is treatable. Metformin, a diabetes medication that improves insulin sensitivity, is often used, particularly in women trying to conceive. Birth control pills and other medications may also be prescribed to help manage symptoms, but, like many modern-day health problems, diet and lifestyle change is key. Being overweight and sedentary aggravates insulin resistance, worsening the symptoms of PCOS and raising the risk of infertility and other health complications. Adopting a few healthful diet and exercise strategies that target insulin resistance -- including weight loss, if necessary -- is critical to managing the underlying hormonal problems seen in PCOS, and truly experience relief from its symptoms:

• As carbohydrate intake dictates the post-meal glucose/insulin response, limit sweets in favor of moderate-sized portions of unrefined carbohydrates, like whole grains, fruits, starchy vegetables, low fat milk and unsweetened yogurt -- spread out over smaller meals and snacks.

• Pair carbohydrates with lean protein and a little healthy fat (for example, whole grain crackers with peanut butter, or stir-fried chicken and vegetables with brown rice) to help slow carbohydrate digestion and enhance the feeling of fullness you get from meals and snacks.

• Trade in trans and saturated fats for heart-healthy monounsaturated fats from olive, canola or peanut oil, nuts, seeds and avocados, and increase your intake of anti-inflammatory omega-3 fats from fatty fish (salmon, mackerel, herring, lake trout, sardines and albacore tuna) or fish oil capsules if you're not a fish eater.

• Take exercise seriously. It's the most natural insulin sensitizer there is. Aim for at least 30 minutes most days with a long term goal of 60 minutes (can be accrued over the day).

Infertility is a major concern for many women with PCOS, but under the care of an OB-GYN or reproductive endocrinologist skilled in managing PCOS, many women are able to conceive. A registered dietitian can also be a great help in making the changes needed to manage PCOS as naturally as possible. For over 10 years I've been helping women with PCOS understand their condition, become empowered to manage their health, and, in many instances, have the babies they once thought they couldn't. You can find a registered dietitian in your area through the American Dietetic Association.

 

 

 

Follow Hillary Wright on Twitter: www.twitter.com/PCOSDiet

Comments

[CyberCyster]

08:38 AM on 02/23/2011

Metformin has been life saving for me. All too often I hear women give up on this medication because of the awful side effects. Taking a pro-biotic really saved me from suffering from the usual stomach ailments. I am now up to 2000mg daily. It has been my experience that no one doctor was able to help me. I suffered for over 15 years being brushed off by doctor after doctor. I had to see an endocrinologist, a gynecologist and a registered dietitian in order to get on the correct path. The only way I knew to take these steps was from the advise from other women on online support groups. Doctors are failing women with PCOS. Thank you HP for bringing this under discussed issue to light.

CyberCyster
http://whatsagrl2do.blogspot.com/

[fellow cyster]

10:13 PM on 02/01/2011

Its important to note that medications are not the only way to control PCOS. I have controlled mine for nearly 7 years with herbs, vitamins and diet. One must also realize the severe risks medications cause, and many meds aren't as effective in controlling PCOS & its symptoms as doctors claim. I've spoken to thousands of women who are so fed up because the medications don't help, they just make them feel worse. I talk to them a few months after changing to a natural regime and they are not only more healthy, but their PCOS is much more controlled and many became pregnant.
I have been blessed with 5 babies, all mine, despite this condition. This is practically unheard of in the PCOS world. Yes, 2 were conceived because of IF medications however 3 are completely natural and surprise/miracle babies. It is possible. Educate yourself. While some doctors are helpful in controlling this condition, the majority don't have any clue about all it entails. If you are not feeling like your PCOS is being controlled well enough, make a change.
Pamela
Diagnosed with PCOS in 2003
Creator of PCOSInfo.com

[fbm10]

05:09 PM on 02/09/2011

I have PCOS and they prescribed me Metformin which did nothing but cause my IBS to flare up really bad. Have you heard of Fertiliaid and was wondering what natural steps you too?

[gleitz05]

02:28 PM on 01/31/2011

The diagnosis of PCOS came too late for me. It's a shame that some doctors don't listen to their patients or that some aren't well versed enough in this disease to be able to make a proper diagnosis or even refer the patient to someone who might be able to help. I had two miscarriges, a partial hysterectomy and then a total hysterectomy by the time I was 30. All the other symptoms were there and the weight gain kept creeping up despite how little I would eat. I was almost 50 before a doctor told me I had insulin resistance and I can't get Metformin, I was told, since I'm not of childbearing years. I'm 60 now, loaded with 2 types of arthritis and still overweight no matter how hard I try to lose it. The good news is that I have been able to keep my blood sugar in line. My point in writing this is that if anyone feels that they know something isn't right with their health and can't get their regular doctor to listen, keep looking for one who will. Don't let any doctor get away with not taking you seriously.

[dadw5boys]

03:22 AM on 01/31/2011

Friend of mine had cyst and I reminded her about Chlamydia and the False Negatives when they test for it. She told her Doctor to just treat her for Chlamydia.
Her Cyst went away.

Chlamydia was hiding under the Cyst.

[kendraro]

10:26 PM on 01/30/2011

I don't have this, but I do have SOME unidentified hormonal disorder, and I will just say that I think someday they will look back on this time as being particularly barbaric towards women because we withhold research, testing and care based on these being "women's problems" and I would like to encourage all my sisters out there to keep demanding the treatment they need, don't take no for an answer, keep seeking until you find the right doctor and the right diagnosis for you. I once told a neurologist that an interesting symptom of my migraines was that they disappeared entirely when I was pregnant (thus the hormonal connection -duh) his answer was: "have lots of babies."
I kid you not.

[onwisconsin]

02:15 AM on 01/29/2011

Thanks for the article on PCOS. I have had this since my late teens and it took over 20 years before I finally got a diagnosis. It was heartbreaking to go through fertility treatments and abuse at the hands of male ob/gyns who simply would not listen to what I was telling them. I can tell stories about this that almost make me cry with the retelling.

Fast forward many years and I finally had a female ob/gyn take me seriously and perform the tests that proved that I had this condition. I've now been able to lose a significant amount of weight. I will always be tall with a large frame but I no longer have to buy plus sized clothing. I'm at a healthy weight and BMI. Luckily, I also am no longer insulin resistant at all and I never had developed high blood pressure or any heart disease. I have low cholesterol as well. Unfortunately, the treatment was too late to save my fertility. I entered menopause at 36 and am now past those years completely at 44. However, it might never have happened for me anyway since I am a cancer survivor.

Still, this taught me to continue to advocate for myself medically. Find the right physician and keep talking until someone, somewhere listens. Don't accept blame from people for conditions you cannot help. And when you get help, finally, take advantage of it fully!

I was able to adopt 3 lovely kids, btw.

[superjules]

08:15 AM on 01/30/2011

Congratulations to you and your family. You must be a fierce lady to take the reins of your own health.

[PCOSDiet]

09:20 AM on 01/30/2011

You're story is very insightful, and unfortunately not uncommon. So great to hear that you finally found the right physician and got the help you needed. Thanks for sharing.

[h3ll0mktg]

12:17 AM on 01/29/2011

Polycystic ovary disease affects hormone cycles. Hormones help regulate the normal development of eggs in the ovaries. It is not completely understood why or how hormone cycles are interrupted, although there are several ideas. Follicles are sacs within the ovaries that contain eggs. In polycystic ovary disease, there are many poorly developed follicles in the ovaries. The eggs in these follicles do not mature and, therefore, cannot be released from the ovaries. Instead, they form cysts in the ovary. This can contribute to infertility. The immature follicles and the inability to release an egg (ovulate) are likely caused by low levels of follicle stimulating hormone (FSH), and higher than normal levels of male hormones (androgens) produced in the ovary.

[Artemis34]

10:25 PM on 01/28/2011

Your body's hormones are like balls on a billiards table, you hit one and others are knocked out of place. 

Thank you for this article.

[Martin 27514]

06:32 PM on 01/28/2011

There is no inherited condition that affects 10% of the female population. PCOS did not exist in the 1960's beyond the rare Stein-Leventhal syndrome.

Diet, exercise and OCPs seem to be the key ingredients in causation. But - that does not tell us the precise mechanism. There is some evidence that the innervation of the ovaries may be disrupted. Since 90% of gynecology seems to result from injured pelvic nerves - it seems an omission to leave out PCOS ?

The conventional framework looks largely at the metabolic consequences of disruption of the ovary.

[JamiSings]

11:15 AM on 01/29/2011

How do you know it "didn't exist"? It just likely didn't have that same name. Like how people with Downs Syndrome were called "mongoloids" or kids with what we'd now called autism were given various names.

Just because the truth of the disorder wasn't discovered until now doesn't mean it didn't exist. Did you ever stop to think how many poisonings in ancient times might have really just been food allergies? Or that many cases of consumption might have actually been AIDS?

PCOS always existed. We just didn't call it by that name until now.

[onwisconsin]

11:39 AM on 01/30/2011

My paternal grandmother had all the symptoms of this condition, a condition I have as well. She was able to get pregnant twice over many years of trying. She had exactly the same symptoms as I, just no diagnosis (but it took me over 20 years to get a diagnosis as well). She died 9 years ago at 83 from pancreatic cancer.

That's just one case but I'd say in my case that's a pretty good argument for an inherited syndrome.

I don't trust many doctors on this one. I was told for 20 years that there was nothing wrong with me except that I was overweight. I ate surprisingly little. I had read about this syndrome for years but out of touch physicians would not even test me for it, thinking like you that this is not a real disease. Real disease or not, when I finally got a diagnosis of PCOS and appropriate treatment, the pounds melted off quickly and I am healthier than I have been since my 20s.

[LizzyFaire]

12:51 PM on 01/28/2011

To anyone suffering from this disorder, please investigate spironolactone as well as the metformin. I was diagnosed in the early 80s and have been taking 200mg of spiro for many years now. Helps with weight loss, definitely helps with the hirsutism and acne. That, birth control pills and weight control were key for me, but conceiving was never a concern. Also, I was recently diagnosed with hypothyroidism, which apparently often goes hand-in-hand with PCOS, so have a look at that as well. A little cytomel sure makes the weight easier to handle, thus lowering thus insulin resistance, thus helping the weight and skin, etc., etc. Good luck to all sufferers.

[Corey Whelan]

12:32 PM on 01/28/2011

Hi Hillary thank you for your article. Two points I would like to mention - starchy vegetables are a no go for women with pcos with the exception of small amounts of sweet potatoes, possibly peas. White potatoes and corn, considered by many to be vegetables, are simply not good nutritional choices for women who experience insulin resistance. On another note, I think it is important for women to be aware that that while pcos may be inherited and does sometimes run in families, it can in fact be inherited from asymptomatic men in your family, such as your father, as well as from your mom.
Thanks again.
Corey Whelan, Program Director, The American Fertility Association

[Hillary Wright]

08:22 PM on 01/30/2011

Hi Corey - Thanks for the feedback. In my practice I educate women to view starchy vegetables as starches when meal planning, (like we already do with potatoes) and as long as they limit their portions and "count" them as carbs I find they can handle them OK. I totally agree that many women inherit this condition from their father. I often hear mention of paternal aunts with the problem.

[where i stand]

12:13 PM on 01/28/2011

I have PCOS too & my current treatment includes Spironolactone which helps with excess hair growth, Doxycycline for acne, and I was on Metformin. It gave me a lot of stomach issues, so my doctor switched my to Januvia, which I've had no problems with. It's definitely worth checking into. I've also been losing weight & carefully watching my diet, which has helped tremendously. Body fat stores those extra hormones & makes the symptoms worse, so getting it off & exercising really helps. I've found that diet is just as important as meds. Hope this helps--best wishes!

[RMankovitz]

11:22 AM on 01/28/2011

A controversial, and sometimes quite effective, treatment for PCOS is high dose supplementation with an iodine/iodide combination. Anecdotal evidence indicates that high rates of fibroids and cystic conditions anywhere in the body may be associated with iodine deficiency.

The therapeutic use of iodine in treating these conditions has been described in the medical literature for many years, and recent informal studies suggest that the majority of women in the US are likely to be iodine deficient. The easy formation of cysts is sometimes probative of a deficiency. For some reports on the subject, use Google Scholar to search: PCOS iodine .

The definitive book on the subject for the layperson is "Iodine, Why You Need It, Why You Can't Live Without It", by David Brownstein, MD.

A discussion of the various ways to self-test for iodine deficiency can be found in "The Wellness Project".

Roy Mankovitz, Director
http://www.MontecitoWellness.com
A research organization

[ErinE1973]

10:09 AM on 01/28/2011

I currently have this disorder...to put it bluntly, it sucks. I gain weight three times as fast as anyone else, the acne is horrible and with the other aspects of this disorder-I feel less than feminine.

[erinker]

10:39 PM on 01/30/2011

Erin (I am also an Erin), I am so with you on this. I have been losing weight recenly but it is VERY hard. And one of the WORST symptoms is the facial hair. God, I hate the facial hair!

I am planning on ding artificial insemination next year. I hope I don't have fertility issues.

[fbm10]

05:14 PM on 02/09/2011

my name is Aeron (Erin) too and I have PCOS and I agree it SUCKS

[JamiSings]

09:57 AM on 01/31/2011

I know, it sucks. And even with the diagnosis people still treat me badly. My own mom, who's fat herself, is constantly on me and says I use PCOS as an excuse. My endocrinologist keeps saying to me "Between the PCOS and your age, your ONLY hope of losing weight is gastric bypass." Frankly, I'd rather be fat!
Then there's the acne and the facial hair - which I have to tweeze on a daily basis. Often digging them out from under the skin because they're badly ingrown.
The only thing about it I do like is the fact many of us are infertile. I've been trying to break into the music business & my mom's friends would tell me to "Settle for the first guy who came along & have a bunch of children like a normal woman." Now they leave me alone because they know it's likely I can't have kids. Don't want them anyway. Music is more important.

[Aviva21]

10:03 AM on 01/28/2011

I was diagnosed with PCOS a few years ago (I am now 27 years old), and I found this article very interesting. While I have a healthy weight (my BMI is in normal range), I do have a problem with all my fat being placed around my middle, which is very frustrating for me. I also have some excess facial hair, but which diligent tweezing I can keep it at bay.

I don't use the pill. I have in the past, but I have an anxiety disorder which I have found is aggravated by the use of hormonal birth control. When left alone, my period comes about once a year, if that.

I have a question: is it useful for me to ask my gynecologist about Metformin, even though I'm not currently trying to conceive?

Thank you.

[Angie Tyne 1]

03:19 PM on 01/28/2011

Yes. But I would bring this up to your primary first unless they are resistant to the idea. In which case get a new primary.

[PCOSDiet]

05:24 PM on 01/28/2011

I would ask about Metformin because, regardless of whether or not you're trying to get pregnant, it can help manage your symtoms and potentially reduce your risk of developing diabetes.