Are you experiencing excessive hair growth on your face, abdomen or chest? Have you suddenly developed adult acne? Experiencing weight gain or unable to lose weight? These symptoms may not just be cosmetic nuances, they could be symptoms of PCOS, a common yet serious endocrine disorder affecting women. Polycystic Ovary Syndrome is a medical condition which occurs when a woman’s sex hormone levels (Progesterone and Estrogen) are out of balance. These imbalances create cysts to form on the ovaries, causing irregular menstrual cycles, infertility, cardiac disease, and physical changes such as increased hair growth.
PCOS affects 5 to 10% of all women, with less than 50% diagnosed or treated, and is the most common cause of infertility today. Studies have determined that patients diagnosed with PCOS were three times more likely to develop autoimmune thyroid disease and are at greater risk for developing coronary heart disease. Another condition that seems to be associated with PCOS is insulin resistance, leading to the development of Type 2 diabetes by the age of 40. PCOS can be diagnosed at all stages in life, starting as early as 8 or 9 years old and appearing throughout the post-menopausal period. In addition to a list of troubling cosmetic issues, women and girls with PCOS typically have irregular menstrual cycles, often skipping their periods for months or having no periods at all. Irregular ovulation is also an issue, and women with PCOS often, but not always, have multiple unruptured follicles (mislabeled as cysts) around the periphery of their ovaries
The exact cause of PCOS is not completely understood, but seems to be linked to insulin and leptin resistance. An increase of insulin produced by the body leads to an increase in estrogen levels making the woman estrogen dominant. A vicious cycle is then created because a symptom of PCOS is an increase in the production of testosterone which exacerbates the symptoms.
Patients with the disorder often present with hormonal imbalances, including elevated testosterone, a classic, hallmark sign of PCOS. Other key determining factors of PCOS and hormone balance are progesterone and estrogen. These two hormones are integral for female health as they influence several bodily processes including reproduction. An imbalance of progesterone and estrogen instigated by PCOS can cause serious dysfunction including irregular or difficult menstruation, endometriosis, and the formation of painful ovarian cysts.
Patients with PCOS can present with one or more of a complex list of symptoms. However, not all patients will have all symptoms, and while some patients will have multiple cysts on their ovaries, some patients will have none at all. There are a variety of predictive elements that may help women recognize PCOS before symptoms become severe. There are certain groups who are at higher risk of having this condition such as adolescent girls experiencing abnormal menstrual cycles for over two years after their first cycle, adolescent girls developing extreme acne that is unresponsive to standard treatment methods, those with high exposure to BPAs like those found in various plastic products, and individuals with a metabolic or endocrine disorder contributing to hormone imbalance.
Although being aware of these high-risk categories may improve the accuracy of diagnoses, the best approach for identifying PCOS is symptom recognition followed by medical testing by your doctor.
When diagnosing PCOS, your doctor will evaluate your symptoms and perform a physical exam. Your doctor may also order blood tests to check for hormone imbalances. Additional blood tests such as fasting cholesterol/triglyceride levels or a glucose tolerance test will check for signs of insulin resistance. A physical exam, including a pelvic exam, can be done to manually inspect the patient's reproductive organs for any signs of a mass or growth. A Transvaginal Ultrasound of the uterus and ovaries can show the thickness of the uterine lining and the appearance of the ovaries. Any abnormalities can be seen visibly with this method of diagnosis.
Is there a connection to hypothyroidism?
It is known that PCOS involves hormonal imbalances, particularly the hallmark sign of elevated testosterone. But there appears to also be a connection to hypothyroidism. One study found that patients with PCOS were three times more likely to have autoimmune thyroid disease, with elevated thyroperoxidase (TPO) or thyroglobulin (TG) antibodies and a higher incidence of TSH levels above the upper limit of the normal range. A second study found a connection between severe, longstanding hypothyroidism and an increase in ovarian volume or formation of ovarian cysts. This study found that treatment with thyroid medications to achieve a euthyroid state (normal thyroid function) resulted in a decrease in ovarian volume, a resolution of ovarian cysts, and reversal of PCOS symptoms, along with improved hormone levels.
Because of the insulin resistance component of PCOS, it is often very helpful for patients to lose excess weight, though this can be difficult. Reduced carbohydrate diets have been shown to be potentially effective, not only at helping achieve weight loss but also in helping to control the excess insulin production that comes with insulin resistance. Focusing on foods with a low glycemic index, such as lean meats, whole grains and non-starchy vegetables can help patients reach their goals. Exercise can also be a very valuable tool in the management of PCOS. Not only can it help with weight loss efforts, but it also increases the sensitivity of cell membranes to insulin, allowing the body to convert glucose into energy more effectively. And an added bonus to improving the body’s ability to use insulin properly is that it could reduce the excess androgens in the body that are the major causes of many of the cosmetic symptoms.
Bioidentical hormone replacement therapy is used in treating the hormonal imbalances created by Polycystic Ovary Syndrome. During treatment, your hormones levels will be checked and monitored regularly. There is increasing evidence that PCOS can be successfully treated and often reversed with the use of insulin sensitizing medications such as Metformin (Glucophage), and Glitazones such as Rosiglitazone (Avandia) or Pioglitazone (Actos). These medications have been shown to reduce the endocrine abnormalities seen with PCOS, often with two to three months, and can result in improved regulation of menstrual cycles, decreased hair loss, diminished facial and body hair growth, normalization of blood pressure, weight loss, and reduction in cardiovascular risks. These medications also can help return normal fertility and reduced risk of miscarriage. Within six months of starting treatment with insulin-lowering medications plus diet and exercise, more than 90 percent of women will resume regular menstrual cycles.
Androgen-related symptoms such as acne and hair loss can often be improved through the use of anti-androgen medications such as Spironalactone (Aldactone), Cyproterone acetage, Flutamide (Eulexin), or Finasteride (Propecia, Proscar). PCOS patients who are dealing with fertility issues can often see improvement with fertility agents such as Clomid or Serophene, Gonadotropin injections, hCG (human chorionic gonadotropin), or GnRH Lutrepulse, and if these treatment options don’t bring results, patients can turn to in-vitro fertilization, commonly known as IVF. While PCOS may bring many unwanted cosmetic symptoms, it is a serious medical condition that needs to be addressed and properly treated. Use of a comprehensive treatment program to bring insulin and androgen levels back into balance, along with assistance in weight loss and other issues, can help patients with PCOS restore their health and fertility, while reducing their risk of heart disease, stroke and diabetes.
Diet can also help in treatment of PCOS by focusing on foods with a low glycemic index, such as lean meats, whole grains and non starchy vegetables. This will control the excess insulin production that happens with insulin resistance. Exercise will also improve the body’s ability to to process insulin properly and convert glucose into energy more effectively.
Call (877) 508-1177 to speak to a Holtorf Medical Group team member today.