Polycystic ovarian syndrome (PCOS) is the most common hormonal disorder found in women. PCOS can be a metabolic dysfunction causing hormonal imbalances or hormonal imbalance causing metabolic dysfunction. PCOS symptoms may be metabolic alone (metabolic X syndrome) or they may be hormonal alone and not affect the metabolism.
Understanding which type of PCOS you have will help guide you to the right treatment options.
What Is Polycystic Ovary Syndrome (PCOS)?
PCOS is a condition in which either:
- the ovaries produce abnormal amounts of androgens (testosterone, male sex hormone),
- hyperinsulinemia (too much insulin in the blood stream) binds with luteinizing hormone (from the pituitary gland- the center of our brain that communicates with the ovaries on which hormone to produce) which converts to testosterone,
- or, rarely, it may be caused by a lesion or mass on your ovary or adrenal glands.
The Signs and Symptoms of PCOS:
- Irregular or no menses (periods)
- Heavy menses (periods)
- Painful periods
- Abnormal weight gain
- Central obesity (holding all your weight in your abdominal area)
- Abnormal facial hair (too much or dark hair)
- Hair loss (head)
- Depression / Anxiety
- Irritability / mood swings
- Snoring (sleep apnea)
- Chronic Fatigue (feeling tired all the time)
- High blood pressure
- Elevated blood sugar levels (pre-diabetic or diabetic)
- Thyroid dysfunction
- Infertility (not being able to get pregnant)
- Decreased libido (sex drive)
Please note that symptoms vary, you may experience one or all of the symptoms above.
PCOS Treatment Options:
- Lifestyle changes-
- a dietary (low carbohydrate) plan that stabilizes your insulin levels can prevent the conversion of testosterone
- Low intense workouts for >45 min/ 5 days a week (such as walking, yoga)
- Metformin- helps stabilize insulin levels, making hormones more usable in the body
- Spironolactone – helps with acne, lowers testosterone
- Weight loss- a 5% reduction in your BMI (body mass index) can improve PCOS
- Stress reduction (acupuncture, massages)
- Specific hormonal birth control pills- that bind with the testosterone and lower the levels. This is a temporary fix that is often utilized to improve future fertility
- Progestin releasing IUD- this does not treat systemic symptoms but rather protects the uterus from hyperplasia (pre-cancer) and cancer of the uterus
- Cyclic progestin- to induce a monthly cycle
These treatments can be used together or individually depending on your type of PCOS and your healthcare goals.
Frequently Asked Questions About Polycystic Ovary Syndrome
Women often have similar questions when it comes to PCOS symptoms and treatment. In addition to the important questions answered above, we’ve prepared some additional FAQs to help you better understand this hormonal disorder.
What is considered an irregular period?
Great question. To answer this is it important to note that periods are tracked from the beginning of one cycle (first day you bleed) to the beginning of the next cycle. If this is less than 24 days apart or longer than 38 days apart then this is irregular. It is common to have a few day differences between the months but routinely skipping or having many periods is concerning and should be evaluated with a healthcare provider.
Can I get pregnant with PCOS?
Possibly. It depends on how well controlled it is. Often, women have oligomenorrhea (a few periods per year) and may ovulate during that time. A metric healthcare provider often reviews to determine ovulation status is the free testosterone lab value, how often you are having a menstrual cycle, and your BMI (body mass index). Do not be discouraged there are several holistic approaches, conservative medicines, and lifestyle changes you can make that can improve your symptoms and help you achieve pregnancy.
How do you get diagnosed with PCOS?
An evaluation with a healthcare provider and taking a detailed history including menstrual (period) history, vitals (blood pressure, weight), medical history, family history, and physical exam. Testing includes- fasting morning blood work and a pelvic ultrasound. If you first period was less than eight years ago the work up may not include a pelvic ultrasound.
I have PCOS, now what?
A follow up visit is needed to review your results and determine the best treatment for your desired healthcare goals. There is not a “one size fits all” treatment for PCOS. During this educational visit, your healthcare provider will review the type of PCOS you have and provide information of the best treatment options for your healthcare goals. Once you have chosen your chosen treatment. You will be followed (either every month or every three months) to monitor your progress and ensure your healthcare goals are being met.
Additional screening may be completed at these visits because individuals with PCOS are more likely to suffer from depression, have sleep disturbances, experience weight gain and pelvic pain.
I was diagnosed with PCOS. I am transgender (FTM), and I want elevated testosterone but how can I control my PCOS?
Depending on your symptoms and healthcare goals, your provider will help you with treatment options that controls the symptoms you do not want while promoting your overall health. Often this involves treatment with non-hormonal or localized treatment options that protect you from cancer.
Are there supplements I can take to help with my PCOS?
Yes. There are several great supplements. The top three most commonly recommending are:
- Omega 3- lowers testosterone and decreases inflammation
- Inositol – improved insulin and blood sugar levels
- Chromium- stabilizes insulin levels
Does PCOS resolve with menopause?
No, PCOS continues to affect women after menopause. Treatment goals are focused on health promotion such as prevention or reversal of diabetes or hypertension (high blood pressure), weight management, and control of menopausal symptoms (hot flashes, night sweats, insomnia).
Does PCOS require surgery?
Surgery can be an option to improve fertility if other treatments don’t work. Ovarian drilling is a procedure that makes tiny holes in the ovary with a laser or thin heated needle to restore normal ovulation.
Is there a medication that can help with hair removal?
A few treatments can help get rid of unwanted hair or stop it from growing.
Eflornithine (Vaniqa) cream is a prescription drug that slows hair growth. Laser hair removal and electrolysis can get rid of unwanted hair on your face and body.
Getting Help With PCOS
Although the exact cause of PCOS is unknown, an early diagnosis and professional treatment along with lifestyle changes, such as weight loss, may reduce the risk of long-term complications. Prolonged treatment may lead to additional health issues such as 2 diabetes and heart disease.
Make an appointment with your doctor if:
- You have missed more than one period and you are not pregnant
- You have other symptoms of PCOS, such as the growth of hair on your face and body
- You’ve been actively trying to get pregnant for a year or more but have not been successful
- You’re experiencing excessive thirst or hunger, have blurred vision or unexplained weight loss – all of which are symptoms of diabetes.
If you are concerned about your symptoms and don’t already have a doctor you can talk to, please reach out to us. Our team of clinicians and surgeons specialize in all aspects of women’s health and we are dedicated to practicing excellence in women’s care.
Kristina Calligan is a sub-specialty nurse practitioner in Women’s Health. A native to Arizona she obtained her Bachelor of Science in nursing in 2006 at Grand Canyon University in Glendale, Arizona. Never one to stop striving and achieving all that she could, she completed two master degrees in Nursing Science and Business Administration in 2012. Ms. Calligan joined Arizona Gynecology Consultants in 2009. Prior to working at Arizona Gynecology Consultants, she worked as a nurse in labor and delivery at several local hospitals and a research coordinator in women’s health care.