Posted On: September 22, 2021

Ask the Gynecologist: Understanding Polycystic Ovarian Syndrome (PCOS)

What is PCOS?

Polycystic ovary syndrome (PCOS) is a complex metabolic and hormonal condition.

It is often underdiagnosed in many women and unfortunately could lead to many reproductive and health implications. In this blog, I will go over the basics of PCOS, such as definition, symptoms, general treatment, and lifestyle modifications you could make if diagnosed with PCOS.

So, what is PCOS? PCOS is the most common endocrine disorder affecting reproductive-aged women, with a prevalence of between 8% and 13%. There’s no universally accepted definition for PCOS. It is often diagnosed by the presence of two of the three following criteria: hyperandrogenism, ovulatory dysfunction, and polycystic ovaries on ultrasound. Because these findings may have multiple causes other than PCOS, a careful, targeted history and physical examination are required to ensure proper diagnosis and treatment.

Where does it come from? Why do I have it? This syndrome is multi-factorial and the different susceptibility of patients is probably determined by several genetic and environmental risk factors. Ethnicity also plays a role.

How do I know if I have PCOS?

You may be asymptomatic or you may have multiple gynecologic, dermatologic, or metabolic manifestations — such as high levels of androgen hormones, irregular or lack of periods, ovarian cysts on ultrasound, infertility, obesity, mood disorders, oily skin, and acne, among other symptoms.

It’s not necessary that you have all the symptoms of PCOS to be diagnosed, and the clinical presentation of PCOS is very variable (hence the environmental predisposition). If you have symptoms that may be consistent with PCOS, discuss your health with your provider so appropriate evaluation is taken.

Why is it important to have an appropriate diagnosis?

Patients with PCOS may be at risk of metabolic syndrome (a condition that increases the risk of diabetes, heart diseases, elevated blood pressure, high triglycerides, nonalcoholic fatty liver disease and sleep apnea), infertility, and endometrial hyperplasia. This is why it is important to have regular visits with your gynecologist or primary care physician for routine blood work and healthcare maintenance to check routinely on all the conditions above and manage accordingly.

I was diagnosed with PCOS, now what?

Fortunately, we have a variety of treatments available to address most of the conditions present in PCOS. Treatment is tailored to each woman according to her symptoms and whether she wants to get pregnant or not.

For treating your menstrual irregularities, we often use combination birth control pills (if you do not wish to become pregnant) or other hormonal methods that you could discuss with your doctors such as the ring, progesterone-only pills, or the IUD. Not only do they help regulate the menstrual cycle, but pills also reduce hirsutism and acne!  They also decrease the risk of ovarian cysts and endometrial cancer by making the lining of the uterus thinner.  

For overweight women, weight loss alone often regulates the menstrual cycle. Studies showed even a small weight loss of 10 to 15 pounds can be helpful in making your periods more regular. Weight loss also improves your cholesterol level and the insulin resistance that is at the core of PCOS. Some drugs used to treat diabetes such as metformin could be added to your treatment plan if found necessary.

If you’re trying to get pregnant, weight loss for overweight women could sometimes help achieve that. Comiphene citrate and letrozole are the drugs most commonly used to aid in ovulation and achieve pregnancy under proper medical care.

What could I do to help my body if I have PCOS?

Maintain a healthy lifestyle!

Regular exercise improves your sensitivity to insulin and metabolic syndrome and balances your hormones, helping with menstrual irregularities, ovulation, and pregnancy. Try to avoid food high in sugar and maintain a diet rich in protein and healthy fat. Also avoid food that triggers inflammation and help yourself with natural anti-inflammatories such as turmeric, omega-3 fatty acids, and antioxidants. Always discuss your lifestyle and diet with your providers to ensure you’re getting the appropriate care.

It’s also very important to reduce your stress level and meditate frequently. Stress could negatively impact your metabolic process and alter your hormones throwing your natural physiology off balance.

I hope the information above provides you with an understanding of PCOS and helps guide you in your hormonal and metabolic health. Always address any concerns with your doctors when it comes to changes you feel in your body. “An ounce of prevention is worth a pound of cure”!

For more information, watch the Facebook Live conversation with Dr. West and Dr. Hammoud.

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Dr. Nadine Hammoud is an award-winning gynecologist with Fairfax Gynecology Group, and she’s also active in education and research. She formerly served as an assistant professor at VCU and currently serves on the faculty at the University of Virginia Inova Campus.