Polycystic Ovarian Syndrome: Fighting for a diagnosis

Polycystic Ovarian Syndrome (PCOS) is a disease affecting many women that, I believe, is misdiagnosed or goes undiagnosed.  Much of this can stem from embarrassment or from the fear of “complaining” about “woman problems.”  So lets do something that doesn’t happen often.  Let’s talk about it.

PCOS is an endocrine (hormone) dysfunction that can present in many ways.  As the name seems to point out, multiple cysts on the ovaries can be a symptom, but not in everyone.  Acne, oily skin, excess hair growth, and male pattern baldness (in a woman) are embarrassing side effects that appear in women, but the severity generally depends on a woman’s genetics and ethnicity.  Central obesity (or an apple figure), uncontrolled weight gain, and difficulty conceiving a child are also symptoms that effect many women with PCOS.  Menstrual irregularities, however, occur in all women, including elongated periods, skipped periods, etc.  This list sounds very sterile and clinical, but these are people we’re talking about here.  These are mothers, sisters, and daughters.  As “enlightened” as our society would like to believe itself to be, “The Angel in the House” standard still lives on, placed on us by society, but also by ourselves.  No complaining, Hellenistic beauty, and fertility.  PCOS effects all these standards and, if we are crushed by them, these standards can cause depression, misdiagnosis, or no diagnosis at all.  So is this one of those diseases that was “made up” so someone has an “excuse” for their body?  No.  Why should you talk to your doctor?  Because it’s not just about looks and fertility folks.  It’s about health.

In a physician’s defense, PCOS can sometimes be very hard to diagnose.  PCOS is marked by the production of too much androgen and estrogen by the body.  The androgen excess is what causes many of the physical symptoms of PCOS and the estrogen surges effect fertility and cause the menstrual abnormalities.  We’re still talking about appearance and fertility, I know, but these are the symptoms we can see.  If there is one thing I want us learn from this blog it is that your body is complicated and you have little control over what it decides to do sometimes.  Hormones control everything.

PCOS can put you at risk for high cholesterol, high blood pressure, heart disease, and type II diabetes.  These are disease states that should not be trifled with.

PCOS can be caused by many things:

Heredity:  If your mother or sister have PCOS it is important that you also watch for signs and symptoms.

Abnormal fetal development:  Being exposed to excess androgen while in utero may produce these effects, but researchers are still digging in this direction.

Low-grade inflammation:  Certain foods can cause inflammation in certain people (this is why I stay away from certain food preservatives).  Inflammation can set off any sort of autoimmune domino effect (asthma, rheumatoid arthritis, etc.).  In this case inflammation can cause insulin resistance, which seems to lead to PCOS in some people.

Excess insulin (from resistance or excess pancreatic production or both):  The possibility is that the excess insulin may somehow boost androgen production in the ovaries.  The other possibility is that insulin resistance may translate to other hormone resistance, increasing the amount of androgens in the blood stream.
So what can be done?  There are, of course, medications that should be taken to help with symptoms, but also to help prevent the other disease states that PCOS is associated with (diabetes, high blood pressure, etc.).  The first medication that women are usually placed on is a diabetes medication called metformin.  Metformin is a medication that will help the bodies insulin resistance, thus decreasing excess insulin, and decreasing the excess androgen in the body.  Spironolactone is a medication used with metformin that helps reduce androgens in the blood stream, but also helps to decrease high blood pressure associated with PCOS.  Spironolactone is also more effective in reducing the oily skin, excess, hair, and acne associated with PCOS.  To treat the male pattern baldness a drug called finasteride can be used, but it is tertiary to the metformin and spironolactone.  Low-dose birthcontrol is effective in women not wishing to become pregnant because it helps regulate the menstrual cycle and decreases the excess estrogen and androgens typical in PCOS.    For women wishing to become pregnant it is important to understand that first the disease should be stabilized, spironolactone stopped, and clomiphene started (to help the body ovulate).  There is a trade off and there is no guarantee.

Medications are a great tool and can help with the other disease states associated with PCOS, but here is that lifestyle change thing again.  Will I ever stop harping on it?  Nope.  Exercise and a low carbohydrate diet are what is called for!  Weight loss is associated with better control over PCOS.  Treating your PCOS symptoms is exactly like living like a diabetic (which is handy since PCOS can lead or be caused by type II diabetes).  Please see the below blogs for additional information:

Carbohydrates: http://mixturesrx.com/blog/?p=168

Fats: http://mixturesrx.com/blog/?p=176

Protein: http://mixturesrx.com/blog/?p=184

Sodium: http://mixturesrx.com/blog/?p=190

Health Detoxing: http://mixturesrx.com/blog/?p=197

Diabetes Basics: http://mixturesrx.com/blog/?p=204

Diabetes Complications, Risk Factors, Prevention: http://mixturesrx.com/blog/?p=213

Hyperglycemia: http://mixturesrx.com/blog/?p=222

Hypoglycemia: http://mixturesrx.com/blog/?p=230

Resources: http://mixturesrx.com/blog/?p=242

Womenshealth.gov also has a nice summery page for PCOS: http://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.pdf

Just remember.  This isn’t complaining about “woman problems.”  This is a disease state that can effect your life expectancy if it is not treated and controlled.  It can strike young or old.  You know your body more than anyone else.  If something isn’t right, something isn’t right.  Fight for yourself because you deserve it.

 

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