PCOS (POLY CYSTIC OVARY SYNDROME)

Despite it’s name, PCOS is not just an ovarian disease.  It’s actually classified as a metabolic syndrome and has consequences outside of the ovaries.  The National Institutes of Health suggested that the name be changed because it doesn’t reflect the entire picture of the disease.  PCOS is a health condition that affects over 10 million women worldwide, and is believed to be caused by a hormonal imbalance.  It is the top cause of infertility, and the emotional and physical symptoms can be devastating to women.  The hormones that are usually involved with PCOS are as follows;

 

Androgens:

Androgens are usually considered the “male hormones”(Testosterone),  however women make androgens as well, though usually to a lesser degree.  The androgen increase in PCOS is usually made by the ovaries, but the adrenal glands can also contribute.

 

Insulin:

Insulin is the hormone that helps the body absorb glucose (blood sugar) into the cells for cellular energy.  PCOS causes a condition called Insulin Resistance, which means that the body doesn’t respond to, or recognize insulin as it should, which can cause the body to have high or unregulated blood glucose.  Having unregulated glucose can lead to a Pre-Diabetes situation or even cause the body to make more androgens.

Progesterone:  In PCOS, the ovaries will sometimes be unable to have a normal ovulation cycle.  This in turn causes a decrease in progesterone, which contributes to irregular periods. 

 

Symptoms:

 

Symptoms in PCOS can vary.  Some women have the typical presentation of PCOS, while others may only have one or two.  It’s easy for symptoms of PCOS to be attributed to other causes or go completely undiagnosed. 

 

Weight Gain:  About half of the women diagnosed with PCOS will have weight gain. The weight is typically stubborn and hard to manage.

 

Excessive Hair Growth:  Women diagnosed with PCOS usually have abnormal hair growth.  The areas that can be affected by extra hair growth include the arms, back, face or abdomen. 

 

Fatigue: Many women diagnosed with PCOS will express feelings of fatigue and lack of energy.  The lack of energy is usually significant enough to interfere with everyday life and may be worsened by non-refreshing sleep.

 

Infertility:  PCOS is a top cause for female infertility; however; each woman is unique in her presentation of symptoms.  Some ladies have no problem conceiving naturally, while others may need fertility treatments to get pregnant.

 

Skin Changes:  The androgens (male hormones) that are usually present with a PCOS diagnosis can be responsible for acne problems, as well as the increased presence of skin tags or darkened patches. 

 

Male Pattern Hair Loss:  Losing hair that resembles male pattern hair loss during midlife, is a common occurrence in women who have PCOS.  The high androgens (male hormones) are usually to blame.

 

Mood Swings:  PCOS is notorious for increasing the chances of mood swings, depression and anxiety.  The shifting and unbalanced hormones, which affect the neurotransmitters, is known to cause mood swings and psychiatric issues in women with PCOS. 

 

Pelvic Pain:  Women with PCOS frequently have pain and heavy bleeding associated with their cycles.  However, due to the irregular ovulation cycle that can happen with PCOS, sometimes pelvic pain can also occur when there is no menstrual cycle.  Pain can also be attributed to the cysts that commonly grow on the ovaries.

Sleep Issues:  Due to hormonal fluctuations and irregular hormone balance, women with PCOS often complain about insomnia or poor sleep.  Sleep apnea is also a common symptom of PCOS due to weight gain.  Sleep apnea is when a person stops breathing multiple times during a sleep cycle.  Over time that can cause fatigue and increased health problems. 

Headaches:  Hormone fluctuations are well known for causing headaches, and the imbalance and swings in PCOS are usually big contributors to headaches and migraines. 

 

Causes:

Just like many women’s health diseases or disorders, there is no one specific cause that has been pinpointed for PCOS.  Researchers have discovered that PCOS typically runs in families, and that genetics and environmental factors can be a strong precursor to developing this disease. 

 

Diagnosing PCOS:

There are no specific tests that can diagnose PCOS; however, doctors will usually use a woman’s history of weight, skipped or irregular menstrual cycles, acne, or excessive hair growth as a clue to the disease.  If there is sufficient evidence of hormone problems, a blood test to check insulin and androgen (male hormone) levels will usually be ordered.  A sonogram may also be ordered to check the ovaries for cysts.  A combination of these tests coming back positive can lead a physician to a diagnosis of PCOS.  Endocrinologists are specialty doctors who work with hormones, and they can be beneficial in the diagnosis and treatment of PCOS.

 

Treatment:

Treatment for PCOS can range from birth control pills (to control ovulation), to an insulin medication called Metformin.  Metformin is not approved by the FDA for the specific treatment of PCOS, however many doctors use it to help the body be more sensitive to insulin and to improve blood sugar levels.  This, in turn, can help the body balance excessive androgens (male hormones).  Clomid is frequently used in women who are trying to conceive, as it helps promote ovulation.  Spironolactone is an anti-androgen medication that can help lower androgen levels and improve the male type symptoms, like excessive hair growth, etc., that plague many women with PCOS. 

 

Alternative treatments like cinnamon (for blood sugar regulation), acupuncture, vitamin D, B-complex vitamins, and diet and exercise can all have beneficial effects on the hormonal imbalance that PCOS can cause. 

 

When all treatment fails or does not provide the amount of relief that women need to manage PCOS, a hysterectomy with ovary removal is usually recommend.  Total hysterectomies for PCOS are usually reserved for women who have uncontrolled bleeding and pain, and should be considered as a last result.  While physicians will frequently say that a hysterectomy or ovarian removal will “cure” PCOS, that is not always true.  PCOS is not just an ovarian disease, but a body-wide metabolic syndrome.  Some women with PCOS get significant relief by having a hysterectomy,  while others will notice a continuation of their symptoms like insulin resistance, if it is not treated appropriately.

 

Surgical Menopause and PCOS:

 

Unfortunately, despite our research, there is little to no information on women with PCOS and Surgical Menopause.  That indicates that there is a lack of research, funding, and diagnosis of PCOS in relation to surgical menopause.  Because PCOS is technically a metabolic disorder, many hormonal systems are involved, and using an Endocrinologist, (hormone specialist) will serve your post-op needs better.  Women with PCOS are used to using hormones in non-typical ways, and we have noticed that they can struggle a bit during the hormone balancing process.  Being informed on how hormones work and how your body uses them can help you and your physician to find balance after a hysterectomy. 

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