Sister, Cyster: All About PCOS

First off, there were SO MANY good questions on my last post, and this is a BROAD TOPIC, so I’m going to have to make several posts to address all of them (don’t worry, they’re already in progress!) For now, we’ll address the basics!

Remember you can always visit this blog anytime to see all this info in case you ever need it later! 

Polycystic Ovarian Syndrome (PCOS), is a condition where the ovaries make more small cysts than normal, and these said cysts make too much androgens (male sex hormones, i.e. testosterone) (above).  Please note that the ovaries normally make androgens and estrogens, but in the case of PCOS, the ovaries make too much.  It has been noted in ~10% of women.  

What causes PCOS? Good question…. But we don’t know entirely.  We consider this disease to be multifactorial, meaning that there are several causes that may contribute to its formation, and will vary in causes from patient to patient.  Some causes include: 

📌Genetics: (in fact, 25% of females with PCOS have a mother with PCOS)

📌Poor in-utero fetal nutrition (if you have PCOS, your mother might not have had the best balanced diet with you in utero)

📌Other disorders that cause and increase in androgen secretion, like adrenal disorders

📌Poor diet leading to increased insulin resistance

📌Gene disorders that cause the ovaries to make too many androgens

Because there are too many androgens being produced in the body, women with PCOS tend to have the following symptoms:

⛔️Menstrual dysfunction (this can bleeding too heavily or not too often ladies!)

⛔️Balding

⛔️Acne

⛔️Clitoromegaly (large clitoris)

⛔️Male pattern body hair distribution (hair on the upper lip, chin, around the areolas, chest, abdomen, and back)

YOU DO NOT HAVE TO HAVE A POSITIVE ULTRASOUND FOR A DIAGNOSIS! I see a lot of people are being told that because their ultrasounds are normal, that they were told they don’t have PCOS.  For diagnosis, 2 out of 3 of the following Rotterdam Criteria is enough for diagnosis!

📝A history of irregular menses, specifically infrequent menses

📝Clinical signs of hyperandrogenism: acne, hirsutism, and/or male-pattern hair loss

📝Polycystic ovaries noted on ultrasound (below)

If you have the first 2 symptoms, notice you don’t necessarily need an ultrasound for diagnosis; however, I would sill recommend an ultrasound to rule out any other pelvic pathology.  You should also receive a pregnancy test, prolactin levels, thyroid-stimulating hormone (TSH) level, and follicle-stimulating hormone (FSH) level.  

If you are diagnosed with PCOS, you are at increased risk for cardiovascular disease, obesity, glucose intolerance and diabetes, dyslipidemia, fatty liver disease, and obstructive sleep apnea.  Because of this, you should be assessed for diabetes and high cholesterol regularly, as well as be assessed for sleep apnea (asked if you have snoring, excessive daytime sleepiness, and morning headaches) at least once.  

While > 50% of women with PCOS have infertility, having PCOS does not mean you can't get pregnant. PCOS is one of the most common, but treatable, causes of infertility in women, and most often relates to not ovulating each month.  See below for treatment options!

Treatment is aimed at symptoms! 

If you don’t want children:

💊Birth control can help to balance out the androgen hormones, regulate your menstrual cycles, and possibly decrease acne.  

If you want children:

💊Losing 5% of your weight can help you begin to ovulate regularly again

💊You may need a short course of birth control to regulate your cycles so we can predict when you ovulate better.

💊You may be placed on a course of Clomid or Femara to begin ovulation

If you have: 

💊Metabolic Syndrome: Diet, exercise, and metformin.  Overall, refined sugars and processed carbs, too avoid those puppies!

💊Acne: Combination of diet changes and avoidance of triggering foods, birth control, spironolactone, or anti-androgens like finasteride.

💊Male pattern hair growth: Combination of electrolysis, laser treatment, topical eflornithine hydrochloride cream (13.9%), spironolactone, or anti-androgens like finasteride.

Natural remedies of course, haven’t been well tested 🙄.  However, I learned A LOT about foods that help with PCOS in my personal research and will be back in a later post to share!