DISCLAIMER: The following post is not intended to act as medical advice. As always, please consult your doctor with any questions about PCOS.
“I was told I have PCOS, but I don’t know what that means. And no one really explained it to me. I’m confused and I’m a little overwhelmed.” Does this sound familiar? If you have been told you have PCOS and you feel confused, nervous, or alone . . . you are not alone.
Our friends from Michigan Center for Fertility and Women’s Health are here to support you on your fertility journey. You might have caught their Fertility Friday series over on our IG page–quick videos to answer common questions and provide information. Below, they’re sharing about PCOS: what it is, how it’s diagnosed, potential implications, and how it’s treated.
What is PCOS?
PCOS stands for Polycystic Ovarian Syndrome and it’s one of the most common hormonal reproductive conditions. It is a hormonal imbalance to some degree that can alter our hormones and affect many different aspects of our health and life, including our menstrual cycles and weight. PCOS may also cause other issues such as acne, hair growth issues, and fatigue, to name a few.
PCOS may look different for everyone–there is a very wide range of symptoms people may have, which can also change over time for individuals as well. Some people may have numerous symptoms or issues associated with PCOS; others may only have a few or more mild symptoms.
PCOS can cause issues with ovulation because your cycles may come more irregularly. Some people may get no periods, or only a few each year. People may also have high levels of androgens, which are our male hormones. Although some individuals may have normal levels from a laboratory standpoint, they may still exhibit issues with acne and hair growth associated with androgen excess or sensitivity. Individuals may also exhibit signs of polycystic ovaries on an ultrasound. These are some of the diagnostic criteria we evaluate when determining a diagnosis of PCOS.
*If an individual has two out of the three mentioned above, there is likely some level of PCOS present.
How is PCOS diagnosed?
PCOS is diagnosed through a physical exam, a detailed history, an ultrasound, and blood work. There’s a wide range of symptoms associated with PCOS in terms of severity and degree, which can also change over time. When we work to make positive changes to manage PCOS (whether it’s lifestyle changes, dietary changes, taking medication, etc.), a lot of the symptoms may improve dramatically.
Physical Exam
The physical exam may include looking for changes such as cystic acne, skin tags, hirsutism, or darkening of the skin commonly in the groin or behind the neck (known as acanthosis nigricans).
Body habitus, weight distribution, and BMI will also be evaluated. Weight gain or difficulty losing weight can be a very common and a burdensome issue for patients with PCOS.
Detailed History
A detailed history allows your provider to review all the symptoms, issues, other underlying health concerns, family history, and social history that may help in the diagnosis and treatment of PCOS.
Ultrasound
When performing the baseline ultrasound, we evaluate the endometrial lining or the thickness of the endometrium, as well as the ovaries, to see if they look polycystic in appearance. A polycystic ovary does not mean there are enlarged cysts throughout the ovary (although a larger cyst may also be present)—but rather an excess of multiple small follicles.
Bloodwork
Bloodwork may include liver and kidney function tests, average blood sugar (A1c), fasting blood sugar, insulin, and androgen hormones. We often check additional labs which may be relevant, such as thyroid and prolactin.
An additional work up may be indicated based on the findings from the history and testing.
What are some implications and issues from PCOS?
PCOS is often associated with infertility. However, there are also patients that are not actively trying to conceive, but desire management and treatment of their PCOS.
General Health
PCOS is commonly associated with insulin resistance. The extra insulin that’s circulating in our bloodstream and bodies may cause multiple issues. It can play a role in the hormonal imbalance, promote fat storage, cause extra weight gain, and increase the risk of health conditions such as diabetes, as well as other conditions such as high cholesterol and hypertension.
Fertility
Irregular or absent menstrual cycles may make trying to conceive more difficult. If ovulation is irregular or absent, it can be challenging to navigate when ovulation occurs, if at all. Many patients with PCOS need intervention to help them ovulate on a more regular basis.
Often when we address the underlying issues of PCOS, menstrual regularity may also improve. Lifestyle change in conjunction with medical management typically results in the best results and overall success. Each patient and treatment plan are different and are customized based on the underlying concerns and goals we are addressing.
Gynecologic Concerns
Irregular or absent menses may still be a concern even for those not interested in conceiving. We still produce hormones that can thicken our endometrial lining, particularly estrogen, and if that lining continues to thicken over time without a regular withdrawal, it can cause concerns and may lead to abnormal cell development and potentially higher risks for uterine cancer. Therefore, addressing menstrual irregularities is important even if we are not trying to conceive.
There are options such as birth control or other contraceptives that can help protect the lining from thickening. There are also other options aside from contraceptives for those that they may not be indicated or safe for, or for those simply not open to or interested in these choices.
Unpleasant + Annoying Symptoms
Hormonal acne, weight gain, hair growth, and sometimes thinning of the hair can be stressful and bothersome. These symptoms count too, even if you are getting regular periods and not trying to have a baby. These issues are certainly still a valid concern. Sometimes we work with dermatologists or endocrinologists for these issues, if needed.
What are the options for treatment of PCOS?
There are numerous options available for the management of PCOS. The options are dependent on what our ultimate goals are, which vary for each patient.
Whether trying to conceive or trying to manage symptoms only, a combination approach to PCOS is typically best and results in the most optimal outcomes. Based on a detailed work-up and history, medications such as Metformin, birth control, ovulation induction medications, as well as vitamin supplements may be recommended. Lifestyle changes including reduced carbohydrates, a Mediterranean diet, exercise, and stress reduction may likely also be a part of the treatment plan.
PCOS may also take a toll on our mental health; we offer therapy and counseling to all our patients to help with this additional burden. Individuals may have difficulty with getting on track or feel confused about their diagnosis, and this can be extremely stressful and overwhelming. We are here to help navigate your diagnosis and treatment plan every step of the way.
