What is PCOS & how do I fix it?

PCOS or Polycystic Ovarian Syndrome is a condition that can be frustrating and confusing. Many people have heard the phrase “Well, you might have PCOS…” without further clarity. The diagnosis can be challenging and treatment options vary.

BUT the good news is that PCOS is a manageable condition!

SO, what is PCOS?

• “Polycystic Ovarian Syndrome” was first used as a description in women with enlarged ovaries with multiple small cysts.
• The term PCOS makes it sound like there is something wrong with the ovaries, but the condition is actually a hormonal syndrome
• Patients with PCOS can have a variety of issues. The most common complaints are:
  • Irregular or absent periods
  • Heavy periods
  • Weight gain, particularly in the mid-section
  • Abnormal hair growth
  • Acne
  • Infertility
  • Pelvic pain
  • Ovarian Cysts
  • Depression

Well, what causes PCOS?

• PCOS is really a condition of disordered ovulation in which the ovulation process begins and multiple small cysts or “follicles” begin to develop in the ovaries
• In PCOS, ovarian follicles get “stuck” and do not go on to complete ovulation
• PCOS is generally caused by a shift in hormones that leads to an elevation in circulating testosterone. This is often caused by a slight elevation in insulin levels
• The underlying cause of PCOS is genetic. Weight gain is often associated with PCOS, but it can be a bit of a “chicken & egg” phenomenon where weight gain exacerbates PCOS which in turn causes weight gain
• On ultrasound, there are multiple small ovarian cysts (usually 2-9 mm in size).
• Because the ovulation process is not completed, the normal hormonal changes that occur to trigger a normal menstrual cycle do not occur which leads to irregular or disordered periods
• Also, since ovulation does not occur normally, people with PCOS can have difficulty getting pregnant

What are the risks associated with PCOS?

• PCOS is a syndrome or collection of signs and symptoms
• Irregular or heavy bleeding can lead to anemia and fatigue
• Irregular or absent periods can be associated with development of abnormal cells in the uterus, even on occasion, cancer cells
• People with PCOS also can have elevated blood sugar levels, which can be associated with development of Type 2 Diabetes
• People with PCOS can also have elevated cholesterol

SO, how do you make the diagnosis?

• The first step is to see a physician and have an evaluation and examination
• Physical examination may show signs of PCOS
• Pelvic ultrasound can help evaluate the uterus and ovaries
• Bloodwork will often show abnormalities, particularly elevated insulin or long-term glucose levels and sometimes disordered hormone levels

This all sounds scary! What can I do about it?

• PCOS can be frustrating and scary, but the good news is that is usually a manageable condition
• The treatment of PCOS depends on the severity of symptoms, lab results and patient goals
• Often, the initial treatment utilizes hormonal management with birth control pills or similar medication to control the menstrual cycle and help reduce testosterone levels
• If insulin levels are significantly elevated, oral insulin-sensitizing medication may be very helpful in management
• Weight loss, which may be assisted by medical or nutritional support, can often help improve symptoms
• If the goal is pregnancy, there are several medications that can be very effective to enhance ovulation
• Aesthetic treatments & medication for acne, skincare and abnormal hair growth can help significantly with the cosmetic issues associated with PCOS

PCOS is a common condition that can be frustrating and difficult. At Modern Gynecology & Reproductive Health, we utilize all the correct tools to help make the diagnosis of PCOS and help patients address their symptoms and treat their concerns. The treatment of PCOS requires a comprehensive approach that incorporates medication, lifestyle management and often aesthetic treatment to achieve improvement in symptoms. We welcome the opportunity to help our patients address their concerns and get back to feeling like the best version of themselves!

Author

Susan Lacy MD FACOG Dr. Susan Lacy is the founder of Modern Gynecology & Reproductive Health & MORE Aesthetics.