PCOS 101

Part One: What is PCOS?

Imagine you are a young woman in your 20s and feeling as if your body is turning against you.  You develop acne that is worse than the acne you had in your teens.  You start to sprout hairs on your chin, maybe peach fuzz at first but then darker coarser hairs.  You watch your diet and exercise regularly, but your weight just seems to climb out of control.  Your periods come whenever they would like–sometimes disappearing for months, only to return for three weeks straight.  You go from doctor to doctor trying to understand what is happening to you.  

This is the experience of many women with PCOS, or polycystic ovarian syndrome.  

What is PCOS?  Why do so many women struggle before being diagnosed? Why are treatment options so limited?

Over the coming week-and-a-half we will tackle all these questions in this three-part series.  Today, Part one: What is PCOS.  Part Two will address how to come to a diagnosis and in Part Three I will outline my thoughts on the available treatment options.

Polycystic ovarian syndrome is a syndrome–that is a constellation of symptoms that often occur together–not a disease.  The hallmark symptoms of PCOS are irregular periods, evidence of high male hormone levels–either in the blood or physical symptoms like acne, increased body hair growth and scalp hair loss–and cysts on the ovaries.  Many women also have obesity or insulin resistance. 

Irregular periods, acne and increased body hair growth are easy to see, but what is insulin resistance?  Insulin is a hormone that helps our cells use glucose.  We all have some and we need it to live, but you can have too much of a good thing.  

The easiest way to think about it is to imagine a typical woman needs 5 units of insulin to keep their blood sugars normal, a woman with insulin resistance might need 50 units of insulin to maintain the same normal blood sugars.  While insulin resistance increases the risk of developing diabetes, it is NOT diabetes or pre-diabetes.  

In PCOS there is a relationship between insulin and male hormones that is not well understood.  Insulin resistance results in less frequent or even completely absent ovulation.  And changes in ovulation result in irregular periods.  Insulin resistance can also lead to carbohydrate craving and weight gain which in turn leads to more insulin resistance.

And if that wasn’t enough, PCOS is a common cause of fertility problems.  If a woman is not ovulating regularly, or at all, conceiving can be tricky or even impossible.  Additionally, when women with PCOS do conceive there is an increased rate of miscarriage.

What should you do if you suspect you may have PCOS?  As always, start with your doctor.  A gynecologist or general practitioner is a good place to start.  Later this week, we will discuss the challenge of diagnosing PCOS.