This post was written by Laura Silver, NP, Parkview Weight Management..
Polycystic ovarian syndrome (PCOS) is a complex, multifactorial condition that affects an estimated 10-13% of women worldwide. This condition can present with a range of symptoms and differ in severity amongst those affected. Awareness of the common symptoms, early evaluation, diagnosis and management of the condition can aid in the outcome of its severity.
Causes
The exact cause of PCOS is not fully understood. What we do know is that, in women with PCOS, their ovaries overproduce hormones. Androgen is a group of male sex hormones that are produced by all women but are found in excess in the setting of PCOS. Excess androgens disrupt the menstrual cycle, leading to irregularity in cycles or lack of cycles and thus can produce issues surrounding fertility. Excess androgen can also produce physical changes such as acne, abdominal fat distribution and abnormal hair growth.
But what is it that causes the excess production of androgens? One key factor could be excess insulin, a hormone naturally produced by the pancreas to allow cells to use sugar. When our bodies release excess insulin, we wear down the response to this hormone and decrease our ability to use it effectively. This creates feedback to the pancreas to secrete yet more insulin, resulting in insulin resistance. The presence of excess insulin in the body triggers the ovaries to produce more androgen hormone.
Genetics also play a role in your risk of PCOS. Women who have a mother or sister with PCOS are more likely to develop the condition.
Obesity and PCOS
Obesity and PCOS are very much interrelated conditions. Of women who have PCOS, 60-80% of them are classified as overweight or obese. We know that women with the disease of obesity have a greater risk of PCOS and women with PCOS have a greater risk of the disease of obesity. The hallmark connection between the two conditions is insulin resistance. When insulin is unable to function normally and is produced in excess, the body deposits fat in the abdominal region. This contributes to worsening of the insulin resistance and perpetuates the already excess androgen production. For some, weight gain and development of insulin resistance begins first and PCOS follows. Yet, PCOS can also be diagnosed in normal body weight individuals who then begin to gain weight and develop obesity due to the inability of insulin to function normally.
Diagnosis
Diagnosis of PCOS typically occurs during early adulthood for women, after they have started menstrual cycles. The diagnosis is made with the finding of 2 out of 3 of the following symptoms:
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Menstrual irregularity
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Excess androgen production
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The appearance of polycystic ovaries
These symptoms can be proven by a comprehensive history and physical examination by a medical provider, a pelvic ultrasound and or blood work.
Managing PCOS
Unfortunately, there is no simple cure for PCOS. There is, however, evidence surrounding lifestyle, behavioral and dietary modifications that can greatly decrease the risk of long-term complications of the condition. Maintaining a healthy weight with even a modest weight loss of 5-7% of body weight can reverse associated comorbidities and better manage effects of PCOS. A dietary intake with appropriate portioning of whole foods that prioritize lean proteins and non-starchy vegetables is a key goal. Along with this, it is imperative to reduce refined sugars and processed foods such as sugar sweetened beverages, cereals, breads, pastas, cookies and pastries.
Another goal in the management of PCOS is engaging in routine physical activity. Exercise is an essential part of maintaining a healthy body weight and controlling the development of abdominal fat. It is also known to reduce insulin resistance. A variety of types of exercise can accomplish this including cardiovascular exercise, high intensity interval training and strength training or a combination of all three.
Your medical provider may also recommend medication use for the management of PCOS. Medications can include birth control pills and androgen reducing therapies to address the symptoms of PCOS. Metformin is another commonly prescribed medication that can help reduce insulin resistance. These treatment decisions are based on the individual woman and the symptoms she presents with.
Conclusion
In conclusion, PCOS is a challenge throughout the full lifespan for women affected. Left undetected and unmanaged, women will become predisposed to conditions such as obesity, diabetes, metabolic disease, cardiovascular risk and many other conditions. With early diagnosis and treatment of PCOS, these long-term complications can be reduced or avoided. Your medical provider, OB/GYN and a weight management specialist can play key roles in early detection of the condition and guidance to reduce your long-term risks.
Sources
Rocha AL, Oliveira FR, Azevedo RC, et al.: Recent advances in the understanding and management of polycystic ovary syndrome.
Barber, T, Hanson, P, Weickert, M, et al.: Obesity and Polycystic Ovary Syndrome: Implications for Pathogenesis and Novel Management Strategies. Clinical Medicine Insights: Reproductive Health.
