PCOS: What You Need to Know

By Walter Futterweit, MD, FACP, FACE

You have been told that you have PCOS (polycystic [pah-lee-SISS-tick] ovary syndrome) in your late teens or twenties, and you are aware that it probably is the cause of your symptoms. You are wondering what you can do to stay healthy. Let us start by defining the syndrome.

PCOS is defined as an excess of your male hormone blood level. A bit of male hormone is normal in every female! When you have more male hormone than normal, you can develop skin features such as more body hair than normal on the face, arms, lower back, abdomen, and pubic area, and/or a laboratory test showing an elevated level of the specific male hormone testosterone [tes-TOS-tuh-rone]. Although ovaries can be enlarged, often they are of normal size. Irregular menstrual periods starting when you first get your period are common. PCOS is often associated with weight gain, tendency to crave carbohydrates, and difficulty in losing weight. You should be aware that one of three women with PCOS may have regular periods, but that does not mean you ovulate most of the time. Your doctor has probably looked for other causes than PCOS, by specific blood testing and other studies.

WHAT ARE THE RISKS IN WOMEN WITH PCOS?

Women with PCOS are at risk for developing type 2 diabetes and metabolic syndrome. This can happen in their teen years and before menopause. What is metabolic syndrome? Three of five factors listed below must be present:

  1. High blood triglycerides
  2. High blood pressure
  3. Elevation of blood glucose (sugar) levels. This is insulin resistance. About one of three women with type 2 diabetes from when their periods first started through to menopause have PCOS. Metabolic syndrome is higher in obese omen PCOS, and those with a family history of type 2 diabetes. Yet, this also occurs in some thin women with PCOS.
  4. Increased amount of body fat accumulating around the waist.
  5. Lower blood levels of HDL cholesterol [ko-LESS-ter-ahl].

The more factors that are present, the higher the risk of developing heart disease or stroke, sometimes prematurely, particularly in obese women with PCOS.

At least 50% of women in the United States are overweight or obese. This is defined by the body mass index (BMI). Those who are overweight have a BMI above 25, and those who are obese have a BMI of 30 or more. It is easy to calculate your BMI. Visit EmPowerYourHealth.org to find the BMI calculator and follow the instructions. A normal BMI less than 25 is a major goal, but even a 10% loss in body weight can change some of the hormonal changes (elevated insulin and testosterone blood levels). Complications of obesity in the long term include type 2 diabetes, heart attack, stroke, cancer of the breast and colon, and effects on fertility and a trigger to skin changes such as acne, hair in unwanted places, as well as thinning of scalp hair.

The Good News

You have the power to reverse many of the features of PCOS and reduce your possible health risks.

First, and most important, a change in lifestyle leads to improving your symptoms. This includes reducing your weight by portion control, reducing some of the carbs in your food, and allowing proteins of various sorts to be part of a meal. Cutting down on starches, pasta, and pastry is a start. You will notice that as you reduce calories below 1200 a day, hunger is reduced and you feel better and more energetic. Changing your lifestyle must also include exercise such as walking, going up flights of stairs instead of an elevator, and walking instead of driving short distances. A habit of walking at a fast pace, and doing supervised exercises at a local gym, is also part of the way to lose weight.

Your doctor will tell you that treatment is necessary for risk factors with medication, in addition to the lifestyle changes, to provide you with major protection against future risks as you get older.

Many researchers have shown the use of the anti-insulin agent metformin can improve menstrual cycles and decrease the tendency toward craving. In a number of women they are able to start losing weight with metformin and improve their chance of delaying or preventing diabetes. Often, mood disorders lessen with the drug as the dose approaches optimal levels of 2 grams a day. These findings are important since depression and anxiety can worsen risk factors. Also, most antidepressants make it difficult to lose weight by increasing insulin resistance.

In conclusion, early diagnosis and treatment is essential in PCOS. Each woman’s treatment is different and needs to be specific to each woman’s needs. You will be in a better position to understand that this condition can be changed and even reversed to some extent with a more positive attitude and adhering to your physician’s advice.

Dr. Walter Futterweit is Board Certified in Endocrinology and Internal Medicine, and in private practice in New York City. He is actively involved as a Clinical Professor of Medicine at the Mount Sinai School of Medicine Division of Endocrinology where he teaches students, Endocrine Fellows and does research in Polycystic Ovary Syndrome. He is internationally known for his published studies and is the President of the Androgen Excess Polycystic Ovary Society (AE-PCOS).