Polycystic ovary syndrome (PCOS) is a prevalent hormonal disorder affecting up to 10-20% of reproductive-aged women. It's a metabolic disorder characterized by abnormal levels of reproductive hormones, often with excess production of androgens and insulin resistance. This hormonal imbalance disrupts ovarian function and can lead to a variety of symptoms and long-term health complications. Weight management is a cornerstone of PCOS treatment, and endocrinologists play a vital role in guiding women through this process.
Understanding PCOS
PCOS is associated with the excess production of certain hormones called androgens, often associated with insulin resistance. The exact cause of this hormone imbalance is unknown. It can affect a woman’s metabolic, endocrine, and reproductive systems.
Symptoms of PCOS
Every woman's symptoms are different, and in many cases, the signs and symptoms of PCOS develop in adolescence. Acne and irregular periods are common in growing teenagers, and doctors need to be able to gauge what is normal, and what is likely to be abnormal and may be PCOS related. Missing one or two periods is not unusual for a teenager; missing six months probably is.
PCOS can manifest in a variety of ways, with symptoms that can include:
- Irregular menstrual periods, which can be missing, infrequent, too frequent, too light, or too heavy
- Infertility
- Acne on the face, chest, or upper back
- Hirsutism, or excess hair on the face, chest, abdomen, or upper thighs
- Mildly elevated androgens
- Excess numbers of pea-sized asymptomatic cysts on the ovaries
- Patches of darkened or thickened skin, especially around the neck, armpits, groin, or under the breasts
- Weight gain
Long-Term Health Risks
The longer PCOS goes untreated, the more likely you are to develop serious health conditions. Many women experience:
Read also: Guide to PCOS Exercise
- Infertility
- Weight gain
- Insulin resistance
- Type 2 diabetes
- High cholesterol
- High blood pressure
- Uterine cancer
- Cardiovascular disease
- Nonalcoholic fatty liver
PCOS is one of the top causes of infertility, and if you get pregnant before treating PCOS, the disease increases your risk of having a miscarriage or early delivery.
The Role of Weight Loss in PCOS Management
Obesity exacerbates PCOS, including infertility, as well as reducing the efficacy and access to fertility treatments. Weight management is, therefore, a key component of treatment for women with PCOS and coexistent obesity. Many women with PCOS describe significant difficulty losing weight, and treatment options are limited.
Weight loss, even a modest reduction of just 5-10% of body weight, can have a significant impact on PCOS symptoms and overall health. It can:
- Lower blood sugar and cholesterol levels
- Improve insulin sensitivity
- Bring hormone levels closer to normal
- Regulate menstrual cycles
- Increase the effectiveness of medications
- Help with infertility
Endocrinologists and PCOS Treatment
Medical endocrinologists are hormone specialists with basic training in internal medicine. They have the training to diagnose and treat hormone imbalances by helping to restore the normal balance of hormones in the body, generally considered the specialist for PCOS.
Diagnosis of PCOS
There is no single test to specifically diagnose PCOS. Your health care provider is likely to start with a discussion of your symptoms, medications, and any other medical conditions. Your provider also may ask about your menstrual periods and any weight changes.
Read also: PCOS Diet Recipe Guide
To confirm a diagnosis, doctors might recommend one or more additional tests, such as:
- Review of personal and family medical history
- Discussion of symptoms
- Physical exam
- Blood tests: Tests of a patient’s blood sample to check levels of male and female hormones, blood sugar, cholesterol, and thyroid hormones. This testing can exclude possible causes of menstrual problems or androgen excess that mimic PCOS. You might have other blood testing, such as fasting cholesterol and triglyceride levels.
- Ultrasound: Imaging that uses sound waves to produce images inside the pelvic region to examine the ovaries and uterine lining. A wandlike device (transducer) is placed in your vagina.
If you have a diagnosis of PCOS, your provider might recommend more tests for complications.
Treatment Approaches
At UT Southwestern, specialists prescribe medications based on the specific PCOS symptoms that each patient has.
PCOS treatment focuses on managing the things that are concerning you. This could include infertility, hirsutism, acne, or obesity.
- Lifestyle changes: Following a healthy diet, getting more exercise, and losing weight (if needed) can prevent and treat the complications that frequently affect women with PCOS.
- Medications: Your provider prescribes one of several medications that restart ovulation and regulate menstruation.
Lifestyle Interventions
Lifestyle behavioral interventions (LBIs) are first line in weight management.
Read also: Natural Ways to Reduce PCOS Facial Hair
- Dietary Recommendations: Women with PCOS are often recommended to eat anti-inflammatory diets. These special diets include moderate to high amounts of fiber with an emphasis on anti-inflammatory foods such as fish, legumes, green tea, and low-fat dairy. Chicken, red meat, and added sugars should be limited. High-carbohydrate diets might make insulin levels go higher. Ask your provider if a low-carbohydrate diet could help if you have PCOS. Choose complex carbohydrates, which raise your blood sugar levels more slowly.
- Exercise: Exercise helps lower blood sugar levels. If you have PCOS, increasing your daily activity and getting regular exercise may treat or even prevent insulin resistance.
- Weight Loss Programs: Ask your health care provider about a weight-control program if you need one.
- Hair removal: Patients can buy creams and razors over the counter or have laser hair removal or electrolysis procedures done by doctors or licensed technicians to remove unwanted hair.
Medications
- Hormonal contraceptives: A combination of birth control pills, skin patches, or vaginal rings that contain estrogen and progestin, which reduce androgen production and regulate menstrual cycles. Hormonal contraceptives reduce abnormal menstrual bleeding, hair growth, and acne.
- Progestin therapy: The progestin-only birth control pill or progestin-releasing intrauterine device helps prevent pregnancy but doesn’t reduce androgen. Taking progestin for 10 to 14 days every 1 to 2 months can regulate your periods and protect against endometrial cancer. This progestin therapy doesn't improve androgen levels and won't prevent pregnancy.
- Fertility Medications:
- Clomiphene
- Letrozole (Femara)
- Metformin: This medicine for type 2 diabetes that you take by mouth improves insulin resistance and lowers insulin levels. If you don't become pregnant using clomiphene, your provider might recommend adding metformin to help you ovulate.
- Gonadotropins: If needed, talk with your health care provider about procedures that may help you become pregnant.
- Anti-Androgen Medications:
- Spironolactone (Aldactone): This medication blocks the effects of androgen on the skin, including excessive hair growth and acne. Spironolactone can cause birth defects, so effective birth control is needed while taking this medication.
- Acne treatments: Medications, including pills and topical creams or gels, may help improve acne. Severe acne can often be treated with a medication called Accutane, which reduces oil production on your skin, slows down the growth of skin cells that clog pores, and kills bacteria in your pores. Some women also choose to try over-the-counter products like creams or lotions. If there are any acne scars remaining, they can be treated with laser therapy.
- Eflornithine (Vaniqa)
Surgical Options
- Bariatric surgery (BMS) can result in improved ovulation and pregnancy rates in women with PCOS and subfertility due to the magnitude of the weight loss and the impact on insulin resistance, hyperandrogenism and other metabolic factors.
The Importance of a Multidisciplinary Approach
Stony Brook has developed an interdisciplinary PCOS program, with the goals of providing faster diagnoses, and easier access to an interdisciplinary group of specialists who can manage the various components of treatment.
In addition to endocrinologists, other specialists who may be involved in PCOS care include:
- Gynecologists: This is a doctor who specializes in women’s health, with a focus on the female reproductive system. In addition to treating PCOS, they deal with a wide range of issues, including pregnancy and childbirth, menstruation and fertility issues, sexually transmitted infections (STIs), and more. Gynecologists can help with irregular menstrual cycles associated with PCOS, often by prescribing birth control pills for those women who aren’t trying to conceive.
- Reproductive endocrinologists (RE): This is a doctor who is a fertility/infertility specialist. They are the only types of doctors trained in providing fertility treatments using assisted reproductive technologies (ART) such as in-vitro fertilization (IVF) and egg freezing. Reproductive endocrinologists are also trained in obstetrics and gynecology, with additional training to provide fertility treatment. In addition to diagnosing and treating infertility, REs specialize in the treatment of PCOS. A reproductive endocrinologist can manage your PCOS treatment and often do ultrasounds in the office.
- Psychologist and/or psychiatrist: In addition to having an increased risk of metabolic disorders, women with PCOS show higher rates of anxiety and depression. They may suffer from mood disorders due to an imbalance in hormones or just need to vent about the everyday frustrations of living with this serious condition. PCOS is associated with insulin resistance, which can be linked to psychiatric disorders like schizophrenia and bipolar.
- Dietitians: Dietitians play an important role in helping women with PCOS optimize their health and prevent disease by managing diet and lifestyle. PCOS can develop into serious complications like high cholesterol, high blood pressure, type 2 diabetes, and heart disease if diet and lifestyle changes don’t get under control. Dieticians can assist in these nutrition and lifestyle strategies, which is a big part of your lifelong approach to treating PCOS.
Personalized PCOS Treatment
Every patient’s symptoms and goals are different, and they may change over time. Because every patient may have slightly different symptoms and require a unique treatment plan, a dedicated nurse navigator will work with you as your main contact for patients and help them to arrange appointments and manage their treatment plan.
Prime Endocrinology of Tampa offers comprehensive care for PCOS, creating a customized treatment plan based on your symptoms and the presence of chronic health conditions.
At PCOS Sisters, our PCOS specialists are led by Dr. Lynsey Johnson, DNP, FNP-C. Our team of Nurse Practitioners are women with PCOS just like you. We create customized treatment plans based on your symptoms and health goals.
tags: #endocrinologist #PCOS #weight #loss #treatment