Polycystic ovary syndrome: mysterious and serious

by Terry Miller Shannon, RRT

What you don't know can hurt you. Six to 10 percent of all women have polycystic ovary syndrome (PCOS), and many don't even realize it. Physicians often overlook the diagnosis although PCOS is one of the most common causes of female infertility and has other serious and far-reaching health repercussions. Learn more about this mysterious condition.

Strange bodily changes

• When Amy (not her real name) entered her twenties, her body went haywire. Dark coarse hair appeared on her abdomen. Her menstrual cycles lengthened until she menstruated only every four to six months. She was plagued by acne. She gained weight that she couldn't lose. She and her husband tried for years to have a child. It wasn't until Amy was in her thirties that an infertility specialist mentioned that she might have polycystic ovary syndrome.
• "I couldn't believe how much those symptoms sounded like me," says Amy. Desperate for information, she searched the Internet. She subscribed to some lists and found support in a wide group of "cysters" (as some of the PCOS women call themselves). "It was a very liberating experience."

What is PCOS?

• No one knows what causes PCOS, a hormonal disorder also known as Stein-Leventhal syndrome. Somehow, the hormones that regulate ovulation are disrupted. Normally, estrogen, testosterone, and luteinizing hormone rise and fall to cause a normal menstrual cycle. But in PCOS, these hormones stay at elevated levels. Eggs don't mature, ovulation doesn't occur (or occurs infrequently), and the ovaries become enlarged and often filled with small cysts. Without nature's hormonal signal to menstruate, the lining of the uterus builds up and bleeding can be heavy and irregular.
• To confirm the diagnosis, your doctor will most likely perform blood tests to check for elevated hormones. He or she may also use an ultrasound to search for enlarged ovaries or ovarian cysts. The primary diagnostic process is to eliminate other conditions that could cause similar problems. Diagnosis is a matter of piecing together all the puzzle pieces to see the big picture of PCOS.

Warning signs

• Robert A. Greene, MD, FACOG, director of Specialty Care for Women in Redding, California says, "Symptoms of PCOS can be very subtle," because victims aren't necessarily heavy, hairy, balding, or acne-plagued.
• Red flags that you may have PCOS include:
• Irregular, absent or heavy periods
• Excess body or facial hair
• Thinning head hair
• Ovarian cysts
• Acne
• High insulin levels, insulin resistance, or diabetes
• Infertility
• Unexplained weight gain or inability to lose weight

Possible long-term health effects

• In the past, some physicians considered PCOS to be "only" a cosmetic problem or even "just" an infertility issue. But today we know that women with the condition are at increased risk for certain chronic and serious illnesses including:

Diabetes

• Some women with PCOS have trouble using the insulin in their bodies—the hormone that maintains proper blood sugar levels.

Endometrial cancer

• High levels of male hormones prevent the uterine lining from shedding monthly, increasing the risk for endometrial cancer at a younger age.

Heart disease -

• Women with PCOS tend to have low HDL (goodcholesterol) levels combined with high LDL (bad cholesterol) and triglyceride levels. Along with a tendency tohigh blood pressure, these cholesterol levels may indicate an increased chance of heart problems orstroke.

Take charge, cysters!

If you suspect you have PCOS, find a compassionate doctor experienced in treating the condition. If he or she belittles your symptoms, get a second opinion. As a reproductive endocrinology specialist, Greene reminds women: "This is far from simply being a cosmetic problem."

Here are some lifestyle changes that increase your chances of living a long and healthy life:

• Lose excess weight and keep it off
• Eat healthily
• Exercise
• Check LDL, HDL, and triglyceride levels regularly

Traditional treatments

Many doctors discourage women from mixing traditional and alternative treatments. "We might be recommending products that are counteracting each other," Greene says. "This can further frustrate patients already dealing with some difficult issues."

Traditional PCOS treatments may include:

• Birth control pills, which lower male hormone levels and establish regular periods.
• Spironolactone, a drug that controls high blood pressure.
• Metformin, (Glucophage) or similar drugs help the body use insulin more efficiently by normalizing menstruation and decreasing the production of testosterone. Sometimes this restores ovulation and often reduces symptoms such as excessive hair growth, acne, obesity, baldness, and heart disease risks.
• Diet - Losing weight decreases cardiac and diabetes risks. Although many women with PCOS follow low-carbohydrate diets, Greene doesn't prescribe them because there are "not enough data" to support these diets. Nor are there enough calories, he says, calling the typical low-carbohydrate restrictions of 900 calories per day "severe."
• Fertility treatment - includes drugs that cause ovulation.
• Surgical treatment - PCOS can cause the exterior of the ovaries to thicken. Doctors may use a laser to drill deep holes into the ovarian capsule to drain cysts, help convert male hormones to estrogens, and promote the release of eggs. But there is some risk of scarring, which could contribute to further difficulties conceiving.

Alternative treatments

Alternative treatments, such as herbs, acupressure, acupuncture, and other approaches, help some women with PCOS. Tori Hudson is a professor at National College of Naturopathic Medicine in Portland, Oregon. Hudson, a naturopathic physician, treats many women with polycystic ovarian syndrome in her private practice.

Her prescriptions include:

Birth control pills

• "They may help a particular individual manage symptoms even though they're not a cure."

Herbs

• Hudson utilizes a variety of herbs to regulate menses. She sometimes uses saw palmetto to decrease testosterone effects of facial hair and acne. Nettles may help bind up some of the serum testosterone.

Fertility

• Hudson sometimes prescribes chaste tree berry to promote regular ovulation. If unsuccessful, she refers the patient to a fertility specialist.

Diet

• "In my opinion, high protein/low carb diets help manage weight while also assisting the blood sugar problem." This remains a controversial area.

One cyster\s tale