September is Polycystic Ovary Syndrome (PCOS) Awareness Month, an opportunity to raise awareness of a health problem that you may not be familiar with. For example: Did you know that PCOS is the most common cause of female infertility? Or that about 5 million women in the United States are affected by it?
Wait, what!? Let’s start from the beginning…
A woman’s ovaries have follicles (tiny, fluid-filled sacs that hold the eggs). When an egg is mature, the follicle releases the egg so it can travel to the uterus for fertilization. In women with PCOS, immature follicles group together to form large cysts or lumps. The eggs mature within the bunched follicles, but the follicles don’t break open to release them. Because of this, women with PCOS often don’t have menstrual periods or only have them on occasion. And because the eggs are not released, most women with PCOS have trouble getting pregnant.
We’re sure you still have plenty of questions about PCOS—and what it means for women with diabetes. Keep reading!
1) What are the causes and symptoms of PCOS?
Unfortunately, we don’t yet know the cause of PCOS, but based on studies of twins, scientists believe there’s a good chance genetics could play a role. But not everyone with PCOS genes develops the condition, so researchers are looking for lifestyle factors that affect a woman’s risk for PCOS.
Though the cause is fuzzy, researchers know one thing for sure: There’s a link between PCOS and diabetes.
How so? Women with type 1 diabetes are at increased risk for PCOS, which suggests that insulin may play a part. Ovaries see more insulin from people with type 1 diabetes than they would from those without diabetes. This extra insulin has a direct effect on ovaries by enhancing the production of testosterone.
The same goes for women with type 2 diabetes, who often have high levels of insulin in the early years of the disease, as their bodies churn it out to fight their insulin resistance. In fact, having PCOS is one of the risk factors doctors look for in screening women for undiagnosed diabetes.
A syndrome, such as PCOS, is defined as a collection of signs that occur together, as opposed to a disease with just a single cause. The most common signs and symptoms of PCOS in teens or adult women are:
- Abnormal menstrual cycles
- No periods or irregular periods
- Heavy or prolonged bleeding
- Painful periods
- Inability to get pregnant
- Facial hair (more than is normal for your ethnic group)
- Waist measurement greater than 35 inches, or waist bigger than hips (apple shape)
- Acanthosis nigricans (darker patches of skin in neck folds, armpits, folds in waistline or groin)
But not everyone with PCOS will have all these traits, as the syndrome can present itself in a variety of ways. It differs from person to person.
2) How is PCOS diagnosed?
Diagnosing PCOS involves several steps. Doctors must rule out other conditions, such as thyroid disease, early menopause or adrenal gland disorders, that often have the same symptoms.
First, your doctor will take detailed notes about your menstrual cycle and reproductive history, including what birth control you use and any pregnancies you have had.
You’ll then receive a pelvic and physical exam to check for swelling of cysts on your ovaries. If cysts are found, a vaginal ultrasound may be performed, or a screening to examine the cysts and the endometrium (lining of the uterus).
If your doctor suspects you have PCOS, he or she may recommend blood tests to measure your hormone levels, as women with PCOS can have high levels of hormones such as testosterone.
Your insulin and glucose levels may also be examined, to look for diabetes or insulin resistance, since many women with PCOS have these conditions. Your doctor may check your levels of cholesterol and triglycerides as well, as they are often abnormal in women with PCOS.
3) How does PCOS affect pregnancy?
We mentioned above that PCOS can negatively affect fertility because it can prevent ovulation. One solution is to take or inject fertility medications to induce ovulation. Insulin-sensitizing medications or steroids (to lower androgen levels) can also help ovulation take place. Some research even shows that taking low doses of aspirin, which helps prevent blood clotting in the uterine lining and improves blood flow, can improve your chances of pregnancy as well.
Sadly, miscarriage rates appear to be higher in women with PCOS, but the reason why is still being studied. Increased levels of leuteinizing hormone, which helps in secretion of progesterone, may play a role.
For women with diabetes, increased levels of insulin and glucose may cause problems with development of the embryo. Insulin resistance and late ovulation (after day 16 of the menstrual cycle) also may reduce egg quality, which can lead to miscarriage.
The best way to prevent miscarriage in women with PCOS is to normalize hormone levels to improve ovulation and normalize blood glucose and androgen levels. Recently, more doctors are prescribing the drug metformin (commonly used to treat type 2 diabetes) to help with this.
4) How is PCOS treated?
Because there is no cure for PCOS, it needs to be managed to prevent further problems. Doctors often prescribe birth control pills to help regulate menstruation, suppress androgen levels and clear acne.
Other drugs can help with cosmetic problems, blood pressure and cholesterol. Progestins and insulin-sensitizing medications can be taken to induce a woman’s menstrual period and restore normal cycles. Eating a balanced diet low in carbohydrates, exercising regularly and maintaining a healthy weight can also help lessen the symptoms of PCOS. Weight loss, even just 5 percent of your body weight, can improve PCOS symptoms.
5) Does PCOS put you at risk for other conditions?
Unfortunately, yes. Women with PCOS can be at an increased risk for developing several other conditions besides infertility.
Irregular menstrual periods and the absence of ovulation cause you to produce estrogen, but not progesterone. Without progesterone, which causes the endometrium to shed each month as a menstrual period, the endometrium may grow too much and undergo cell changes. This is a pre-cancerous condition called endometrial hyperplasia. If the thickened endometrium is not treated, over a long period of time it may turn into endometrial cancer.
PCOS also is linked to other diseases that occur later in life, such as insulin resistance, type 2 diabetes, high cholesterol, hardening of the arteries (atherosclerosis), high blood pressure and heart disease. Depression or mood swings are common in women with PCOS as well.
This month, take the time to learn more about PCOS and share your own experiences with others. You can start by leaving a comment below!