Search for tag: "pcos"

PCO, OCP that is a palindrome, something that's the same when you read it forwards and backwards, but it also refers to a common hormonal problem in women, and something used for management. This is not a quiz game, but this is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health, and this is the "7 Domains of Women's Health" on The Scope.

PCO, polycystic ovaries and polycystic ovary syndrome is a hormonal condition in women of reproductive age. It's not a disease, but a syndrome, meaning a constellation of symptoms and findings without a single common cause. The symptoms and the findings that define PCOS include irregular periods and evidence of increased androgens or male hormones. Some definitions include having multiple small cysts on the ovaries that can be seen on ultrasound. However, not all women all over the world have access to an ultrasound to look at their ovaries, so many experts just use irregular periods and evidence of androgen excess. Also, young women who have lots of eggs, have lots of follicles. So, on ultrasound, they look like they've PCOS, but they don't. So the ultrasound part is kind of controversial.

Irregular periods mean that menstruation comes more than 35 days apart, and not on a schedule. Now, some women feel that their cycles are irregular, if some months they have periods on the 15th of the month and some months on the 17th, but PCOS means that the cycles are much more irregular and often without ovulation. If women who have PCOS usually don't ovulate, they don't make the hormone progesterone, which is made by the ovulation cyst, and is important for keeping the uterus healthy each month. So having regular periods makes the uterus healthy, and having irregular periods can lead to unpleasant or dangerous bleeding and a not very healthy uterus.

The excess androgens part of PCOS means that women have more than normal levels of hormones made by the ovary that are like testosterone. Now, all women make male hormones. In fact, the female hormone estrogen is made out of male hormones. However, women with PCOS have many small egg follicles that are stuck in development that makes male hormones. That's the polycystic part of polycystic ovaries. These little follicles usually do not ovulate. They don't make the estrogen at the level of an ovulating follicle, and they don't make progesterone to keep the uterus lining healthy and that causes irregular periods.

So what are the main symptoms of PCOS? Well, irregular periods and excess hair growth on the face and other parts of the body. If a woman with PCO is trying to get pregnant and doesn't ovulate, she may be infertile. Many women with PCOS have gained weight, and this complicates the problem of irregular periods and extra male hormones. Some women have insulin resistance and may be prediabetic, partly related to the PCO part and partly related to obesity.

Now, PCOS is very common, as many as 1 in 20 to 1 in 10 women have this syndrome. It was probably less common in years past when women were much less likely to be obese, and not all women experienced PCO to the same degree. Some women have slightly irregular periods with only minimal signs of excess male hormones, and some women have extremely irregular periods and very significant hirsutism or excess body hair.

Okay, that's the PCO part. What about the OCP part? Oral contraceptive pills have estrogen and progestin in them. The way OCPs work for contraception is to block the development of follicles, so ovulation doesn't happen and they control the uterus lining, so periods are regular and light. The way OCPs work by suppressing the development of little follicles, those little cysts that can make male hormones, make them useful in controlling symptoms of PCO. Also, women with PCO have estrogen but lower amounts and the higher estrogens in the OCPs can help counteract the effects of male hormones. The progestin in the OCPs help control the lining of the uterus, so women can have regular periods. There you go.

Now, clearly OCPs do not cure PCO, but they are very useful in the control of symptoms. There's even some evidence that women who are taking OCPs for the PCOS and then choose to try to get pregnant, may actually be more likely to ovulate the first several months after stopping OCPs. Not all women who have PCO are good candidates for OCPs. Some women with PCO who are obese and have high blood pressure, which may be a contraindication to OCPs. Some women don't like the way they feel on OCPs, although many women with PCO say they feel better on OCPs.

Are you guys getting tired of the PCO or OCP palindrome? Well, hang in there. We're almost done. Some women may have other contraindications to OCPs, including a history of blood clots or migraine headache. And of course, some women want to get pregnant. For women who are overweight with PCO, their first effort might be diet and exercise with the focus on weight loss. Women with PCO who lose as little as 10% of their body weight are more likely to ovulate and to have regular periods. Then, of course, they may choose OCPs for birth control. For some young women, a diet low in refined carbohydrates, high in vitamins and minerals and good nutrition, and regular exercise may make them feel the best. However, for some women, and many women, diet and exercise do not work to control their symptoms and OCPs may be the best option.

There are many kinds of OCPs, but they all work mostly the same way. The combination pills with estrogen and progestin work the way we just talked about. The lowest dose pill that does the job would be the first choice. The OCPs are different in the kind of progestin in the pill, and some women feel better on one pill than another. They all work to control periods and lower male hormone effects. So, because PCO is so common, most primary care providers, which include internists, family physicians, pediatricians who see teenagers, and OB/GYNS are familiar with the signs and symptoms and routine treatments. However, there are other options in treatments for symptoms other than OCPs and weight loss and exercise and diet. If a woman with PCOS is struggling to understand her condition, is not getting help with symptoms, or is struggling to get pregnant, she may want to see a specialist in PCOS such as a reproductive endocrinologist.

PCOS is complicated in all of the 7 domains of women's health -- physical, emotional, social, environmental, intellectual, financial, and spiritual. Having irregular periods, being infertile, having the body that you don't think is really you, all those things are affected. If you or someone you know is struggling, we can help. And thanks for joining us on The Scope.

Dr. Jones: "I have irregular periods, and I'm overweight. Do I have PCOS? I looked it up on the web." This is a question I hear all the time. What is PCOS, and how do you know if you have this condition? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care, and we're talking about the most common endocrine problem in women today on The Scope.

Announcer: Covering all aspects of women's health, this is The 7 Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: PCOS, I hear some people say, "P-COS," but in fact, those of us in the know just say, "P-C-O-S" is polycystic ovarian syndrome. The "poly-" part is "many," the "-cystic" part is little fluid-filled pockets, the "ovary" part is self-explanatory, and the "syndrome" part is that it's a condition with several symptoms and it's not caused by any one thing. It's not a specific disease.

So the many cysts are very small, little egg cysts called follicles in the ovary, stuck, in that they are less than a half inch, and they are ordinarily much smaller than a normal follicle. It makes an egg. They don't grow big and hatch an egg every month, and they don't go away every month. They eventually shrink, but new ones take their place.

Because they don't grow big to about an inch and hatch out of the egg every month, women with PCOS don't have regular periods. Their periods are more than 35 days apart, and they're not predictable. This is one of the symptoms of PCOS. Now, there are many different conditions and diseases that can make irregular periods. Women at the beginning of their reproductive life and at the end of reproductive life are almost always irregular for a while.

The other symptom, which may be subtle comes from the fact that all these little egg follicles in the ovary make male hormones, and this is normal. When you have a lot of them, though, you have increased male hormones. Until a follicle gets big enough to make estrogen and ovulate, they make male hormones, so the other symptom that goes with PCOS is an excess of male hormones. Now, this isn't a huge excess, nowhere near the level that men have, but enough that some women may have acne or hair growth on their face or abdomen, coarse hair, not the little fine hairs that all women have.

So you said you were overweight and had irregular periods. Although many women with PCOS are overweight and being overweight does complicate PCOS, it isn't necessary for the syndrome. What is necessary for the syndrome of PCOS has been debated furiously on both sides of the Atlantic for more than 50 years.

Europeans prefer that the diagnosis be made by two of the following three findings. Irregular periods, evidence of excess of androgens or male hormones, and multiple little cysts on the ovary on ultrasound. Well, these criteria would be seen in every adolescent with irregular periods and acne, which most 13-year-olds have. Americans like just two criteria, but you have to have both, irregular periods and evidence of extra male hormones.

If you Google PCOS, and you'll find that this syndrome is found in 5% to 10% of women in reproductive age, PCOS isn't a syndrome of little girls or post-menopausal women. But 1 in 10 to 1 in 20 young women will have this. It is very common. Also, if you make the mistake of Googling PCOS, you will scare yourself by the claims of PCOS women that they will be infertile, obese, hairy, diabetic, and die early from heart disease.

We know that women with PCOS can have a hard time getting pregnant, but most of them will if they seek medical care, and many of them will, even if they don't. Those sneaky little eggs do ovulate on occasion. Weight management is particularly important for women with PCOS, as many do have an increased risk of Type 2 diabetes, but many don't get diabetes. Women with PCOS, who are obese, have more difficulty getting pregnant and staying pregnant than those of normal weight or those obese women who don't have PCOS.

And the claims of increased coronary heart disease have not really panned out, so I wouldn't worry about that, except that all women should worry about that.

Okay, so how do you know if you have PCOS? If you have irregular periods and you aren't a teen or breastfeeding or using hormonal contraception or close to menopause, you should see your doctor. And if you have unwanted acne and facial hair, you probably want to see your doctor. If you have both, you may have PCOS.

And there are many ways to manage the symptoms or help you get pregnant if you want to. There are a few rare conditions that look like PCOS, problems with the adrenaline glands or tumors that make male hormones, but these are very, very rare and easy to rule out.

PCOS is common, and the signs and symptoms can make a woman worried and unhappy, but there are lots of things we can do. We don't have a cure, but we have some very good workarounds. If your primary care doctor or your OB/GYN can't help you get your symptoms under control, there are specialists called reproductive endocrinologists who can help you out.

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Interviewer: Birth control pills are not adequate treatment for polycystic ovarian syndrome. So what should you do to treat it? That's next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: There's sometimes a misunderstanding that birth control pills are an adequate treatment for polycystic ovarian syndrome, but they actually can make it worse. So what should you do? Dr. Joseph Stanford is with University of Utah Healthcare. What do you know about treating this syndrome? What can we learn?

Dr. Stanford: So we know a lot more about the underlying causes of the syndrome now. There's underlying insulin resistance so we want to treat that to get at the underlying condition, underlying disease and not just mask it with a birth control pill, which actually worsens insulin resistance.

Interviewer: Does it really? Okay. So what are some of the things that a woman can do to help manage that?

Dr. Stanford: So we start with diet and exercise. Don't we always start with that? But it is really critical, in this condition especially. Women with polycystic ovarian syndrome sometimes have a lot of trouble losing weight. They may be overweight. And so there may be medications as well as the diet and exercise to help with that to some degree. But still, the cornerstone is diet or healthy weight.

Also, a diet that is what we call a "low-glycemic index diet." And that's a diet that does not raise blood sugar suddenly. So obviously minimize the added sugar, we want to minimize simple sugars, and also minimize simple starches. We want a diet that will give you a low, steady blood sugar. So that's complex carbohydrates and proteins and fats. Good amounts of good fats. So that's a diet called a low-glycemic index diet used for diabetics. Also, it works very well with polycystic ovarian syndrome.

Interviewer: And if a woman does this diet well, first of all, are there medications that go along with it?

Dr. Stanford: There are medications that can be used along with it and some women need them and some may not.

Interviewer: Okay. So some diet is enough.

Dr. Stanford: For some, yes.

Interviewer: And then you do the diet. The cysts go away. The symptoms go away. Do you have to stay with that diet then for the rest of your life?

Dr. Stanford: Yes.

Interviewer: You do? Okay. Isn't that the way it always is as well?

Dr. Stanford: If you meet with a dietician and get your diet adjusted to something you enjoy but is also healthy, that's the goal really for long-term maintenance.

Interviewer: Are physicians still using birth control pills pretty commonly to treat this condition?

Dr. Stanford: Yes, I would say they are, especially when it's just dealing with the irregular periods that are part of the condition. And they do make the periods regular. The problem is they don't treat the other underlying issues.

Interviewer: And if you don't treat those underlying issues, those other ones, what other issues could arise as a result?

Dr. Stanford: Some women could still have problems with infertility later on. She could also be at higher risk for diabetes, gestational diabetes or regular diabetes later in her life.

Interviewer: Do those cysts go to scar the ovaries at any point? Or once you kind of get back on that diet, they just kind of go away?

Dr. Stanford: These are small cysts and they don't cause scarring. With management of the disease with diet, exercise, and maybe medications, those cysts can get smaller or fewer of them. They won't go away entirely. In fact, a certain small level cyst is normal to have. It's the excessive small cysts that cause the polycystic ovarian syndrome.

Interviewer: So it sounds like the first thing you should do is just pretend like you have diabetes and eat accordingly.

Dr. Stanford: That could work. If you have questions about that, it doesn't hurt to meet once or twice with a dietician and really get it figured out.

Interviewer: All right. Are there other diet considerations?

Dr. Stanford: Yes. There's a good study recently that showed that women who eat more of their calories at breakfast and a lot fewer at dinner sort of the opposite of what most Americans do right? No breakfast and a big dinner. But if you turn that around and eat a bigger breakfast and a very small dinner, that actually reduces your insulin secretion and your testosterone for women with PCOS. So that sort of switch around on the diet can be really helpful.

Interviewer: It's amazing. So some of these small, little changes really can make that much of a difference.

Dr. Stanford: It makes a big difference.

Interviewer: Wow, that just is incredible to me. What about exercise?

Dr. Stanford: Exercise is critical. Isn't it critical for anything? But it's definitely critical for this condition. And that doesn't have to be running marathons. Just regular aerobic exercise. Walking every day, 20 minutes, can do wonders. So just a consistent level of exercise.

Interviewer: So it sounds like this condition arises out of poor diet and not exercising enough.

Dr. Stanford: Women that have this condition have some underlying genetic issues that make them more susceptible to that. So some women could get away with a poor diet and not exercising, and women with PCOS basically can't get away with it because they have an underlying condition that's exacerbated by the way they're living. It's not something to blame the women. Our society kind of pushes us in one direction and we have to push back and push into a more healthy direction.

Interviewer: Gotcha. What about supplements?

Dr. Stanford: So there actually is one supplement that's been shown to really help in this condition. It's called inositol. I-N-O-S-I-T-O-L. That is related to the B vitamins and you can look that up. It's been shown in randomized trials to actually improve the PCOS biochemical anomalies.

Interviewer: What's the takeaway from this conversation?

Dr. Stanford: The takeaway is that women with PCOS can get to be normally healthy. They just have to pay more attention to it than someone who doesn't have it. And maybe in the long run that's a good thing. It'll help you live your whole life healthy.

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