What is it?           

Polycystic ovary disease (also known as Polycystic Ovary Syndrome or PCOS) is defined as a condition in which there is an imbalance in female sex hormones. This can lead to a number of changes including abnormal and irregular menses, acne and infertility. The typical woman with PCOS is thought of as being overweight, with acne, excess body hair and other signs of androgen excess such as male pattern baldness and even clitoral enlargement. However, as so frequently occurs in medicine, there are many varying degrees of PCOS and a woman may have PCOS without expressing the above typical symptoms. Many women with infertility may have underlying PCOS. One of the main issues with PCOS is insulin resistance which leads to obesity, infertility, and contributes to acne. A woman may have completely normal testosterone levels but still have evidence of androgen excess because in PCOS the problem is not simply testosterone excess, but a hypersensitivity of the androgen receptor. The symptoms may begin as a teenager but is usually diagnosed in the 20s and 30s. The majority of women probably go undiagnosed unless they have the typical symptoms. Many women out there with irregular or even fairly normal periods may have a form of PCOS and be at risk for infertility, diabetes and endometrial and breast cancer (because of progesterone deficiency). Cystic ovaries are not essential to the diagnosis of PCOS.

Could you be at risk for PCOS?

The point of this post is that PCOS is much more prevalent than generally known and is frequently not diagnosed leaving these women at risk for the complications (infertility, diabetes, endometrial and breast cancer) associated with PCOS. Diagnosis can be made with hormonal evaluation, analysis of insulin resistance and risk for diabetes, and attention to the clinical symptoms.

How is PCOS treated?

Treatment consists of aggressive management of abnormal blood sugar through diet (mostly low glycemic, low carbohydrate, high protein), lifestyle (regular exercise and nutrient support to help decrease abdominal fat and increase muscle mass) and medication (metformin) if needed. Studies have shown that having a fasting blood glucose above 86 leads to increased risk for cardiovascular disease (CVD). It is well known that diabetics have an increased risk for CVD, cancer, accelerated aging and dementia. It is likely that fasting blood sugars between 90-100 (prediabetes) carry similar risk. Balancing the hormones can be done with bio identical hormones to correct for progesterone deficiency instead of using oral contraceptives (especially if pregnancy is desired) and is frequently much better tolerated.

If you think you might be at risk for PCOS, it might be a good idea to get screened by a physician knowledgeable in this area. In addition to routine lab tests such as lipids and thyroid function, lab tests should include fasting glucose, fasting insulin, FSH, LH, estradiol, progesterone and possibly vaginal ultrasound. A program of diet, lifestyle, medication, and hormone balancing should be the initial treatment. With commitment, many women with PCOS are able to get pregnant and manage their glucose issues to prevent the well know sequelae of pre-diabetes and diabetes.

Marsha Nunley MD
Marsha Nunley MD
I am an internist, trained and experienced in Western Medicine, who believes that illness and disease are best treated by working to discover their underlying causes. Come to me for bioidentical hormones, advice on healthy aging, and whole-body medicine.