What is PCOS?

PCOS is the most common cause of irregular cycles in the US today. It is caused by hormone irregularities in the ovary. Normally you will ripen an egg every month, ovulate it, and either get pregnant or have your period. In PCOS, the hormone pathway that causes this to happen is disrupted and the hormones between the ovary and the pituitary gland don’t talk to each other properly.

Have you ever had a miscommunication at work, where you though you were saying one thing, and the person you were talking to thought you were saying something else? That’s what happens in PCOS. PCOS is also associated with other problems such as diabetes, obesity, abnormal hair growth on your face and body, lipid disorders, depression, miscarriage, and infertility.

There is often a family tendency in PCOS, where the fathers of women with PCOS have higher risks of diabetes. Because women don’t ovulate regularly, they tend to accumulate more follicles. This can be cheering when doing egg freezing or IVF because the more follicles the better, right? But the problem is many of these follicles have been hanging around for a long time and the eggs in them are poorer quality. This leads to worse outcomes with fertility treatments. 

How is it diagnosed? There are 3 symptoms used to diagnose PCOS and a 4th criterion that is often forgotten. These are called the Rotterdam criteria. You need two of these three symptoms to meet criteria. These are:

  • Irregular cycles or irregular ovulation
  • Elevated levels of male hormones, abnormal hair growth on your face or body, or acne
  • PCOS appearance of your ovaries on ultrasound. 

The 4th criterion is that your condition can’t be explained by something else. So our evaluation of PCOS is a history, exam, ultrasound and hormone tests to rule out other conditions. We will also look for metabolic problems that are commonly associated with PCOS such as pre-diabetes. PCOS stands for “polycystic ovary syndrome” but it is a lifelong condition with metabolic implications that continue even after menopause and is not typically associated with cysts. 

What can you do? If you have irregular cycles, acne, hair growth, or weight gain, you should be evaluated. Even if you don’t plan to have children soon, or ever, PCOS is linked with many other problems that could affect your future health. 

Diet is important. Women with PCOS do best on a low-sugar, low-glycemic diet. Some women benefit from gluten-free. Some do best on a modified keto diet with healthy fats and low levels of processed foods and red meats. Weight loss often helps many PCOS symptoms. However, if diet remains poor quality, PCOS problems may persist despite weight loss. 

Regular exercise also reduces risk of diabetes and heart disease. Avoid food additives such as antibiotics in meats and high fructose corn syrup, which gets stored as fat, cannot be used as energy, and is addictive. 

Some supplements help with lowering insulin resistance. These are myoinositol which is a powder 2000 mg daily, and N-acetyl cysteine, 600 mg daily. These can be found over the counter or online. 

You should avoid environmental toxins as well. These are called “endocrine disruptors” and are things like BPA, phthalates and other chemicals that can actually change your hormonal environment. They are found in plastics and cosmetics. Don’t cook in plastic or store your food in plastic containers and check your cosmetics with an app like the Environmental Working Group or Think Dirty. 

What can we do? Sometimes, you need help with weight loss. At Kindbody, we are partnering with Form Health in our Atlanta clinic to help our patients normalize their weight with nutritional support and medications tailored to their specific needs. For irregular cycles, hormonal birth control can help and also lower male hormone levels. Having regular cycles protects your uterus from developing precancers of the uterus. For abnormal hair growth, we can use a medication called spironolactone which can be given in women who are not planning pregnancy soon. Finally, metformin, a diabetes drug, is effective at improving the response to fertility medications and may also help with weight loss. For infertility, fertility medications such as letrozole and Clomid help induce ovulation so that you can conceive. These medications require at least two office visits during your cycle to check the growth of your eggs and to trigger ovulation. 

PCOS is something you are born with, and certain things, such as poor diet, weight gain, and environmental toxins can make it worse. It is not curable, but it is manageable. In fact, many of the symptoms can be reversed by the changes mentioned above. If you think you may have PCOS, get an evaluation and a complete plan for the best way to manage it in your life. Kindbody can help with this. We would love to see you!

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Dr. Kristen Cain
Dr. Kristen Cain
Dr. Cain is a dual board-certified in Reproductive Endocrinology and Obstetrics and Gynecology. She received her fellowship at the University of California Los Angeles, after completing her MD and her residency at Johns Hopkins. Her expertise includes infertility, fertility preservation, IVF, PCOS, uterine anomalies, and fertility planning. She is passionate about patient advocacy and has worked successfully to defeat personhood legislation in North Dakota.