PCOS — polycystic ovarian (or ovary) syndrome — is a chronic condition that affects the lives and health of millions of women globally. Studies show that at least one in 15 women (of childbearing age) suffers from PCOS. As Dr. Stephanie Long, MD put it to us recently, if you have PCOS, your ovaries and uterus "don't get the signals in the right way" from your brain, leading to a slew of damaging health effects that impact a patient's everyday life.
We spoke with Dr. Alyssa Dweck, MD, New York gynecologist about the rise in diagnosis of PCOS. She told POPSUGAR, "I am seeing so many patients with PCOS now," and confirmed that it's on the rise. "I'm not sure whether there's more of it, or if we're realising we need to recognise it, or if people are more aware of their [symptoms] and bringing that to their doctors."
Either way, it's important to get the information out there so more women get in touch with their bodies, spot symptoms, and treat the issue as soon as possible, as untreated PCOS can lead to deadly disease and infertility.
What Is It?
PCOS is a hormonal disorder that causes enlarged ovaries with multiple small cysts on the outsides of the ovaries, due to the follicles not maturing into eggs (lack of ovulation).
What Are the Signs?
There is a spectrum of symptoms, and each woman is impacted differently. However, a handful are "telltale signs," as Dr. Dweck said, and they are extremely typical of PCOS. Here's what doctors are looking for and what you should look for if you think you might be at risk.
- Hair growth. "On the face, specifically," said Dr. Dweck, and "in male places like sideburns, chin, mustache . . . more than 'you have to pluck a couple.'" If you notice dark, thick hairs growing in those areas, it's an indicator of a hormonal imbalance that may be related to PCOS.
- Acne. More than your typical breakout? This is "Not just your typical teenage acne — it's persistent, significant." Acne plus hair growth are "signs of excess male hormone or androgen levels, which is typical of PCOS," Dr. Dweck said.
- Difficulty with weight. Whether it's losing weight or maintaining weight, "Many women with PCOS are overweight," she told us. She did, however, mention that there are atypical cases in which they're referred to as "Atypical PCOS or Skinny PCOS." These are "women who are not ovulating and their weight is normal."
- Menstrual irregularity. This is one of the hallmarks of PCOS. "Your menstrual cycle is going havoc." You either have no period, many missed periods, or skip several months at a time. This is due to a lack of or infrequent ovulation, according to Dr. Dweck.
- Difficulty getting pregnant. If you've been struggling with fertility and have any of these other symptoms, it may indicate that you have PCOS. This is definitely a time to check with your healthcare provider.
- Male pattern baldness. It's not just happening in males! In addition to that oh-so-pleasant facial and body hair growth, you may also lose the hair you actually want on your scalp.
- Intolerance to sugar. PCOS is often linked with insulin resistance and "borderline diabetes," according to Dr. Dweck.
"Without question, there are atypical presentations [of symptoms]," said Dr. Dweck. You may have "a hormonal imbalance with only one or two of the symptoms," so it's imperative you see a healthcare provider for a proper diagnosis.
How Is It Diagnosed?
Dr. Dweck told us that "there's no foolproof way," but the most accurate way of diagnosis is the most invasive. "A true diagnosis is done by ovarian biopsy," she said, but "that's highly aggressive — no one does that."
In most cases, your doctor will do a pelvic ultrasound, looking for a typical sign known as "a string of pearls." These are "teeny cysts around the periphery of the ovary that look like a string of pearls."
Additionally, your doctor may run hormone blood tests to see if you have elevated testosterone or DHEAS, as well as low estrogen. These can all be indicators of PCOS as well.
Doctors are looking into patients' BMI as well; Dr. Dweck mentioned that "controversy is coming in about whether or not BMI plays a role in PCOS — what comes first? Is the patient overweight and developing PCOS, or vice versa? The jury is still out."
How Do You Treat It?
The priority in treatment focuses on "regulating the menstrual cycle and preventing pregnancy to regulate ovulation," she said. Here's the main plan of attack you'll encounter.
- Combination Birth Control Pills.
The most common treatment for PCOS is "a combination birth control pill," which "increases a particular protein made by the liver called sex hormone binding globulin." Why is this important? "It binds free testosterone in the blood stream," meaning all that extra testosterone that's unchecked will be regulated once again. "The testosterone level is lowered, so those signs of high testosterone like hair growth or hair loss on the top of the head or acne will diminish quickly."
- Diet and Exercise.
"When dealing with the overweight type of PCOS," Dr. Dweck told us "getting on a good diet" is imperative. She mentioned restricting caloric intake and really limiting carbohydrates is paramount and encourages "exercise to keep BMI low," which lowers the chance of diabetes, a common occurrence in women who have PCOS.
- Hormonal IUD.
This form of treatment has "no impact on the testosterone levels at all" (and she noted that a rare group of women get acne from the hormonal IUD), but "it keeps the uterine lining very thin — that's protective against uterine cancer," and it's "excellent for birth control." This is important for someone who doesn't know when they're ovulating, so they would have no idea if they were or weren't pregnant. It also "lightens the period or eliminates it," without creating uterine buildup by "chemically cleansing." Keep in mind that the hormonal IUD only contains progesterone, no estrogen.
It's important to note that your doctor will create a treatment plan that is specific to your body, your symptoms, and your needs. Additionally, there are holistic treatments for PCOS symptoms, including acupuncture.
What Happens If You Don't Treat It?
If left untreated, PCOS has a serious impact, and can lead to:
- Implications of obesity (and all the health problems that come with it, including mortality)
- Uterine cancer (thanks to "unopposed estrogen and build up of the uterine lining")
Is It Curable?
Short answer, no. Dr. Dweck referred to PCOS like "a chronic disease," but the glimmer of hope is that "it's very treatable." And it's true — we've heard from multiple doctors that it's one of the most correctable forms of infertility and that there are several avenues and combinations for treatment. Arm yourself with knowledge and pick your all-star healthcare team to set yourself up for success. You can learn more from Dr. Dweck in her book, The Complete A to Z For Your V, (which outlines PCOS) on Amazon.