Rose, 32, owner of a business firm in Davao City, grew up having irregular periods and battling her weight.
Rose, 32, owner of a business firm in Davao City, grew up having irregular periods and battling her weight. In her late 20s, her weight ballooned to 110 kilograms, she began sprouting facial hair, she felt lethargic, and she stopped menstruating. She didn’t know it, but her ovaries were riddled with cysts. She saw three doctors in a row, but no diagnosis. “They all said, ‘You need to lose weight.’ ”
Finally, Rose got an answer. She had polycystic ovary syndrome (PCOS), a condition in which her high levels of testosterone prevented her ovaries from releasing eggs, which then became cysts. “Two weeks into treatment I got my first period in four years,” she says. In the three years since diagnosis she lost 40 kilograms.
About five to 10 percent of women ages 20 to 40 have PCOS. “It is a disease of the reproductive age women,” points out Dr. Darleen Estuart, an obstetrician and gynecologist in Davao City.
Most women with PCOS have a characteristic appearance to their ovaries, known as polycystic ovaries. These consist of multiple small “cysts” or follicles less than half inch in diameter that forms in the ovary.
A doctor explains: “During the normal maturation process of a woman’s egg (ovum), the egg develops within a cyst inside the ovary. The rupture of the follicle and release of the mature ovum is called ovulation. The multiple small cysts seen in the polycystic ovary are the result of eggs that only partially develop within the ovary. It is thought that a slight elevation of male hormones may inhibit the egg’s development. The egg’s failure to mature leads to a lack of ovulation (anovulation) in women with PCOS.”
Causes
Although PCOS (which used to be called Stein-Leventhal syndrome) was first recognized in the 1930s, doctors can’t say for sure what causes it. Some studies suggest that genetics may be a factor. Sisters and daughters of a woman with PCOS may have a 50 percent chance of developing PCOS.
Abnormal insulin production and metabolism may also affect the development of PCOS. As Steven Dowshen, an American endocrinologist, puts it: “Women with PCOS may produce too much insulin, which signals their ovaries to release extra male hormones.” Research has also found that when a woman does not ovulate normally for any length of time, polycystic ovaries often result.
Symptoms
PCOS often comes to light during puberty due to period problems, which affects around 75 percent of those with the disease. Infrequent, irregular or absent periods are all common variations, many finding their periods particularly heavy when they do arrive. The period disturbance is a sign that there is a problem with regular monthly ovulation.
In industrialized countries, many teenagers use the contraceptive pill to control their periods as irregularity or heaviness is a common complaint at this time, even in the absence of PCOS. This often leads to a delay in the diagnosis of PCOS, many not presenting until the pill is stopped and finding periods cease or become irregular.
Both girls and boys produce hormones called androgens, which play a role in sexual function. Although androgens are sometimes referred to as male hormones, every female produces them, too (but at much lower levels). PCOS sufferers often have higher than normal levels of androgens, which most often cause excess hairiness, but some women find acne or even male-pattern hair loss a particular problem.
Given that the period disruption with PCOS is due to irregular or absent ovulation it is not surprising that it is a common cause of infertility. It is not usually 100% absolute, and some women with PCOS will ovulate normally, some will ovulate less frequently (leading to a delay to pregnancy) and some will not ovulate at all, meaning that for some treatment will definitely be necessary.
Obesity is a double-edged sword for women with PCOS, according to studies. In fact, around 40% of sufferers are overweight. Obesity itself will initiate the symptoms described above in some women who would not have otherwise suffered had they remained of normal weight. It will worsen the symptoms for those who do have PCOS and, unfortunately, the hormone changes associated with PCOS make weight loss more difficult.
Medical books say that some PCOS symptoms that a woman may notice quickly include: abnormal vaginal bleeding (occurs in about 30-percent of women with PCOS); skin problems such as acne, oily skin, dark skin patches on the neck, groin, underarms; depression or mood swings; and high blood pressure (hypertension).
Studies have shown that women with PCOS seek medical care for a specific symptom like infertility (74 percent of the time), menstrual problems (70 percent), excess hair growth (69 percent), and obesity (41 percent).
“Many women don’t know they have it, they might have a slight excess of body hair or they may have slightly irregular periods, but some women with this condition have neither of those things,” explains Dr. Warren Kidson, an endocrinologist with the Prince of Wales Hospital in Sydney. “They have regular periods but have mildly elevated levels of male hormone in the blood. Some women find that from their time of puberty, they have a problem of easy weight gain and difficulty with losing weight.”
Diagnosis
If a woman thinks she has PCOS, she must visit a gynecologist (a doctor who specializes in the female reproductive system) or an endocrinologist, a physician who specializes in hormonal problems), for a diagnosis. The gynecologist or endocrinologist will obtain a detailed history, which will involve asking a woman several questions about her family’s medical history and her period and its regularity; check her weight and perform a thorough physical examination, checking especially for physical signs such as acne, hair growth, and darkened skin.
A doctor may also perform blood tests to diagnose PCOS or to rule out other conditions, such as thyroid or other ovarian or gland problems. Blood tests allow doctors to measure insulin and other hormone levels. The results of these tests can help doctors to determine the type of treatment a woman will receive. The doctor may also order another test, called an ultrasound, to look at her ovaries and to determine if she has cysts or other abnormalities of the ovaries. Because cysts are not always visible, though, this test is not always used.
Early diagnosis and treatment for PCOS are important because the condition can put women at risk for long-term problems. “Getting treated for PCOS is a good idea if you want to have a baby someday,” says Dr. Estuart. “Oftentimes, PCOS causes infertility if it’s not treated. But when PCOS is treated properly, many women with the condition have healthy babies.”
Women diagnosed with PCOS are also at a greater risk for diabetes, cardiovascular disease and uterine cancer.
Treatment
Although there’s no cure for PCOS, there are several ways that the condition can be treated and managed. If a woman is overweight or obese, a doctor will recommend that she losses weight. “Weight loss can be very effective in lessening many of the health conditions associated with PCOS, such as high blood pressure and diabetes,” says Dowshen. “Sometimes weight loss alone can restore hormone levels to normal, causing many of the symptoms to disappear or become less severe.”
Dowshen further suggests: “A doctor or a registered dietician can look at your food intake and your exercise and activity to tailor a weight-loss program for you. Exercise is a great way to help combat the weight gain that often accompanies PCOS.”
Sometimes physicians prescribe medications to treat PCOS. A doctor might first have a woman try birth control pills to help reduce the androgen levels in her body and regulate her menstrual cycle. Birth control pills may help control acne and excessive hair growth in some women, but they don’t work for everyone.