April 13, 2022
Source/Image licensed from Ingram Image
Polycystic ovary syndrome, the most common cause of infertility, tends to run in families. It is not uncommon for a mother and daughter or sisters to have it.
Polycystic ovary syndrome is a very common hormone problem for women of childbearing age and a major cause of infertility. It affects about 1 in 10 U.S. women.
Globally, PCOS cases among women of reproductive age increased by 4.47% between 2007 and 2017.
Dr. Katherine Sherif, chief of Women's Health at Jefferson Health, said estimates on the syndrome's prevalence vary. Yet, it's clear that PCOS affects a sizable portion of the population.
"Ten to 15 percent of the population might not sound like a lot, but 7-8% have diabetes and it is considered an epidemic," she said.
Many obstetrician-gynecologists refer to PCOS as a hidden epidemic because the syndrome can be difficult to diagnose, but it has long-reaching consequences if not treated properly.
Women with PCOS may not only struggle with infertility, but they are also at higher risk for diabetes, heart disease, sleep apnea, non-alcoholic fatty liver disease, high blood pressure, high cholesterol and stroke – especially if they are overweight.
Women with PCOS have at least seven times the risk of heart attack and heart disease than other women. And more than half of women with PCOS develop type 2 diabetes by age 40.
They also are more likely to develop certain cancers ,including endometrial and uterine cancers. PCOS brings an increased risk of hyperplasia – enlargement of an organ or tissue – a precursor to the development of cancer cells.
PCOS also has been linked to depression and anxiety, although the exact connection is not completely understood. Some studies have even shown that PCOS increases a woman's risk of a COVID-19 infection.
Polycystic ovary syndrome is a condition in which the ovaries produce an abnormal amount of male hormones, especially androgens. The name of the disorder comes from the numerous small cysts that form in the ovaries, though not all women with POCS develop them.
These cysts can develop when ovulation – when a mature egg is released from an ovary – doesn't occur. The cysts make androgen which is why women with POCS often have high levels of the hormone.
These high hormone levels lead to further problems with a woman's menstrual cycle and can cause many of the symptoms of polycystic ovary syndrome.
Those symptoms may include: missed periods, irregular periods or very light periods; ovaries that are large or have many cysts; excess body hair on the chest, stomach and back; weight gain, especially around the belly; acne or oily skin; male-pattern baldness or thinning hair; infertility; skin tags on the neck or armpits; and dark or thick skin patches on the back of the neck, in the armpits and under the breasts.
Some women will experience just one symptom while others will suffer all of them. Many women don't find out they have PCOS until they have trouble getting pregnant. It often begins to develop after a girl's first menstrual period, but it can develop in a woman's 20s or 30s, too.
The exact cause of the syndrome is still unclear, but researchers believe there is a connection to insulin resistance because many women with POCS are insulin resistant. When insulin builds up in the body, it may cause an increase in androgens as well.
Obesity has been linked to polycystic ovary syndrome. It is known to increase insulin levels and make symptoms worse. One study found that obesity increases risk of multiple reproductive disorders, including PCOS.
PCOS also tends to run in families. It is not uncommon for a mother and daughter or sisters to have it.
Sherif said the main challenge with PCOS is properly diagnosing it.
Some of the symptoms are similar to those caused by other health problems. Many women see several different specialists before getting a correct diagnosis.
"Physicians are just not thinking of it," Sherif said. "Patients may see their primary doctor, an endocrinologist, a gynecologist and a dermatologist for a variety of symptoms. Each doctor is just looking at their own section, not the whole picture.
"Fifty percent of women are undiagnosed. There are about 150,000 women in Delaware Valley with PCOS and that is an underestimation. Because it is often not detected before a woman has a baby, women with PCOS are two to three times more likely to have gestational diabetes, preeclampsia and miscarriages and a baby in NICU. It is a hugely expensive price for not recognizing and treating it."
There is no single test to diagnose PCOS. A diagnosis is typically made when a women meets two of the three following criteria:
• History of irregular period• Signs of high levels of the androgen hormone• Classic cysts on ovaries
Women can expect their health care providers to take their medical history and ask them to describe their symptoms. They will undergo a physical exam which likely will include a pelvic exam to check the reproductive organs. They also may need an ultrasound and blood tests to check blood glucose levels and levels of androgens and other hormones.
There are four types of PCOS and treatment may vary for each: insulin-resistant PCOS, PCOS induced by stopping oral contraceptive pills, inflammatory PCOS and adrenal PCOS, caused by abnormal stress response.
"How to capture all types of PCOS and who will get it worse is not clear," said Dr. Saifuddin T. Mama, an obstetrician-gynecologist with Cooper Health. "It is a very important public health issue. Doctors are getting better at diagnosing it.
"When there are more obvious symptoms – facial hair, darkening of skin, obesity, irregular or no menses – then it is easy to diagnose. When symptoms are less obvious it harder to diagnose."
Treatment for PCOS can vary depending on the type, severity of symptoms and a woman's overall health, but it often includes a change in diet and physical activity.
A healthier diet and more physical activity can help reduce symptoms and help with weight loss, which is important for many of these patients, Mama said.
It also can help the body use insulin more efficiently, lower blood glucose levels, and improve a woman's ovulation.
"Diet is extremely important," Sherif said. "So is sleeping 7-9 hours, exercising, as well as taking medications and supplements."
But she acknowledged that eating well consistently can be a challenge for many people. Mama agreed.
"In my mind, it is extremely important to change attitudes towards food and exercise," Mama said. "Doctors need to give people the tools they need to change their lives."
Medication also can help reduce symptoms and prevent some health problems. There is no cure for PCOS.
For women who don't want to become pregnant, birth control pills can help control their menstrual cycles, lower androgen levels and reduce acne.
Some women may be prescribed diabetes medication to lower insulin resistance and improve other symptoms including androgen levels, excess hair growth and ovulation problems.
Other medications and cosmetic treatments, including electrolysis and laser hair removal, also may be recommended to eliminate excess hair growth and acne.
In the past few years, researchers have been exploring modulation of the gut microbiome as a potential therapeutic target for PCOS. They have discovered that PCOS might arise from an imbalance of bacteria in the gut, which can cause insulin resistance and increased levels of testosterone.
In several studies, researchers were able to give mice PCOS through a fecal transplant. Other studies have shown that a fecal transplant from a healthy gut microbiome could offer protection against PCOS. Eating the proper balance of prebiotics and probiotics also may reduce the risk of developing the condition.
Other studies have focused on the possible role of the cytokine interleukin-22 may play in gut health and the development of PCOS.
PCOS is the most common cause of infertility. If left untreated, hormonal imbalance interferes with the growth and release of the eggs from the ovaries.
Difficulty getting pregnant is usually one of the biggest concerns of women with PCOS. But a PCOS diagnosis does not mean a women will never get pregnant, Sherif and Mama stressed.
When the condition is under control with diet, sleep and medications, women can easily conceive, Sherif said.
There are also ways to improve ovulation, Mama said. From his viewpoint, the focus should be on fertility, not infertility. Conceiving may be harder, but not impossible, he said.
