What is PCOS?

Polycystic ovary syndrome (PCOS) is an endocrine disorder affecting 5% to 10% of reproductive age women. First recognized in 1935 by Stein and Leventhol for its relationship to menstrual disturbances, PCOS is characterized by high levels of androgens (male hormones such as testosterone) from the ovary and is associated with insulin resistance. Tiny cysts, hence, “poly cysts”, usually but not always, surround the ovaries appearing upon an ultrasound as a strand of pearls. The cysts are actually a result of hormonal imbalances not the cause of them.

Additional results from an overproduction of androgens in females is excessive hair growth on the face and body (hirsutism), hair loss from head (alopecia), acne, skin problems, and irregular or absent periods. Women with PCOS who are insulin resistant as in the majority of cases, will experience weight gain in the abdominal area, difficulties losing weight, intense cravings for carbohydrates, and hypoglycemic episodes.

Do I have PCOS?

You may have PCOS if you experience several of the following:

• A family history of PCOS, especially mother, sister, or grandmother
• Excessive abdominal weight > 35 inches
• Difficulties losing weight despite diet and exercise
• Heavy, irregular (> 40 days or frequent bleeding) or absent periods
• Intensive carbohydrate cravings even after eating meals
• Hypoglycemic episodes or low blood sugar
• Problems with excessive hair growth on face
• Hair loss from head
• Dirty looking or velvety patches of skin on some parts of your body

What are signs that I have hypoglycemia?

Hypoglycemia or low blood sugar can be a result of high insulin levels and also waiting long periods to eat. Symptoms may vary from person to person and may include some of the following:

• Nausea
• Lightheadedness
• Headaches
• Hunger
• Shakiness
• Irritability

For most people, eating small amounts of carbohydrates when these symptoms occur as well as eating every 3-5 hours with protein at every meal or snack can help treat the symptoms and prevent them from happening. Suggestions include cheese and crackers, slice of whole wheat toast with peanut butter, or an egg sandwich.

What should I do if I think I have PCOS?

If you think you may have PCOS schedule an appointment with your primary physician, gynecologist, or contact a reproductive endocrinologist or endocrinologist. Your physician should order the following blood tests to determine if you do have PCOS:

• Leutinizing hormone (LH)
• Follicle stimulating hormone (FSH)
• DHEAS sulfate
• Total and free testosterone
• Fasting glucose
• Fasting insulin (can be part of oral glucose tolerance test-OGTT)
• HA1C
• Transvaginal pelvic ultrasound

Because PCOS is often misdiagnosed, I always encourage people to get copies of their lab results to make sure the correct tests were ordered. You can do this by getting a copy of the results sent to you directly or picking up a copy of them at your physician’s office. And always trust your own instincts. If you think you were misdiagnosed, seek another opinion.

What Causes PCOS?

The cause of PCOS is unknown, however, much research is directed at finding out why it develops. Nonetheless, there does appear to be a strong genetic component. Researchers have found polycystic-appearing ovaries in young girls even before puberty and some even suggest the possibility of some girls even being born with polycystic ovaries. Some theories suggest that women may develop PCOS from being exposed to high androgen (testosterone) levels in the womb. Others may develop PCOS over time especially with long-term cycles of bingeing followed by fasting and/or vomiting.

I have PCOS and have always exercised regularly. Why did I gain so much weight and why is it all around my mid-section? Will it ever go away?

The weight gain you experienced, especially if it is mostly in your middle, was most likely due to you having elevated insulin. When insulin levels are elevated, it causes us to store fat very easily not to mention that elevated insulin stimulates appetite, making us hungrier for food. I have worked with exercise physiologists and athletes who have PCOS and even though they were very active, they still gained weight in their mid-section without changes in eating.

Modifications in your eating as well as taking insulin lowering medications such as metformin, avandia, and/or actos, can help bring down elevated insulin levels and may help you to lose some weight. Some of my clients report that being on insulin lowering medications make them less hungry and less interested in food. Some, but not all people who take insulin-lowering medications have experienced some modest weight loss. Most agree that these medications help prevent hypoglycemic episodes and reduce carbohydrate cravings. The main side effect of these medications is diarrhea and may not be tolerated by all.

Can changes in my eating help improve my PCOS symptoms?

Absolutely! Numerous studies have shown that weight loss and/or improvements in eating patterns can reduce insulin and androgen levels and induce ovulation. Some studies have even shown that normalizing eating patterns in people with eating disorders including bulimia and binge eating disorder, can improve the appearance of cysts around the ovaries. This includes eating a balanced diet with regular activity. Some dietary supplements may be helpful as well. If you are confused over what to eat or find yourself bingeing or out of control with food, consider scheduling a nutrition appointment.

Is eating a low-carb diet the only way to lose weight if I have PCOS?

No. Again, studies are still lacking into the proper dietary treatment of PCOS but the majority of the evidence suggests that a moderate intake of whole grain carbohydrates balanced with healthy fats and lean protein are the keys to losing weight with PCOS. Many women with PCOS have found that if they cut out carbohydrates or eat very minimal amounts that it only causes them to binge eat on them in the long run. This can actually make PCOS symptoms worse by increasing insulin levels.

NOTE: The information is not intended to treat, diagnose, cure or prevent any disease, and is provided for educational purposes only. Always seek the advice of your physician regarding any medical condition, and before undertaking any diet, exercise, medication, or other health program.