By Theresa Garnero, APRN, BC-ADM, MSN, CDE
What causes women to have missed periods or irregular menstrual cycles, small ovarian cysts, difficulty getting pregnant, male-pattern baldness or hair thinning, weight gain, acne, and excessive hair growth on the face, chin, chest, stomach, back, thumbs, or toes?
Did someone say chocolate? Wrong!
These are some of the symptoms of polycystic ovary syndrome, or PCOS. It’s named for the cysts that often form on one or both ovaries. When an egg produced by the ovary doesn’t mature properly or isn’t released from the follicle (the sac that holds the egg), the follicle starts to grow and build up fluid, forming a cyst. After many months of this pattern, the ovaries end up with many cysts. But PCOS is much more than that.
What is PCOS?
The cause of PCOS is unknown—just as the PCOS-diabetes connection isn’t fully understood—but it’s thought that insulin resistance plays a key role. In insulin resistance, cells “resist” the hormone insulin so the body has to produce more of it. As insulin levels rise, the ovaries produce more androgens (commonly known as “male hormones,” but women make them too). Higher-than-normal levels of androgens in women may cause ovarian cysts and other symptoms.
Problems associated with PCOS may include high cholesterol, high blood pressure, acanthosis nigricans (dark brown patches of skin most commonly found on the neck), pelvic pain, and sleep apnea. All of these symptoms are due to excess androgens.
PCOS is one of the most common endocrine disorders in young women, affecting about one in ten women of childbearing age. Symptoms typically peak between ages 15 and 25. More than half of the women with PCOS will have prediabetes or type 2 diabetes before the age of 40. This syndrome affects lesbian women at higher rates than heterosexual women.
PCOS is a serious condition. Women with PCOS have a higher risk of cardiovascular disease than those without it.
If you have signs or symptoms of PCOS, your doctor may do a physical exam, measure your body mass index, ask about your menstrual cycle and your family medical history, check your blood glucose, insulin levels, cholesterol levels and blood pressure, and perform a pelvic exam. The doctor may also perform a vaginal ultrasound. Abnormal lab test results that suggest PCOS include a high androstenedione levels, a luteinizing hormone (LH) level that is two- to three-times higher than the follicle-stimulating hormone level, a low progesterone level, and a mildly elevated or normal testosterone level.
PCOS has no cure but is treated with healthy eating, physical activity, and taking medications, possibly birth control pills. To help reduce symptoms, diabetes specialists may prescribe metformin, a drug used to treat type 2 diabetes. For women who are overweight, a weight loss of 10 percent of their total body weight may restore the menstrual cycle to normal. Treatment is tailored to address symptoms and may take a couple of years to be fully effective.
PCOS can affect girls as young as 11, and although metformin is used with children who have type 2 diabetes, it is usually not prescribed for pre-adult girls with PCOS.
Pregnant women with PCOS have higher rates of gestational diabetes, miscarriages, premature delivery, and pregnancy-induced high blood pressure.
Women with PCOS who want to get pregnant need specialized care. An endocrinologist will work with a perinatologist (a specialist in maternal and fetal medicine) to come up with the safest pregnancy plan, which could include taking fertility medications. It is common for women with PCOS to use metformin until they become pregnant and then switch to insulin, since the long-term effects of metformin on the baby aren’t known. Some specialists will prescribe oral medications such as the diabetes drug glyburide off-label.
PCOS and diabetes—they travel in similar circles. Both require perseverance and good self-care to maximize health.
Theresa Garnero, APRN, BC-ADM, MSN, CDE has thirty years of experience working with people affected by diabetes. For more info visit: http://www.tgarnero.com/.
“Polycystic Ovarian Syndrome (PCOS).” American Diabetes Association. Last modified July 2, 2014. Accessed March 12, 2017. http://www.diabetes.org/living-with-diabetes/treatment-and-care/women/polycystic-ovarian-syndrome.html.
“Polycystic ovary syndrome.” Womenshealth.gov. Office on Women’s Health, U.S. Department of Health and Human Services. Last modified June 8, 2016. Accessed March 12, 2017. https://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html
“Are there disorders or conditions associated with PCOS?” Eunice Kennedy Shriver National Institute of Child Health and Human Development. National Institutes of Health. Accessed March 16, 2017. https://www.nichd.nih.gov/health/topics/PCOS/conditioninfo/Pages/conditions-associated.aspx.