PCOS FAQs | PCOS Wellness | Gretchen Kubacky
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PCOS frequently asked questions | PCOS Wellness
1. What is PCOS?

Polycystic Ovary Syndrome, otherwise known as PCOS, is an endocrine disorder in women that can cause fertility problems, and problems related to blood sugar and heart health.  It is so common, in fact, that it is the leading cause of infertility and affects 10% of the world’s female population.  It is a condition you’re born with.  You can’t catch it from a friend or develop it later in life.  You either have it or you don’t.

 

At it’s most basic level, this is what is happening in the ovaries:  For women with normal, regular periods, their ovaries are able to produce fully mature eggs, one of which is released into the fallopian tubes in anticipation of fertilization and the cysts where the other mature eggs are contained dissolve back into the body and her period begins.  For a woman with PCOS, her eggs don’t fully mature and therefore don’t get released into the fallopian tube.  The follicles encasing the developing eggs also don’t fully dissolve after the cycle has ended, leaving cysts behind in the ovaries.  This is where the name Polycystic Ovary Syndrome comes from. This also explains why infertility is often a symptom for women with PCOS.

 

A woman’s reproductive cycle is kicked off and controlled every step of the way by hormones.  This explains why diabetes and heart disease —two other hormone-related diseases—are also common complication complications for women with PCOS.

 

Other symptoms of PCOS include excessive hair growth on the body, hair thinning, weight gain or obesity, acne, sleep apnea and depression, and PCOS also increases a woman’s risk of miscarriages, post-partum depression, diabetes, and certain kinds of cancer.

 

No one knows the exact cause of PCOS and there is no cure, but researchers are constantly making new progress that gets us closer to answering a lot of our questions about how PCOS functions and how it impacts the rest of our body processes.  What we do know is that because it is something you’re born with, it impacts your life from puberty well into menopause.

2. How does PCOS Happen? What causes it?

In order to understand how PCOS happens, we have to have a basic understanding of the endocrine system in the body.  The endocrine system is a collection of glands and the hormones they produce.  You can think of hormones as the body’s little messengers.  They trigger chain reactions in the body for all of our necessary processes to happen.

 

The ovaries, for example, are obviously key players in PCOS.  You probably learned in 6th grade health class that the ovaries are one of our sex organs, but did you also know that they are hormone-producing glands?  Estrogen and progesterone are produced here.

 

The other major player is the pituitary gland, which is located at the base of the brain and produces Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH).  These two hormones are what initiate the cycle.  They travel through the blood stream and once a certain level of the hormones reaches the ovaries, they trigger the ovaries to begin growing follicles (where the eggs are individually encased and are allowed to mature).  When those eggs reach maturation, that triggers the ovaries to release estrogen into the bloodstream, which travels up to the pituitary signaling that it is time to release a surge of Luteinizing Hormone.  This travels back down through the bloodstream (Are you seeing a pattern here?) and communicates to the ovaries that it is time to release an egg, which then either gets fertilized or shed with your period.

 

Well, this is how it normally goes anyway.  For a woman with PCOS, her pituitary gland releases an unusually high level of LH, which disrupts the normal cycle and causes the egg follicles to not mature.  You can see how this would cause a whole other chain of events causing imbalance and unpredictability.

 

The other piece of the puzzle is insulin—a hormone that is produced in the pancreas and regulates blood sugar levels.  Often, doctors find that women with PCOS also have abnormally high levels of insulin.  High insulin combined with high LH causes the body to produce testosterone, the male sex hormone.  And testosterone is the reason that ovulation is prevented from occurring, which can cause infertility.  It is also the culprit in causing symptoms like acne, hair thinning, and body and facial hair growth.

 

Now you can easily see what a delicate balance our hormones are.  But, this is just one process of many that the endocrine system manages.  So, imagine how this imbalance affects all the other delicate hormonal balances in the body and you can begin to see why PCOS is a multi-systemic syndrome that requires multiple medical specialists to treat.

3. How is PCOS diagnosed?

PCOS can often be suggested as a possibility based on a combination of several factors:

  • Your height, weight and blood pressure (which every primary care physician checks during a routine physical).
  • The detection of abnormalities in the ovaries, which can be felt or seen during a manual pelvic exam.
  • Abnormal hormone levels from a blood test. Often checking your blood sugars or other factors can help in determining PCOS as the cause.
  • Confirmation of abnormalities by checking the appearance of your ovaries during an ultrasound.

 

Once these routine tests can often tip your doctor off that PCOS could be the cause, it often requires further testing from specialists to rule out other potential causes (such as tumors or other hormone disorders) to officially diagnose.   (See FAQs 5 & 6 for more.)

4. What can PCOS Wellness do for me?

PCOS Wellness was created to empower you to be your own health advocate and create a life that you love in spite of your PCOS.

 

This is your go-to resource for support and otherwise hard-to-find information on how PCOS affects your life.  PCOS Wellness is all about how you want to FEEL–healthy, happy, beautiful, confident and in charge of your own life.

 

As a PCOS patient myself, I understand what this experience is like for you–the frustrations you feel and the physical hardships you deal with.  Not only that, but as a psychologist, I specialize in working with women who have been diagnosed with PCOS. 

 

It is my goal to use PCOS Wellness to spread awareness about what living with PCOS is like and push for further research that can make real differences in our quality of life.

 

Check out my blog for the latest research findings and for tips on self-care for PCOS patients.

5. What lab work do I need to have done?

After the routine physical and blood work, your doctor should recommend further testing.

 

Make sure your doctor tests for pregnancy, your androgen levels (including FSH, TSH and testosterone), your thyroid activity, your insulin and sugar levels, and your cholesterol levels.  These things will confirm whether diabetes or thyroid issues are factors influencing your PCOS or vice versa.

 

Your doctor should also test for sleep apnea, since it is often a problem for women with PCOS.

 

These tests might seem excessive to you–and the experience of enduring them all is definitely emotionally taxing–but, they’re important in reducing risk for other more serious health conditions later.

6. What should I ask my doctor? What specialists do I need?

Be sure to ask your doctor about the specific symptoms you’re experiencing.  Not every woman’s experience with PCOS is exactly the same.  For example, some women might not necessarily have issues with weight gain or excessive hair.  This doesn’t necessarily mean that PCOS is not the cause.  It is important to get clear answers even if your case isn’t exactly typical.  Do not let your doctor dismiss your questions or insistence on further testing.  If this does happen, it might be time for a new doctor.

 

Your doctor should refer you to any number of specialists, including an endocrinologist (possibly even one who specializes in reproductive endocrinology), a gynecologist, a nutritionist, an internist, a dermatologist, a cardiologist, and last but definitely not least, a psychologist.  (See FAQ question 7.)

 

It is also important to ask about the repercussions of PCOS–health complications that you’re at risk for and how to reduce those risks.

7. What does psychology have to do with PCOS?

Statistics tell us that 34% of women with PCOS have depression compared to 7% of women in the general population and around 45% have anxiety, compared to only 18% of the general population.   PCOS patients are also at higher risk for things like eating disorders and suicide.

 

The complications are serious and they’re real.  The heartache of struggling to conceive isn’t something you should have to grin and bear.  The burden of hating your body, for not feeling feminine or beautiful enough, or for feeling like your body is sabotaging your happiness–these aren’t things to brush aside or ignore.  Even mood swings or mild depression, if it is holding you back from living your best life, is worth taking seriously.

 

If you’ve already undergone all the testing necessary and PCOS was confirmed, then you’ve already had a taste of the psychological trauma and emotional exhaustion living with PCOS can cause.

 

The sooner you can find a psychologist or therapist that resonates with you, the better.  Having this specialist there for you to support you while you navigate these complications in your life can make all the difference.   If therapy isn’t something you’re ready for at this time, consider purchasing The Action Plan for self-guidance.

8. How does PCOS affect my fertility and what can I do about it?

An intricate chain of hormonal signals tell the body when to encourage egg maturation and when to release a mature egg in anticipation of fertilization. (See FAQ question 2 for entire sequence of events.)  When this chain of events is disrupted, either the egg doesn’t mature or it isn’t released for fertilization, or both.

 

Sometimes hormone balance can be restored through diet and lifestyle changes.  Sometimes stress reduction can help.  And sometimes medical attention is necessary.  Things like Intrauterine Fertilization (IUI), In-vitro Fertilization (IVF), fertility drugs like Clomid and Novarel, Laproscopic Ovarian Drilling can help.  These are only a few of the possibilities out there and researchers are constantly making breakthroughs for new treatments every day.

 

So, while infertility is definitely a risk, pregnancy isn’t always impossible for many women with PCOS.

9. How do diet and exercise play a role in how PCOS impacts me?

Because women with PCOS typically have abnormal insulin levels, this makes sugar harder to process.  When it’s harder to process sugar, these excess sugars get stored as fat, making it  harder to lose weight.  High sugar levels can also make your energy levels erratic, affect your sleep, make it harder for your body to process stress, and aggravate hormone levels.

 

Because of this, reducing the sugar in your diet, whether you’re diagnosed diabetic or not, is important in managing PCOS symptoms.

 

Women with PCOS should also try eating an anti-inflammatory diet, especially avoiding dairy and gluten.  Anti-inflammatory diets reduce the amount of foods that actually stress the body and increase foods with anti-inflammatory micro-nutrients in them.

 

The key goal in eating an anti-inflammatory diet is to reduce the amount of stress in the body and process the stress that is unavoidable.  It seems stress and its negative effects on the body are constantly making headlines these days, not only regarding our mental wellbeing, but also showing its connection to things like cancer, heart disease, infertility, libido, aging and more.

 

Exercise should also be integral to any PCOS management plan because of its powerful ability to boost mood, manage stress, process sugars, and of course, maintain a healthy weight (see FAQ 10).

10. Why is it so hard for me to lose weight?

In addition to making it harder to process sugars (see FAQ 9), women with PCOS also tend to have a lower metabolism.  A slower metabolism means that women with PCOS require fewer calories than “normal” women.

 

As if that wasn’t unfair enough, women with PCOS also have a more than ample appetite.  Because hunger is triggered in the brain by hormones and PCOS is at it’s core a hormone disorder, the brain of a woman with PCOS doesn’t get the signal that she’s full as soon as a “normal” woman’s brain does.  This means that women with PCOS can often eat to a point well past the calorie requirement of their slower metabolism.

 

Weight loss is a test of will-power and self-control for anyone, but especially for someone with PCOS.  This need for self-control also puts women with PCOS at risk for eating disorders and body dysmorphia.  If you are currently trying to lose or maintain weight, a psychologist can be a profound support to aid in losing weight healthfully, just as much as a dietician or trainer can.

11. Is birth control helpful in managing symptoms?

The use of birth control in managing PCOS symptoms is a bit controversial.  Yes, birth control can help to encourage regular periods, reduce acne, and lower testosterone levels.  For those who aren’t interested in having children, this might be a good option.

 

However, there’s a pretty solid argument out there opposing the use of birth control to manage PCOS.  Some say that birth control simply masks the underlying issues, making it harder to see which methods and therapies actually working and further increasing risk for more serious problems like heart disease, blood clots and others.

 

It’s important to note that birth control isn’t a cure and if a woman quits using birth control, her PCOS symptoms will come back and might even make insulin resistance even worse than it was before.

 

If getting pregnant some day (even if not in the near future) is a goal, a PCOS patient’s body needs extra time to get better regulated in order to encourage fertility.  This is especially true if a PCOS patient has been imposing a false sense of balance through the use of birth control.  Depending on the age of the woman and the number of years she’s been on birth control, once she decides to quit, it might already be too late.

 

If the risks are greater for you than the positives, more natural methods like diet, exercise and supplements, might be a better option.

12. What about hair loss or unwanted body hair?

Ah, the dreaded hair issue.  Yes, it’s true that women with PCOS definitely tend to have some hair challenges.  Once again, we can blame this on the excessive amounts of androgens in our bodies.

 

Hirsutism, or excessive hair growth, affects about 10% of women, but the good news is, it can often be treated very successfully, especially if you seek treatment sooner rather than later.

 

(The longer you wait, the harder the situation becomes to treat, which can increase your risk for side effects.  Moral of this story is don’t let shame or embarrassment keep you from talking to your primary care doctor, your dermatologist, or esthetician!)

 

There are a variety of treatments out there, some medical and some cosmetic, including birth control pills, steroids, and other medications, and laser hair removal, electrolysis, waxing and, of course, shaving.  All options have their varying degrees of effectiveness, side effects, pros and cons, so always be sure to do your research before choosing the best option(s) for you.

 

Hair loss, on the other hand, can be a little more challenging to treat and, despite the perceptions of outsiders that might consider this superficial, hair loss can be especially taxing on one’s confidence and emotions.

 

To that end, let me be the first to say that what you feel isn’t wrong.  Hair loss is discouraging at best and might even make you feel like you’re going a little cuckoo if your doctor isn’t finding that your hormone levels are off the charts.  But trust yourself, if you notice more hair in the shower drain than you used to.

 

The positive news is that there are things you can do to improve the situation.  The most important steps you should be taking to liven up your locks are the steps you should be taking to manage your PCOS anyway:  That is, good nutrition, good sleep, and regular exercise.

 

Nutritional supplements can help, as well as making sure you’re consistently getting enough food and sleep (it’s not just about what, it’s also about how much and how often!).  Self-care should be your number one priority.

 

Another important component is stress management.  Science is showing that chronic levels of the stress hormone cortisol can wreak havoc on anyone’s health, but it can especially do a number on PCOS symptoms.

 

Additionally, it might be worthwhile to have your thyroid checked and/or try reducing environmental toxins from your life as well as you can.  Your hair care routine and product usage can also make a difference, so easy on the tugging, scrubbing, and chemical-treating.

Check out the blog for more tips, tricks, perspectives and research these and other topics.

Have a Question that didn’t make the list?  Contact Dr. Gretchen at drgretchen@pcoswellness.com