St. Augustine Woman's Journal - Educational Resource to the Women of St. Johns County Since 2009

Polycystic Ovarian Syndrome

 

February 1, 2020 | View PDF



Polycystic Ovarian Syndrome or PCOS is one of the most common metabolic endocrine (hormonal) disorders in women. Most women who receive an eventual diagnosis of PCOS will present for evaluation with irregular periods (either infrequent or irregular), difficulty getting pregnant and symptoms of androgen excess (skin that is more oily or hairy then they would like). Other symptoms that women find troublesome that are related to PCOS can be obesity, severe acne, patches of thickened, velvety, darkened skin and multiple cysts on the ovaries visualized on ultrasound. Despite the name, not all women with PCOS will have cysts on their ovaries. But all women will have an excess of androgen, a male hormone produced by the ovaries.

The exact cause of PCOS is unknown. Many women will have an insulin resistance. Some women will not produce enough hormones to ovulate which in turn cause multiple cysts on the ovaries. Unlike other disorders, PCOS cannot be diagnosed with just one test. Rather, a diagnosis of PCOS is based on symptoms after ruling out other possible causes for the symptoms experienced. You could be diagnosed with PCOS if you have at least two of the following symptoms:

• Irregular periods, including periods that come too often, not often enough, or not at all

• Signs of excessive androgens:

• Extra hair growth of your face, chin, and body

• Acne

• Thinning of scalp hair

• Difficulty getting pregnant

• Multiple cysts on one or both ovaries

• Excessive weight around the waist (apple shaped body)

There are three goals of PCOS treatment:

Protect the uterus, decrease insulin resistance and achieve a healthier weight.

Whether or not a woman wishes to achieve pregnancy immediately will help guide how to “protect the uterus”. For a woman who does not want to get pregnant in the near future, a hormonal birth control is usually the most common way to regulate a woman’s period and decrease her long term risk of overgrowth of the uterine lining. Birth control can also decrease the androgen hormones that cause acne and unwanted hair growth. For a woman who desires pregnancy, initial lifestyle modifications can be beneficial. In some situations, a weight loss of 5-10% body weight can reinitiate ovulation without any other intervention. If this is unsuccessful, a medication called Metformin, approved to treat Type 2 Diabetes, may be started to assist in ovulation. It affects the way insulin controls blood sugar and lowers testosterone levels, which can lead to ovulation. There are also two oral medications used to induce ovulation. If none of these treatments result in pregnancy, the patient may need further fertility treatments such as gonadotropin injections or surgery. At any point, the woman may be referred to a fertility specialist for management.

PCOS changes how your body reacts to some hormones, like insulin, that then cause the body to make more androgens. While all women have some androgens, excessive amounts will cause the male like symptoms associated with PCOS. Exercise, weight loss, diet and sometimes medications can all help a woman use her insulin more efficiently. When less insulin is made, the body in turn will make less androgen.

Some health risks associated with PCOS include development of metabolic syndrome, insulin resistance, and endometrial hyperplasia. Metabolic syndrome and insulin resistance both are associated with Type 2 Diabetes and heart disease. Endometrial hyperplasia occurs because the endometrium, the lining of the uterus becomes too thick and increases the long-term risk of endometrial cancer. Women with PCOS can also have trouble getting pregnant. Once they do, they have an increased risk of developing gestational diabetes, elevated blood pressure and having a large baby. The best prevention of complications from PCOS is to eat healthy, exercise, and stop smoking. It is important if you have symptoms of PCOS that you talk to your health care provider sooner rather than later. The earlier a woman gets her symptoms under control, the lower the risk of long-term complications.

“Some health risks associated with PCOS include development of metabolic syndrome, insulin resistance, and endometrial hyperplasia. Metabolic syndrome and insulin resistance both are associated with Type 2 Diabetes and heart disease. Endometrial hyperplasia occurs because the endometrium, the lining of the uterus becomes too thick and increases the long-term risk of endometrial cancer.

Women with PCOS can also have trouble getting pregnant.”

Elizabeth Arnett, ARNP, CNM

Elizabeth grew up in Saginaw, Michigan until she graduated from Saginaw Valley State University with her BSN degree. She then went on a search for warmer weather and moved to Raleigh, NC where she worked as an ICU and Labor and Delivery nurse at Duke University Medical Center. Elizabeth knew her passion was always caring for women during pregnancy. She then went back to school to at Frontier Nursing University where she graduated with her MSN degree and became a Certified Nurse-Midwife.

Elizabeth moved to St. Augustine before she started her clinical training with OBGYN Associates. After graduation, she joined the practice as a Nurse-Midwife in 2016 and is very excited to continue caring for the women in our community.

 
 

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