Rose, 32, owner of a business firm in Davao City, grew up having irregular periods and battling her weight. In her late 20s, her weight ballooned to 110 kilograms, she began sprouting facial hair, she felt lethargic and she stopped menstruating. She didn’t know it, but her ovaries were riddled with cysts. She saw three doctors in a row, but no diagnosis. “They all said, ‘You need to lose weight’.”
Finally, Rose got an answer. She had polycystic ovary syndrome (PCOS), a condition in which her high levels of testosterone prevented her ovaries from releasing eggs, which then became cysts. “Two weeks into treatment, I got my first period in four years,” she says. In the three years since diagnosis, she lost 40 kg.
Women have male and female hormones. When these hormones stop behaving, trouble ensues. According to health experts, PCOS results from an imbalance of male hormones called androgens.
About 5 percent to 10 percent of women aged 20 to 40 have PCOS says, Dr. Darleen Estuart, an obstetrician and gynecologist in Davao City. “It is a disease of the reproductive age women,” she points out.
“PCOS is genetic, and presents differently in each woman of childbearing age,” explains Sydney Parker in an article published by The Atlantic. “For some women, symptoms emerge shortly after they begin menstruating. Others may not show signs of the disorder until later in life, or after substantial weight gain, and many don’t receive a diagnosis until they are struggling to get pregnant.”
PCOS (which used to be called Stein-Leventhal syndrome) was first recognized in the 1930s, but until now doctors can’t still figure out what causes it. Some studies suggest that genetics may be a factor. Sisters and daughters of a woman with PCOS may have a 50-percent chance of developing PCOS. According to www.webmd.com, PCOS can be passed down from either the mother’s or father’s side.
The National Institute of Health (NIH) of the United States Department of Health and Human Services says that high levels of androgens among women can interfere with signals from the brain that normally result in ovulation so that ovulation does not occur regularly.
Insulin has also something to do with PCOS. “Insulin helps move sugar (also called glucose) from the bloodstream into cells to use as energy,” NIH explains. “When cells don’t respond normally to insulin, the level of sugar in the blood rises. In addition, the level of insulin goes up as the body produces more and more of it to try to get glucose into the cells. Too much insulin increases the production of androgens, which then cause symptoms of PCOS.”
The www.webmd.com web site says symptoms of PCOS tend to be mild at the beginning.
A woman may experience a few symptoms while others may undergo several symptoms. Generally, the most common symptom is irregular periods.
“If a woman has fewer than eight menstrual periods a year on a chronic basis, she probably has a 50-percent to 80-percent chance of having PCOS based on that single observation,” John Nestler, the chairman of the department of internal medicine at Virginia Commonwealth University, was quoted as saying by The Atlantic feature. “But, if she has infrequent menstruation, and she has elevated levels of androgens, such as testosterone in the blood, then she has a greater than 90 percent chance of having the condition.”
Women with PCOS usually have fertility problems. “Many women who have PCOS have trouble getting pregnant,” www.webmd.com states. The reason: they have ovaries that contain many small cystic structures, about 2 to 9 millimeters in diameter.
“The basic difference between polycystic and normal ovaries is that, although the polycystic ovaries contain many small antral follicles with eggs in them, the follicles do not develop and mature properly—so there is no ovulation,” the website, www.advancefertility.com, explains.
Since women with polycystic ovaries do not ovulate regularly, they do not get regular menstrual periods as a result.
Obesity is a double-edged sword for women with PCOS, according to some studies. In fact, around 40 percent of sufferers are overweight. Obesity itself will initiate the symptoms described above in some women who would not have otherwise suffered had they remained of normal weight. Studies show that it will worsen the symptoms for those who do have PCOS and, unfortunately, the hormone changes associated with PCOS make weight loss more difficult.
Medical books say that some PCOS symptoms that a woman may notice quickly include: abnormal vaginal bleeding (occurs in about 30 percent of women with PCOS); skin problems such as acne, oily skin, dark skin patches on the neck, groinand underarms; depression or mood swings; and high blood pressure (hypertension).
Studies have shown that women with PCOS seek medical care for a specific symptom like infertility (74 percent of the time), menstrual problems (70 percent), excess hair growth (69 percent) and obesity (41 percent).
“Many women don’t know they have it. They might have a slight excess of body hair, or they may have slightly irregular periods, but some women with this condition have neither of those things,” explains Dr. Warren Kidson, an endocrinologist with the Prince of Wales Hospital in Sydney. “They have regular periods but have mildly elevated levels of male hormones in the blood. Some women find that from their time of puberty, they have a problem of easy weight gain and difficulty with losing weight.”
If a woman thinks she has PCOS, she must visit a gynecologist (a doctor who specializes in the female reproductive system) or an endocrinologist (a physician who specializes in hormonal problems) for a diagnosis. The gynecologist or endocrinologist will obtain a detailed history, which will involve asking a woman several questions about her family’s medical history and her period and its regularity; check her weight and perform a thorough physical examination, checking especially for physical signs, such as acne, hair growth and darkened skin.
A doctor may also perform blood tests to diagnose PCOS or to rule out other conditions, such as thyroid or other ovarian or gland problems. Blood tests allow doctors to measure insulin and other hormone levels. The results of these tests can help doctors to determine the type of treatment a woman will receive. The doctor may also order another test, called an ultrasound, to look at her ovaries and to determine if she has cysts or other abnormalities of the ovaries. Because cysts are not always visible, though, this test is not always used.
Early diagnosis and treatment for PCOS are important because the condition can put women at risk for long-term problems. “Getting treated for PCOS is a good idea if you want to have a baby someday,” Estuart says. “Oftentimes, PCOS causes infertility if it’s not treated. But, when PCOS is treated properly, many women with the condition have healthy babies.”
The Mayo Clinic says that, aside from infertility, other complications a woman may experience are: gestational diabetes or pregnancy-induced high blood pressure; miscarriage or premature birth; nonalcoholic steatohepatitis (a severe liver inflammation) and metabolic syndrome (a cluster of conditions, including high blood pressure, high blood sugar and abnormal cholesterol).
Other complications include: type 2 diabetes or prediabetes, sleep apnea, depression, anxiety and eating disorders, abnormal uterine bleeding and cancer of the uterine lining (endometrial cancer).
Although there’s no cure for PCOS, there are several ways that the condition can be treated and managed. If a woman is overweight or obese, a doctor will recommend that she losses weight.
“Weight loss can be very effective in lessening many of the health conditions associated with PCOS, such as high blood pressure and diabetes,” says Dr. Steven Dowshen, an American endocrinologist. “Sometimes weight loss alone can restore hormone levels to normal, causing many of the symptoms to disappear or become less severe.”
Dowshen further suggests: “A doctor or a registered dietician can look at your food intake and your exercise and activity to tailor a weight-loss program for you. Exercise is a great way to help combat the weight gain that often accompanies PCOS.”
Sometimes physicians prescribe medications to treat PCOS. A doctor might first have a woman try birth-control pills to help reduce the androgen levels in her body and regulate her menstrual cycle. Birth-control pills may help control acne and excessive hair growth in some women, but they don’t work for everyone.