Sometimes what may appear to be a cosmetic issue could actually be a symptom of a serious medical problem. For example, consider the beauty challenges of adult acne, hair loss, oily skin, abdominal weight gain, darkened patches of skin, and excess hair growth in areas like the abdomen, chest or face. While these problems may seem cosmetic or simply a nuisance, they could also be warning signs of an endocrine disorder called Polycystic Ovarian Syndrome, or PCOS.
What is PCOS?
PCOS, also called Stein-Leventhal Syndrome, is the most common endocrine disorder among women, affecting as many as 5% to 10% of all women. And while many of its symptoms are externally visible, PCOS can involve multiple organ systems within the body. It is the most common cause of infertility in women, and carries a higher risk of heart disease and diabetes in those patients who have it. PCOS appears to have a genetic component. Patients affected with PCOS often will have both male and female relatives with adult-onset diabetes, obesity, high blood pressure, and elevated triglycerides, as well as female relatives with menstrual problems, excess hair growth, and infertility.
Cause and Diagnosis
It is not clear what causes PCOS, and there are no specific blood tests to diagnose the disorder. But patients with the disorder often are seen with hormonal imbalances, including elevated testosterone, a classic, hallmark sign of PCOS.
PCOS can be diagnosed at all stages in life, starting as early as 8 or 9 years old and appearing throughout the post-menopausal period. In addition to a list of troubling cosmetic issues, women and girls with PCOS typically have irregular menstrual cycles, often skipping their periods for months or having no periods at all. Irregular ovulation is also an issue, and women with PCOS often, but not always, have multiple unruptured follicles (mislabeled as cysts) around the periphery of their ovaries.
Symptoms of PCOS
Patients with PCOS can present with one or more of a complex list of symptoms. However, not all patients will have all symptoms, and while some patients will have multiple cysts on their ovaries, some patients will have none at all.
- Irregular or missing menstrual periods
- Obesity, weight gain, difficulty losing weight
- Excess or abnormal hair growth
- Skin tags
- Scalp hair loss
- Oily Skin
- Moodiness and/or depression
- Lack of mental alertness
- Infertility, difficulty getting pregnant, or multiple miscarriages
- Elevated blood pressure
- Elevated cholesterol levels
- Darkened, velvety patches of skin, called acanthosis negricans
- Possible ovarian cysts (not in all patients)
- Pelvic or lower-abdominal pain (not in all patients)
- Sleep apnea
Is There a Connection to Hypothyroidism?
It is known that PCOS involves hormonal imbalances, particularly the hallmark sign of elevated testosterone. But there appears to also be a connection to hypothyroidism.
One study found that patients with PCOS were three times more likely to have autoimmune thyroid disease, with elevated thyroperoxidase (TPO) or thyroglobulin (TG) antibodies and a higher incidence of TSH levels above the upper limit of the normal range.
A second study found a connection between severe, longstanding hypothyroidism and an increase in ovarian volume or formation of ovarian cysts. This study found that treatment with thyroid medications to achieve a euthyroid state (normal thyroid function) resulted in a decrease in ovarian volume, a resolution of ovarian cysts, and reversal of PCOS symptoms, along with improved hormone levels.
Connection to other health conditions
A study conducted in 2000 found that women suffering from PCOS have a much higher risk of developing coronary artery disease. PCOS patients often also are seen with high blood pressure, high levels of LDL cholesterol, obesity, and atherosclerosis, which occurs when fatty plaque deposits stick to the inside of artery walls, leading to blockages that can cause heart attack or stroke. PCOS patients over the age of 45 have been found to have thicker plaque deposits in their arteries than seen in non-PCOS patients.
In addition to the cardiovascular effects seen with PCOS, another hallmark of the condition is insulin resistance. It is not known whether insulin resistance is the cause of obesity that is seen in 60 percent of PCOS patients, or if the obesity causes the insulin resistance. Regardless of which is the cause and which is the effect as many as 40 percent of PCOS patients will have impaired glucose tolerance or Type 2 diabetes by the time they reach age 40.
Is There Anything a PCOS Patient Can Do?
Because of the insulin resistance component of PCOS, it is often very helpful for patients to lose excess weight, though this can be difficult. Reduced carbohydrate diets have been shown to be potentially effective, not only at helping achieve weight loss but also in helping to control the excess insulin production that comes with insulin resistance. Focusing on foods with a low glycemic index, such as lean meats, whole grains and non-starchy vegetables can help patients reach their goals.
Exercise can also be a very valuable tool in the management of PCOS. Not only can it help with weight loss efforts, but it also increases the sensitivity of cell membranes to insulin, allowing the body to convert glucose into energy more effectively. And an added bonus to improving the body’s ability to use insulin properly is that it could reduce the excess androgens in the body that are the major causes of many of the cosmetic symptoms.
Medical treatment options
There is increasing evidence that PCOS can be successfully treated and often reversed with the use of insulin sensitizing medications such as Metformin (Glucophage), and Glitazones such as Rosiglitazone (Avandia) or Pioglitazone (Actos). These medications have been shown to reduce the endocrine abnormalities seen with PCOS, often with two to three months, and can result in improved regulation of menstrual cycles, decreased hair loss, diminished facial and body hair growth, normalization of blood pressure, weight loss, and reduction in cardiovascular risks. These medications also can help return normal fertility and reduced risk of miscarriage. Within six months of starting treatment with insulin-lowering medications plus diet and exercise, more than 90 percent of women will resume regular menstrual cycles.
Androgen-related symptoms such as acne and hair loss can often be improved through the use of anti-androgen medications such as Spironalactone (Aldactone), Cyproterone acetage, Flutamide (Eulexin), or Finasteride (Propecia, Proscar).
PCOS patients who are dealing with fertility issues can often see improvement with fertility agents such as Clomid or Serophene, Gonadotropin injections, hCG (human chorionic gonadotropin), or GnRH Lutrepulse, and if these treatment options don’t bring results, patients can turn to in-vitro fertilization, commonly known as IVF.
While PCOS may bring many unwanted cosmetic symptoms, it is a serious medical condition that needs to be addressed and properly treated. Use of a comprehensive treatment program to bring insulin and androgen levels back into balance, along with assistance in weight loss and other issues, can help patients with PCOS restore their health and fertility, while reducing their risk of heart disease, stroke and diabetes.