What Is PCOS?
PCOS - Polycystic Ovarian Syndrome
PCOS is present in 6-10% of Caucasian women and 15-20% of
African-American and Hispanic women. How do you know if you have this
condition?
How do you know if you have this condition?
Take the Foley Score questionnaire - the score will determine the likelihood.
One of the common questions asked is, are there blood tests to tell
for sure if you have PCOS? The answer is no. Primarily, medical history
and physical appearance make the diagnosis. The medical literature
discusses many different laboratory values but so far, none has been
found to diagnose PCOS consistently. Some helpful tests would be an
insulin level, FSH and LH levels (female hormones), a blood glucose
level, and ultrasound. Approximately 60% of the patients with PCOS will
have abnormal levels of the above or will have an abnormal ultrasound.
In other words, an elevated insulin level will only be found in 60% of
the women with PCOS. When patients had ultrasounds, only 50-60% of the
women with PCOS had abnormal ultrasounds and 20% of normal women had
abnormal ultrasounds. This illustrates why this is such a difficult
disorder to diagnose and why many doctors do not recognize it. We have
found the "Foley Score" to be quite accurate in determining which women
actually have PCOS.
What is PCOS? It is a genetic disorder common in women with a family
history of PCOS and/or a history of a parent, particularly a father,
with elevated cholesterol, heart disease, and history of being
overweight. Many times it first becomes noticeable in the late
childhood/early teen years with abnormal weight gain. Poor eating
habits or lack of exercise do not bring it on. It is a complex hormonal
problem with effects on many body systems. The good news is that it can
be treated!
The major component of this disorder is insulin resistance. To help
illustrate what this does to your body, you must first understand how
your body takes the food you eat and turns it into energy. Whatever you
eat (carbohydrates, proteins, fat) must be turned into glucose in order
for your body to use it as fuel. Your pancreas secretes insulin to help
the glucose to get into the individual cells. For some reason that is
not completely understood, people with insulin resistance require more
insulin than normal for glucose to be used. The excessive insulin
and/or the abnormal response to insulin cause most of the abnormalities
seen in PCOS.
- Insulin resistance causes the ovaries not to work properly.
- It may cause cysts to form (thus the name polycystic ovarian syndrome)
- It
may stimulate cells in the ovaries to secrete extra amounts of
androgens (male hormone) and thereby not allow regular ovulation (thus
the irregular periods and difficulty getting pregnant experienced by
many women with PCOS)
- The excessive secretion of androgens also leads to male
pattern hair growth and/or male pattern baldness (thus the increased
facial, chest, and abdominal hair growth experienced by many women with
PCOS) and excessive acne
- Insulin resistance leads to weight gain.
Treatment
The hallmark of treatment of PCOS is the treatment of insulin
resistance. This has two major components; medical and nutritional. Our
nutritional program is covered separately on this site.
Medication
The current medication recommended is Metformin or Glucophage. It is
very safe and is even continued during pregnancy without adverse
effects to the woman or the unborn child. The only contraindication to
taking Metformin is for those patients with kidney disease.
Metformin works by allowing insulin to work more efficiently and by
decreasing the resistance. This allows the pancreas to secrete less
insulin thus decreasing the amount of insulin circulating in the blood
and therefore decreasing the side effects mentioned earlier. It also
appears to decrease the absorption of glucose in the intestine, which
explains the most common side effect - increased intestinal gas and
loose stools. If the appropriate foods are eaten, this side effect is
minimal. There are many research studies on file that show there is no
need to monitor blood sugar levels while on Metformin.
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