My Doctor Said I Have Polycystic Ovary Syndrome

Each week, I wonder what I should write about on the SeasonsWC blog. Then, I listen to my patients, and they tell me what they want to know. (Funny thing listening to your patients). This week, at least three women had questions about their diagnosis of polycystic ovary syndrome. Some time ago an ultrasound revealed that they had multiple ovarian cysts, and they were given birth control pills to control their symptoms. That was all they knew.

“So I learned I have cysts on my ovaries,” they said. “But what does that mean?”

Doctors call it polycistic ovary syndrome. To make things even more confusing, we’ll often just call it PCOS or PCO. (It’s fewer syllables.)

PCO is a hormonal syndrome. A syndrome is a group of symptoms that collectively indicate a disease or other abnormal condition–and PCO is an abnormal condition, not a disease. Of course, abnormal conditions can lead to disease. But an abnormal condition can also be restored to a healthy condition, whereas disease cannot.

PCO is the most common hormone problem in women today, effecting 5% of reproductive aged women. It causes androgen excess, another fancy medical term that means a woman’s body is producing too many male hormones. This means women may have facial hair, hair loss, low voice, acne… Androgen excess in women has been recognized by doctors since Hippocrates. You may have heard of the Hippocratic Oath. Hippocrates discovered a lot of things, including facial hair in women.

To be more specific, PCO is characterized by

• High androgen levels (think testosterone)
• High insulin levels and insulin resistance
• Irregular cycles (due to anovulation)
• Multiple ovarian cysts

It doesn’t really sound so bad–just facial hair, acne, deep raspy voice, and irregular cycles. Obviously, those symptoms are a very big deal for many women. In fact, they are the primary complaints of women with PCO. But they aren’t the biggest problems. PCO is associated with some pretty serious diseases and health problems:

• Obesity (50% of women with PCO)
• Type II diabetes (10% of women with PCO)
• Infertility
• Cardiovascular disease (hypertension, abnormal cholesterol, atherosclerosis)
• Psychopathology (anxiety, depression, bipolar, eating disorders)
• Cancer (breast, uterine…)
• Metabolic syndrome

Worst of all, polycystic ovary syndrome, if untreated, leads to poor health and early death. But don’t worry! We know how to treat PCO, and I’ll talk about that in my next post.

What is Metabolic Syndrome?

Metabolic syndrome is a collection of conditions that occur together to increase a women’s risk of heart disease, peripheral vascular disease, stroke, and type II diabetes.

It isn’t a disease, so much as a collection of conditions. However, it can still be dangerous if left untreated, possibly leading to the diseases listed above: peripheral vascular disease, heart disease, stroke, and type II diabetes.

The identification of metabolic syndrome provides a window of opportunity for treatment to prevent disease.

The following risk factors co-exist in metabolic syndrome…

• abdominal obesity
• blood fat and cholesterol disorders
• elevated blood pressures
• insulin resistance
• pro-blood clot state
• pro-inflammatory state

Abdominal obesity and insulin resistance are the dominant risk factors. Other conditions that affect metabolic syndrome include physical inactivity, aging, hormonal imbalances, and genetic predisposition.

Since it isn’t a disease, we diagnose metabolic syndrome by looking for co-existing symptoms. Any three of the following are required to meet the classification of metabolic syndrome…

• abdominal obesity (waist circumference >35 inches)
• elevated triglycerides (>150)
• low HDL (<50)
• elevated blood pressure (> 130/85)
• elevated fasting glucose (>110)

Metabolic Syndrome is not uncommon. It is estimated that over 50 million Americans have it. We treat it by managing a patient’s weight loss, increasing physical activity, treating hypertension, prescribing daily aspirin therapy to reduce pro-blood clot states, and treating elevated triglycerides and/or low HDL levels.