Most women associate hormones with menopause. However, most women are unaware that premenopausal women might need hormones too.
Over 20% of all premenopausal women have a hormonal disorder termed polycystic ovary syndrome (PCOS). The name is misleading because the defect does not lie in the ovaries. In spite of the name, the ovaries are not to blame for this syndrome, but here are the facts:
- At least 50% of women with PCOS will have ovarian cysts (thus the name);
- However, 50% of women with PCOS do not have ovarian cysts;
- And not all women with ovarian cysts have PCOS.
Ovarian cysts can be the result of PCOS, but the cysts are not the cause. PCOS is actually an endocrine disorder and not a gynecological disorder. The syndrome is genetic and due to insulin resistance. Treating the insulin resistance is the key to controlling the symptoms of PCOS as well as all of the potential and serious complications of PCOS related to insulin resistance.
Common signs of PCOS are irregular periods, heavy periods, difficulty getting pregnant, weight gain, and difficulty losing weight. Most women with PCOS do not have all the signs. In fact, many women will have normal periods and conceive normally. Many women with PCOS are overweight, yet 50% will be of normal weight. Therefore, making the diagnosis of PCOS is elusive to both doctors and patients. This is precisely why PCOS is often missed. In addition, many doctors are not aware of PCOS, don’t know how to diagnosis or treat it, and often dismiss women’s complaints as normal.
Other common symptoms of PCOS include acne, hirsutism (unwanted hair growth), sugar craving, and severe PMS. The ovarian cysts can be painful or asymptomatic. Any women with any of the symptoms should be evaluated, and if PCOS is diagnosed, they should be treated to improve symptoms, as well as to preserve health and wellness. Simple blood tests will determine the diagnosis and the severity will determine the treatment.
If left untreated, PCOS can contribute to heart disease, diabetes, breast cancer and early mortality, yet all of these conditions can – and should – be prevented with early diagnosis and aggressive treatment.
The cause of PCOS is genetic and related to insulin resistance. Insulin resistance results in alterations of the pituitary hormones FSH and LH. These hormones can be the cause of the ovarian cysts and menstrual irregularities. Insulin resistance also causes loss of sex hormone binding globulin (SHBG) which results in less binding of testosterone with the resultant increase in free testosterone. This higher level of free testosterone results in the skin and aesthetic changes such as acne and excessive hair growth, such as facial hair. The insulin resistance increases the risk of diabetes, heart disease and cancer.
PCOS is a prevalent hormone disorder in premenopausal young women and physicians often miss the diagnosis, especially in “normal” premenopausal women; however, the importance of early diagnosis and treatment is clear.
With a confirmed diagnosis, the treatment is straightforward and simple using insulin sensitizers, medications that decrease insulin and insulin resistance and reverse menstrual and fertility abnormalities.
Although testosterone is extremely important in both premenopausal and post menopausal women, too much can adversely affect the skin. Therefore, medications that prevent the skin sensitivity of PCOS are also recommended. The potential harm of future diabetes and heart disease is eliminated by lowering the adrenal hormone known as aldosterone which increases systemic inflammation of blood vessels that eventually lead to heart disease and strokes.
Obviously it is imperative to decrease the insulin resistance with diet, exercise and medication and to lower the systemic inflammation that causes plaque formation. Most young women just want their symptoms and skin changes to improve and don’t appreciate the long term health risks from PCOS. Unfortunately, many physicians don’t either.
A recent study demonstrated that women with PCOS have a five-fold increased risk of breast cancer due to loss of progesterone. Prescribing natural progesterone is very beneficial in the treatment of PMS and heavy bleeding; however, it is of upmost importance in protecting against breast cancer. The medical literature very adequately demonstrates progesterone’s protective effect against breast cancer and most women with PCOS lack adequate progesterone which puts them at risk. Inadequate production of progesterone, due to anovulation (failure to release an egg from the ovary), also puts one at risk for uterine cancer.
Women who demonstrate irregular periods and anovulation will also experience fertility difficulty. Progesterone maintains pregnancy as it is pro-gestational, or the hormone of pregnancy. Women with PCOS have a 50% miscarriage rate due to loss of progesterone, thereby making it imperative that women with PCOS take natural progesterone throughout their pregnancy to prevent miscarriages.
Finally, most women with PCOS are thyroid resistant. Optimization of thyroid function improves metabolism and fatigue associated with PCOS as well as assisting in weight loss. Thyroid should be optimized by supplementing with natural thyroid hormone. Diet, exercise and weight loss are emphasized to further lower insulin resistance which, along with thyroid administration, increases success in lowering insulin resistance.
Appropriate treatment of PCOS:
- Treat the insulin resistance
- Replace progesterone
- Optimize thyroid
- Treat acne and hirsutism
Early diagnosis and adequate treatment of PCOS is of utmost importance for health and well-being. Increased patient awareness and understanding will hopefully lead to better diagnosis and treatment strategies, less health risks, and better quality of life for those 20% of women that have this endocrine (not gynecological) disorder.
Also, I am amazed at the number of women that I diagnose with PCOS that don’t have the “classic” PCOS symptoms. Any premenopausal women that complain of menstrual irregularity, PMS, heavy bleeding, mood disorder or sugar craving should be screened and treated for PCOS. With the advent of the internet, many women present to us having self-diagnosed themselves with PCOS from what they have researched.
Dr. Rouzier is founder of the Preventive Medicine Clinic in Palm Springs and can be reached at (760) 320.4292.