Chapter 1 : Polycystic Ovary Syndrome (PCOS) Polycystic ovary syndrome, known as PCOS, is the most common disorder, involving hormones, affecting women. It includes a variety of health issues and causes a multitude of symptoms. Pelvic exam Pelvic exam In a pelvic exam, your physician inserts two gloved fingers inside your vagina. While simultaneously pressing down on your abdomen, he or she can examine your uterus, ovaries and other organs. Transvaginal ultrasound Transvaginal ultrasound During a transvaginal ultrasound, your doctor or a medical technician inserts a wandlike device transducer into your vagina while you lie on your back on an exam table. The transducer emits sound waves that generate images of your pelvic organs, including your ovaries. On an ultrasound image inset, a polycystic ovary shows many follicles. Each dark circle on the ultrasound image represents a fluid-filled follicle in the ovary. Your doctor may suspect PCOS if you have 20 or more follicles in each ovary. Your doctor is likely to start with a discussion of your medical history, including your menstrual periods and weight changes. A physical exam will include checking for signs of excess hair growth, insulin resistance and acne. Your doctor might then recommend: The doctor visually and manually inspects your reproductive organs for masses, growths or other abnormalities. Your blood may be analyzed to measure hormone levels. This testing can exclude possible causes of menstrual abnormalities or androgen excess that mimics PCOS. You might have additional blood testing to measure glucose tolerance and fasting cholesterol and triglyceride levels. Your doctor checks the appearance of your ovaries and the thickness of the lining of your uterus. A wandlike device transducer is placed in your vagina transvaginal ultrasound. The transducer emits sound waves that are translated into images on a computer screen. If you have a diagnosis of PCOS, your doctor might recommend additional tests for complications. Those tests can include: Periodic checks of blood pressure, glucose tolerance, and cholesterol and triglyceride levels Screening for depression and anxiety Screening for obstructive sleep apnea Treatment PCOS treatment focuses on managing your individual concerns, such as infertility, hirsutism, acne or obesity. Specific treatment might involve lifestyle changes or medication. Lifestyle changes Your doctor may recommend weight loss through a low-calorie diet combined with moderate exercise activities. Even a modest reduction in your weight â for example, losing 5 percent of your body weight â might improve your condition. Losing weight may also increase the effectiveness of medications your doctor recommends for PCOS, and can help with infertility. Medications To regulate your menstrual cycle, your doctor might recommend: Combination birth control pills. Pills that contain estrogen and progestin decrease androgen production and regulate estrogen. Regulating your hormones can lower your risk of endometrial cancer and correct abnormal bleeding, excess hair growth and acne. Instead of pills, you might use a skin patch or vaginal ring that contains a combination of estrogen and progestin. Taking progestin for 10 to 14 days every one to two months can regulate your periods and protect against endometrial cancer. The progestin-only minipill or progestin-containing intrauterine device is a better choice if you also wish to avoid pregnancy. To help you ovulate, your doctor might recommend: This oral anti-estrogen medication is taken during the first part of your menstrual cycle. This breast cancer treatment can work to stimulate the ovaries. Metformin Glucophage, Fortamet, others. This oral medication for type 2 diabetes improves insulin resistance and lowers insulin levels. If you have prediabetes, metformin can also slow the progression to type 2 diabetes and help with weight loss. These hormone medications are given by injection. To reduce excessive hair growth, your doctor might recommend: These pills decrease androgen production that can cause excessive hair growth. This medication blocks the effects of androgen on the skin. Spironolactone can cause birth defect, so effective contraception is required while taking this medication. This cream can slow facial hair growth in women. A tiny needle is inserted into each hair follicle. The needle emits a pulse of electric current to damage and eventually destroy the follicle. You might need multiple treatments. Request an Appointment at Mayo Clinic Clinical trials Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease. Maintain a healthy weight. Weight loss can reduce insulin and androgen levels and may restore ovulation. Ask your doctor about a weight-control program, and meet regularly with a dietitian for help in reaching weight-loss goals. Low-fat, Page 1
high-carbohydrate diets might increase insulin levels. Ask your doctor about a low-carbohydrate diet if you have PCOS. Choose complex carbohydrates, which raise your blood sugar levels more slowly. Exercise helps lower blood sugar levels. If you have PCOS, increasing your daily activity and participating in a regular exercise program may treat or even prevent insulin resistance and help you keep your weight under control and avoid developing diabetes. Preparing for your appointment You may be referred to a specialist in female reproductive medicine gynecologist, a specialist in hormone disorders endocrinologist or an infertility specialist reproductive endocrinologist. What tests do you recommend? How does PCOS affect my ability to become pregnant? What medications do you recommend to help improve my symptoms or ability to conceive? What lifestyle modifications do you recommend to help improve my symptoms or ability to conceive? What are the long-term health implications of PCOS? I have other medical conditions. How can I best manage them together? What to expect from your doctor Your doctor is likely to ask you a number of questions, including: What are your signs and symptoms? How often do they occur? How severe are your symptoms? When did each symptom begin? When was your last period? Have you gained weight since you first started having periods? How much weight did you gain, and when did you gain it? Does anything improve or worsen your symptoms? Are you trying to become pregnant, or do you wish to become pregnant? Has your mother or sister ever been diagnosed with PCOS? Page 2
Chapter 2 : Polycystic ovary syndrome - NHS Polycystic ovary syndrome is referred to as PCOS. It's shockingly common - affecting up to 18% of women of reproductive age, 1 making PCOS the most frequently occurring hormone-related disorder. Polycystic ovary syndrome affects insulin, body weight, oxidative stress, inflammation, lipid levels. A PCOS guide to finding the right doctor and resources about polycystic ovary syndrome to help you manage your symptoms and assure you receive the best care. And, no matter what happens or what you are told, stay positive. The truth is, finding the right doctor for you may take a while. Seeking out support will go a long way in helping your stay positive during your PCOS journey. You are not alone! There are beneficial ways to help you stay optimistic, focused, and well-informed during your PCOS journey. Learn everything you can about PCOS. The most important point is to be sure you gather information from trustworthy sourcesâ online, in books, from well-informed not to be confused with well-intentioned but uninformed individualsâ to help you feel empowered to guide your own care. This can help you make smart lifestyle choices and to figure out what questions to ask your doctors about your diagnosis and care. Listen to your own body. No one knows you better than you. Jot notes in a notebook, or on your phone. The type of doctor that will be best for you will depend on your symptoms and needs, as well as the types of specialists available in your area. Doctors who can treat PCOS include: Your own primary care physician can take the lead in your PCOS care, and will likely draw in other specialists to help treat and resolve hormone and menstrual cycle irregularities as well as acne and hair growth concerns, metabolic challenges such as weight gain, and infertility. With advanced training in a wide variety of hormone-related medical problems, these specialists diagnose and treat PCOS as part of their medical focus but some focus on treating this condition specifically, which would be ideal for those in bigger cities or with access to a teaching hospital. Because menstrual and fertility problems can be your first warning signs of PCOS, many women start their journey with their gynecologist. Depending on your needs and other symptoms, your gynecologist might continue to treat you or refer you to an endocrinologist to coordinate your care. Reproductive endocrinology and infertility specialists: These doctors have advanced training in menstrual disorders, ovulation problems, and infertility issues. You may work with one of these specialists in order to gain specific help so you can conceive and have a baby. Practitioners who seek to determine the underlying cause of your specific symptoms by evaluating your genetic, biochemical and lifestyle patterns and then working with you to lessen the symptoms through lifestyle adjustments so you can achieve a healthy equilibrium. Unfortunately, these specialists, or many of the tests they require, may not be covered by your insurance. There is no one-size-fits-all treatment so you should only pay for what you need personally. To feel secure in your selection, make certain the functional medicine specialist has been certified by the Institute for Functional Medicine. You may also find it helpful to work with a dermatologist to address your skin problems like acne and with excess hair growth. How do you decide which doctor you should go to? Start with your current healthcare providers. Ask them for a referral to someone who a lot of experience with PCOS. Another option is to use the search tool provided by PCOS Awareness Association whose list of specialists have proven experience treating this condition. Search for a PCOS specialist. What is the likely cause of my polycystic ovary syndrome PCOS? Am I at risk for other health problems? What lifestyle changes should I be making to help relieve some of my symptoms and how do I make the right changes successfully? What kind of diet will help me regulate my blood sugar levels? What are my treatment options and what treatment would be best for me? In a British study,4 women said they felt they received the best treatment from doctors who: EndocrineWeb is constantly updating the information on polycystic ovary syndrome and will introduce new research findings regarding the diagnosis and treatment of PCOS. J Clin Endocrinol Metab. Williams T, et al. Diagnosis and Treatment of Polycystic Ovary Syndrome. Understanding and supporting women with polycystic ovary syndrome: Page 3
Chapter 3 : Book Review: The Dietitian's Guide to Polycystic Ovary Syndrome theinnatdunvilla.com Polycystic ovarian syndrome affects as many as 1 out of 5 women between the ages of It is a complex condition, which we will explore more deeply. If you are one of us, please read on, we can beat this PCOS thing together! Polycystic Ovary Syndrome PCOS is recognized as the most common endocrine disorder of reproductive-aged women around the world. It is a summary of current best practices in PCOS has been defined using various criteria, including menstrual irregularity, hyperandrogenism, and polycystic ovary morphology PCOM. General agreement exists among specialty society guidelines that the diagnosis of PCOS must be based on the presence of at least two of the following three criteria: Free testosterone T levels are more sensitive than the measurement of total T for establishing the existence of androgen excess and should be ideally determined through equilibrium dialysis techniques. New ultrasound machines allow diagnosis of PCOM in patients having at least 25 small follicles 2 to 9 mm in the whole ovary. Ovarian size at 10 ml remains the threshold between normal and increased ovary size. The management of women with PCOS should include reproductive function, as well as the care of hirsutism, alopecia, and acne. Ovulatory dysfunction is associated with increased prevalence of endometrial hyperplasia and endometrial cancer, in addition to infertility. In PCOS, hirsutism develops gradually and intensifies with weight gain. In the neoplastic virilizing states, hirsutism is of rapid onset, usually associated with clitoromegaly and oligomenorrhea. Hair loss patterns are variable in women with hyperandrogenemia, typically the vertex, crown or diffuse pattern, whereas women with more severe hyperandrogenemia may see bitemporal hair loss and loss of the frontal hairline. Oral contraceptives OCPs can effectively lower androgens and block the effect of androgens via suppression of ovarian androgen production and by increasing sex hormone-binding globulin. Physiologic doses of dexamethasone or prednisone can directly lower adrenal androgen output. Anti-androgens can be used to block the effects of androgen in the pilosebaceous unit or in the hair follicle. The choice of antiandrogen therapy is guided by symptoms. The diagnosis of PCOS in adolescents is particularly challenging given significant age and developmental issues in this group. Management of infertility in women with PCOS requires an understanding of the pathophysiology of anovulation as well as currently available treatments. Many features of PCOS, including acne, menstrual irregularities, and hyperinsulinemia, are common in normal puberty. Menstrual irregularities with anovulatory cycles and varied cycle length are common due to the immaturity of the hypothalamic-pituitary-ovarian axis in the 2- to 3-year time period post-menarche. Persistent oligomenorrhea 2 to 3 years beyond menarche predicts ongoing menstrual irregularities and greater likelihood of underlying ovarian or adrenal dysfunction. Metformin is commonly used in young girls and adolescents with PCOS as first-line monotherapy or in combination with OCPs and anti-androgen medications. In lean adolescent girls, a dose as low as mg daily may be effective at reducing PCOS symptoms; in overweight and obese adolescents, dose escalation to 1. Anti-androgen therapy in adolescents could affect bone mass, although available short-term data suggest no effect on bone loss. Page 4
Chapter 4 : Polycystic ovary syndrome (PCOS) - Diagnosis and treatment - Mayo Clinic Clinical Background [return to contents]: Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects about 1 in 15 women of reproductive age. 1 The exact cause is unknown but is thought to involve complex genetic and environmental interactions. Polycystic ovary syndrome Polycystic ovary syndrome Polycystic ovary syndrome is a disorder involving infrequent, irregular or prolonged menstrual periods, and often excess male hormone androgen levels. The ovaries develop numerous small collections of fluid â called follicles â and may fail to regularly release eggs. Polycystic ovary syndrome PCOS is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone androgen levels. The ovaries may develop numerous small collections of fluid follicles and fail to regularly release eggs. The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications such as type 2 diabetes and heart disease. Sometimes PCOS develops later, for example, in response to substantial weight gain. Signs and symptoms of PCOS vary. A diagnosis of PCOS is made when you experience at least two of these signs: Infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS. For example, you might have fewer than nine periods a year, more than 35 days between periods and abnormally heavy periods. Elevated levels of male hormone may result in physical signs, such as excess facial and body hair hirsutism, and occasionally severe acne and male-pattern baldness. Your ovaries might be enlarged and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly. Factors that might play a role include: If your cells become resistant to the action of insulin, then your blood sugar levels can rise and your body might produce more insulin. Excess insulin might increase androgen production, causing difficulty with ovulation. Research has shown that women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgens, which can lead to heart and blood vessel problems. Research suggests that certain genes might be linked to PCOS. The ovaries produce abnormally high levels of androgen, resulting in hirsutism and acne. Infertility Gestational diabetes or pregnancy-induced high blood pressure Miscarriage or premature birth Nonalcoholic steatohepatitis â a severe liver inflammation caused by fat accumulation in the liver Metabolic syndrome â a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular disease Type 2 diabetes or prediabetes Sleep apnea Depression, anxiety and eating disorders Abnormal uterine bleeding Cancer of the uterine lining endometrial cancer Obesity is associated with PCOS and can worsen complications of the disorder. Page 5
Chapter 5 : Polycystic Ovarian Syndrome (PCOS): The Ultimate Guide to PCOS Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly. Problems with breast milk production Insulin resistance Abnormally high LH: FSH ratios Usually to meet the criteria for a diagnosis of PCOS, on a pelvic ultrasound scan there will be 12 or more follicles visible on one or both ovaries, measuring between 2 and 9mm. Alongside these results, a blood test will be carried out to look for increased levels in testosterone and LH luteinising hormone, whereas FSH follicle stimulating hormone and SBGH sex hormone binding globulin will be at normal or reduced levels. This is because we are all different. Our bodies react to the hormones differently and what is a high androgen level for you, might be normal for my body, and so on with the other hormones. There is definitely a genetic component, if your mother had PCOS then the chances are much higher that you will also get it. Doctors believe that high levels of male hormones androgens, particularly testosterone prevent the ovaries from producing hormones and making eggs normally. Genes, insulin resistance, and inflammation have all been linked to excess androgen production. Studies show that PCOS runs in families 1. Extra insulin triggers the ovaries to produce more male hormones. Being overweight can also contribute to inflammation, but then higher inflammation also causes weight gain. It is a horrible upward spiral. Studies have linked excess inflammation to higher androgen levels 9. Underlying food intolerances, pollution and chronic stress are also major factors in modern day raised inflammation markers in the general population, especially women with PCOS. Most doctors will say there is no cure for PCOS. But there are plenty of women who have totally cured their PCOS with dietary and lifestyle changes and some key supplements. It is NOT about losing weight, no matter what your doctor might say. You need to turn your focus on getting good quality nutrition in to your body, to give it the healthy building blocks it needs to heal itself. Women with PCOS have higher markers of inflammation than women without the syndrome. Insulin resistance simply means your cells have shut down some of their insulin docking sites, which means your body produces more and more insulin to try and get the same effect that it used to have. The aim of a diet for PCOS is to 1 Remove inflammation 2 Stabilize blood sugar levels 3 Replace the missing and depleted nutrients A sick body cannot lose weight. By increasing the nutrition, and removing the toxic rubbish, we can cure PCOS naturally. Because our bodies are so out of whack, many of us really benefit from some hormone balancing herbs and vitamins. Myo-inositol and Vitex are my two favorites, as well as a top quality cod liver oil. No matter what your doctor tells you, no amount of going on the oral contraceptive pill is going to help or cure your PCOS. All it does is mask the problem. Your cycle is regular due to the pills so it seems like it worked. Try coming off of the pill for 6 months. If you managed to get a period in that time, then yay! But more commonly, people come off the pill to try and get pregnant, only to discover the underlying PCOS is still there. They still do not ovulate, and the longer they are off the pill, the more of the classic symptoms start turning up again. That is because the oral contraceptive pill does not cure PCOS! While people are on the pill, they tend to blame the pill for the weight gain, and the moodiness, and the cravings. We believe what the doctor said, this pill will fix your PCOS. It does seem to help somewhat with insulin resistance, and in some women it reduces sugar cravings. If you are finding Metformin is working for you, I am not suggesting that you stop it. But, what I am suggesting is that you should look into more long term, effective lifestyle changes. A healthy whole food diet, effective supplements and regular weight-bearing exercise. This is the tough one. I know it is hard, I have been there, and I am still struggling with it. If only it was that easy! Why is it so hard to lose weight with PCOS?? It is a multi-faceted issue. Estrogen is the hormone that makes you hungry AND helps you store fat. And on top of that, guess what? Fat cells produce more estrogen. When you ovulate, your body starts making much more progesterone, this is a sleepy sluggish hormone, designed to slow you down and protect your body in case you are pregnant. It allows you to burn the fat, and slows down digestion, meaning you absorb more goodness from it, but you are also less hungry. The problem is, your cells are still hungry, crying out for that sugar, so they tell your body that you are hungry. So you eat more, even Page 6
though there is actually plenty of energy being eaten and stored as fat. In a properly functioning body, the fat can be changed back into sugars when the body is hungry and it gets used back up. But because your insulin delivery system is broken, the energy sugars cannot get in to your cells, so you feel tired and lethargic, you crave sugar, AND your body slows its metabolism down because your cells are starving. Chronic inflammation can be caused by stress, food allergies and pollutants. All of these things put stress on your liver, and your liver is busy trying to metabolize and get rid of all that excess estrogen your body is making. But halfway through that process, your liver is being interrupted, to process these more urgent chemicals related to stress and toxins. This means that the half processed, but still active estrogen is re-released back into your blood stream only increasing the estrogen effects further. Chronic inflammation also seems to play a part in developing insulin resistance in the first place, and high insulin levels can trigger inflammation 5. Again it is that horrible ever-worsening spiral. What does inflammation do in your body? A body in this state of inflammation is on high alert at all times. You have excess fluid stored at inflamed sites to allow for extra passage of nutrients and white blood cells, who are marching around their territories on guard constantly. Your immune system is making and using up your immune cells very quickly. You may well catch every illness going, as your immune system is stretched to full capacity already. There is an emphasis on storing and keeping fat in case this high alert going full disaster and our food supply being cut off think of what our bodies are wired to protect us from, a chronic high alert scenario was one of war, famine or natural disaster. It is also the soft fat used to patch holes and cracks in stressed and inflamed blood vessels. The plaques we blame heart disease on, are formed to try and heal our inflamed and stressed veins and arteries. Why the sudden big rant about heart disease?? Women with PCOS are at much greater risk of developing heart disease 6. Chronically inflamed bodies are tired, depleted and sick. People with PCOS should avoid: Page 7
Chapter 6 : Your Guide to PCOS: What is Polycystic Ovary Syndrome? Polycystic ovary syndrome (PCOS), also known as polycystic ovarian syndrome, is a common health problem caused by an imbalance of reproductive theinnatdunvilla.com hormonal imbalance creates problems in the ovaries. Although the precise causes of PCOS are unknown, certain factors may contribute to its development. Insulin resistance contributes to the pancreas producing more insulin in the body. This excess insulin can increase male hormone production, which may hinder ovulation. Women with higher incidences of inflammation throughout the body can develop symptoms of PCOS. The inflammation may cause the ovaries to produce more male hormones. The Impact on Fertility In simple terms, PCOS alters menstrual cycles and hormone production, preventing ovulation, or the release of an egg. Without ovulation, women will be unable to become pregnant. Although ovulation issues are common in those with PCOS, there are many options available to help women become pregnant. What Treatments Are Available? While there is currently no cure for PCOS, there are a number of approaches for treating the symptoms of it. Combination birth control pills can be used to decrease male hormone production and regulate the female hormones, estrogen and progestin. Progesterone therapy is an alternative for those who cannot take combination birth control pills. This therapy regulates the menstrual cycle and helps to prevent endometrial cancer. Unlike the birth control pill approach, this therapy will not prevent pregnancy. A number of medications may be prescribed or suggested by your doctor, Metformin is one such medication commonly used. Although this medication is often used to lower insulin levels in patients with type two diabetes, it may also help to promote regular ovulation and regular menstruation. In patients that are prediabetic, it can slow the progression to full type two diabetes. For women trying to become pregnant, medications may be necessary to help ovulation. Clomiphene is another medication which is taken orally during the first phases of the menstrual cycle. Metformin is then often used in conjunction with clomiphene to increase the effectiveness. Follicle-stimulating hormone FSH and luteinizing hormone LH therapy approaches are hormone replacement therapies that can be used when clomiphene and metformin fail. Injectable medications such as Letrozole may later be prescribed if these other medications do not work. For those looking to avoid medicated assistance with managing PCOS symptoms and becoming pregnant, key lifestyle changes can be made to help conceive. Because of the link between PCOS and diabetes, a proper diet and the maintaining of a healthy body weight can aid in avoiding bigger problems down the road. Since inflammation and high blood glucose levels are two threatening factors with PCOS, foods on the high glycemic index, dairy, bad fats, sugar and artificial sweeteners, processed foods, and soy should be avoided. These foods cause a spike in blood sugar and can affect the amount of insulin released into the blood stream. A low carbohydrate diet, with a focus on complex-carbs, can help to lower insulin levels. These carbohydrates are high in fiber content and take the body longer to digest, thus leading to a slower increase in blood sugar levels. Planning out meals with whole foods, lots of fresh produce and an increase in fiber can help guide a PCOS-friendly diet. In addition to a healthy diet, frequent exercise and proper supplementation may help further increase fertility levels to help with conception. In addition to lifestyle changes and medications women can take, there are more aggressive approaches for conceiving. These approaches include in vitro fertilization IVF is also available. IVF involves removing an egg or eggs from the patient and fertilizing it with sperm outside of the body. Surgery is another treatment option available to help with conception. In women with PCOS, the outer shells of the ovaries are often thickened, thus hindering normal ovulation. Ovarian drilling is one approach which can be successful in promoting ovulation, but only works for a short time. For a laparoscopic ovarian drilling approach, the doctor makes small holes in the surface of the ovaries. This procedure results in a significant decrease in male hormones. PCOS is a common disorder affecting women, but there are a number of treatment options and lifestyle changes available for women to select to help increase fertility and overcome hindering symptoms. Women exhibiting possible signs of PCOS should contact their primary care doctor to discuss diagnosis and treatment options. Chapter 7 : Polycystic ovary syndrome (PCOS) - Symptoms and causes - Mayo Clinic Page 8
Polycystic ovarian syndrome (PCOS) is a disorder involving excessive androgen production. PCOS affects an estimated 6%-8% of women in the United States, but diagnosis can be difficult due to the variability of presentation and actual prevalence may be considerably higher. Chapter 8 : A Complete Guide to Polycystic Ovary Syndrome - theinnatdunvilla.com What Is It? Polycystic ovary syndrome is a hormonal disorder that affects millions of women. Sometimes it's called Stein-Leventhal syndrome. All bodies need both "male" and "female" hormones to. Page 9