OBGYN shares advice for those who have been diagnosed with PCOS

Polycystic Ovarian Syndrome, or PCOS, is a common, yet complex, hormonal and endocrine disorder that affects an estimated 6-13% women of reproductive age, according to the World Health Organization. During Polycystic Ovarian Syndrome Awareness Month in September, Dr. Utsavi Shah, assistant professor of obstetrics and gynecology at Baylor College of Medicine, explains the signs and symptoms of the condition and provides advice and treatment options.

There are many factors as to why a woman may develop PCOS. It is caused by a complex interplay of genetics, environmental factors such as obesity and lifestyle, hormonal abnormalities, and metabolic factors. All of these can lead to dysfunction of the hypothalamic-pituitary-ovarian axis, which is the connection between the brain, the ovary and the production of hormones leading to increased androgens and insulin resistance

“I always tell my patients that PCOS is a clinical diagnosis, meaning it’s based on both laboratory findings, symptoms and a wide range of factors. There isn’t a single test that we could use to check to see if a person has PCOS,” Shah said.

How is PCOS diagnosed? What are the signs and symptoms?

“The most widely used and accepted diagnosis method for PCOS is the Rotterdam criteria,” said Shah.

The criteria include:

• Menstrual irregularities such as skipping months due to irregular or absent ovulation.
• Signs of hyperandrogenism either due to clinical symptoms such as hirsutism which is increased hair growth, acne, etc. or laboratory elevations of testosterone and/or DHEA sulfate levels (your testosterone and DHEA sulfate).
• An ultrasound of a woman’s ovaries to see if their polycystic features present, usually multiple tiny follicles on the outer rim of the ovary like a pearl necklace.

PCOS treatment: What are your goals?

For those with PCOS, Shah says that she makes sure to ask her patients what their goals are because there isn’t a specific pill or treatment for the condition.

“A lot of times, the treatment can be contradictory to what a patient’s goals are, so I always ask,” Shah said. “Treatment options are going to be different for those who want to conceive versus those who don’t.”

For those who do not want to be pregnant, PCOS treatment can start with hormonal medications to regulate the menstrual cycle, like birth control pills, the NuvaRing, an IUD or the patch. There also is medicine like spironolactone that can help to reduce testosterone levels.

“If you are a woman with PCOS and are overweight or obese, modest weight loss, about 10% of your body weight, can dramatically reduce PCOS symptoms including regulating your cycles, decreasing testosterone and helping with fertility,” Shah said.

Treatment is individualized based on factors and symptoms that women may be experiencing, such as insulin resistance, hair growth or acne.

Shah adds that if she has a patient with PCOS who is looking to get pregnant and is actively trying to conceive, there are medications that can help stimulate ovulation. There are also more aggressive approaches, like in vitro fertilization (IVF).

An OBGYN’s advice for those diagnosed

For women who have been diagnosed with PCOS, know that you are not alone.

“It is important to give yourself grace, even though this condition feels like it can be isolating. There are great resources and physicians who can help you,” said Shah. “You must stay consistent with your medications, and if a certain treatment doesn’t work, see your physician to readdress and reevaluate.”

By Taylor Barnes