A recent report revealed that there are so many cases of polycystic ovary syndrome (PCOS) in the US that costs for diagnosis and lifetime treatments are estimated to be $8 billion a year.
If you have PCOS, obviously you’re not alone. It’s estimated that PCOS affects one woman in seven (estimates go as high as 15-20% of reproductive-age females), and, sadly, most go undiagnosed for years and years. We do see a lot of women with PCOS at our WholeHealth Chicago centers.
The most common PCOS symptoms are irregular periods, a disruption in glucose and sex hormone metabolism leading to weight gain, and elevated levels of the male hormone testosterone. All of these frequently result in infertility, obesity, diabetes, acne, increased facial hair, and heart disease and can increase your risk of developing endometrial cancer (the lining of your uterus).
The four types of PCOS:
- Insulin resistance PCOS. This is by far the most common, occurring in 70 per cent of women with PCOS.
- Adrenal PCOS. Triggered by an episode of severe and protracted stress.
- Inflammatory PCOS. Caused by chronic inflammation.
- Post-pill PCOS. This type can occur after you stop taking birth control pills.
The symptoms of PCOS may include:
- Missed periods, irregular periods, or very light periods;
- Excess body hair, including the chest, stomach, and back (hirsutism);
- Weight gain, especially around the belly (abdomen);
- Acne or oily skin;
- Male-pattern baldness or thinning hair;
- Infertility;
- Small pieces of excess skin on the neck or armpits (skin tags);
- Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts.
The standard diagnostic tests for PCOS are:
- Blood tests that check for evidence of elevated male hormones (testosterone and androstenedione).
- Tests to check for insulin resistance (Hemoglobin A1c, fasting blood glucose and triglyceride levels).
- Vaginal ultrasound to look for cysts.
- Tests for levels of cholesterol and other hormones (estrogen, progesterone, and thyroid and adrenal hormones).
However, and this is a big however. If you have all the clinical findings of PCOS, but your tests are normal, you should assume you are pre-PCOS and begin treatment with diet, exercise, and natural remedies. Start with nutritional counseling with one of our nutritionists along with weight reduction and exercise. I suggest the supplement CinndromX by Xymogen (one capsule, twice a day).
Every woman who has PCOS should work with a nutritionist. There’s probably no endocrine disorder, except perhaps for diabetes, whose outcome relies so heavily on healthful eating. Avoid ultra processed foods with additives and chemicals like the poisons they are. Our nutritionists are familiar with the glucose changes of PCOS and will familiarize you with using a Continuous Glucose Monitor (CGM).
If insurance denies coverage (as they are prone to do) a CGM is less than $100.
The causes and medical treatments of PCOS are not completely known although some cases run in families.
- The cysts in the ovaries produce androgens (like testosterone) responsible for acne and facial hair. A variety of medications are used to treat these hormonal imbalances, which for most patients are very safe. First: a combined oral contraceptive (estrogen/progesterone) will drive down levels of testosterone; if not completely effective, your doctor may add spironolactone or cyproterone to further reduce testosterone. The latter is not available in the U.S. but readily available in Canada and mailed to your home.
- Similarly to Type 2 diabetes, there is resistance to insulin’s ability to lower your blood glucose. The starting medication for PCOS obesity and diabetes has been metformin, but the very best news on the horizon has been how dramatically many cases respond to the semaglutide family (Ozempic, Trulicity, etc.) Here’s a great story about a young woman with PCOS whose life was changed by semaglutides (75 lb weight loss, no more diabetes!).
- Since semaglutides are not FDA approved for PCOS, you will need an rx for the compounded version ($300/month instead of $1300/month for Big Pharma’s version).
- Another piece of exciting news is that semaglutides are now available in tablet form. Rybelsus 3 mg. and 7 mg. (one tablet daily), and although only FDA approved for Type 2 diabetes, clinical trials are finishing up for PCOS. It will be quite a while before insurance picks up the $950/month, but it is readily available in Canada for $255/month (not generic but not covered by insurance).
- Many women with PCOS and menstrual irregularity also discover they have trouble getting pregnant. They polycystic ovaries are simply not releasing eggs. Fortunately, these patients usually respond to the “ovulation inducers”, like Clomid, letrozole and gonadotropin agents.
Keep in mind that the average woman with PCOS sees a half a dozen members of the health care system (physicians, nurse practitioners, dermatologists, alternative practitioners) before she learns about PCOS. Along the way, she may be discouraged by the “fat shaming” from friends or the medical profession itself and simply give up hope. Also add the risks of diabetes, cholesterol, obesity and heart disease, having PCOS and not taking it seriously will subtract at least a year from her life .
When I was in med school, PCOS was quite uncommon. Now you see articles in magazines and experts on daytime talk shows trying to explain a condition no one really understands. At least today there’s hope for affected women, who find themselves becoming overweight and infertile, growing facial hair, and getting acne.
This diagnostic delay is a good example of a serious flaw in the specialized education of doctors. Ovaries, infertility, and irregular periods are considered the purview of obstetrician-gynecologists. Obesity, excess facial hair, metabolic syndrome, and cholesterol are internist territory. PCOS requires that an obstetrician-gynecologist think like an internist…and vice-versa.
And it’s only been recently that the two groups of physicians sat down and started discussing what seems to be a near-epidemic of PCOS.
What causes PCOS? A Summary:
The situation is further complicated by the absence of straightforward tests to make a clear-cut diagnosis, not helped by the fact that doctors are uncertain what triggers PCOS in the first place. There appears to be a genetic predisposition. PCOS is common in sisters and mothers, and brothers of PCOS patients have high levels of pre-testosterone DHEA, though it’s harmless to them.
Some researchers attribute the explosion of PCOS to hormone disruption caused by the massive amounts of toxic chemicals in our environment, which can trigger PCOS in genetically susceptible women.
The underlying problem in PCOS begins when the ovaries develop fluid-filled sacs called cysts and begin to secrete an excessive amount of the male hormone testosterone. This in turn disrupts menstrual regularity and ovulation and leads to infertility. It’s the testosterone that also causes excessive facial hair and acne.
To complicate matters, women with PCOS develop resistance to the blood sugar-lowering hormone insulin, a situation similar to Type 2 diabetes that leads to high levels of glucose (sugar) in the blood, weight gain, high cholesterol, and even more testosterone production.
To compensate for insulin resistance and high blood sugar, the body produces even more insulin, which in turn produces even more male hormone, like a snowball rolling downhill out of control. After years of elevated glucose and cholesterol levels, women with untreated PCOS become susceptible to heart disease and high blood pressure.
In short: High levels of insulin lead to pre-diabetes, diabetes, and obesity. High levels of testosterone lead to irregular periods, infertility, facial hair, and acne.
Treating “Pre-PCOS”
Often, women with PCOS will see improvements in their overall health and well-being by wholeheartedly embracing a healthy lifestyle. It is well-established that junky foods make matters worse with PCOS. Here are four steps to consider:
- Immediately begin a weight-reduction program centered on eating a low-carbohydrate diet with protein, veggies, and fruit. You should eat as organically as possible to detoxify yourself, but this needn’t be the $100-a-bag approach from WholeFoods. Many groceries now carry organically grown produce, and with the money you’ll be saving by not purchasing prepared and processed foods, trust me you’ll come out ahead. If you need help with all this—including very practical and eminently usable advice on how to shop your local grocery for best results–set up an appointment with one of our nutritionists.
- It’s essential you start a regular exercise program to burn off toxin-storing fat and to strengthen your muscles. This isn’t a question of vanity–it’s a medical necessity. You can hire a personal trainer or you can easily start on your own. Look for a workout that combines cardio, strength training, and stretching. The online choices are endless.
- Supplements. You need a good general multiple vitamin like O.N.E. or a good prenatal if you’re trying to conceive.
Be well,
David Edelberg, MD