What is PCOS?
One of the common questions asked is, are there blood tests to tell for sure if you have PCOS? The answer is no. Primarily, medical history and physical appearance make the diagnosis. The medical literature discusses many different laboratory values but so far, none has been found to diagnose PCOS consistently. Some helpful tests would be an insulin level, FSH and LH levels (female hormones), a blood glucose level, and ultrasound. Approximately 60% of the patients with PCOS will have abnormal levels of the above or will have an abnormal ultrasound. In other words, an elevated insulin level will only be found in 60% of the women with PCOS. When patients had ultrasounds, only 50-60% of the women with PCOS had abnormal ultrasounds and 20% of normal women had abnormal ultrasounds. This illustrates why this is such a difficult disorder to diagnose and why many doctors do not recognize it. We have found the "Foley Score" to be quite accurate in determining which women actually have PCOS.
What is PCOS? It is a genetic disorder common in women with a family history of PCOS and/or a history of a parent, particularly a father, with elevated cholesterol, heart disease, and history of being overweight. Many times it first becomes noticeable in the late childhood/early teen years with abnormal weight gain. Poor eating habits or lack of exercise do not bring it on. It is a complex hormonal problem with effects on many body systems. The good news is that it can be treated!
The major component of this disorder is insulin resistance. To help illustrate what this does to your body, you must first understand how your body takes the food you eat and turns it into energy. Whatever you eat (carbohydrates, proteins, fat) must be turned into glucose in order for your body to use it as fuel. Your pancreas secretes insulin to help the glucose to get into the individual cells. For some reason that is not completely understood, people with insulin resistance require more insulin than normal for glucose to be used. The excessive insulin and/or the abnormal response to insulin cause most of the abnormalities seen in PCOS.
- Insulin resistance causes the ovaries not to work properly.
- It may cause cysts to form (thus the name polycystic ovarian syndrome)
- It may stimulate cells in the ovaries to secrete extra amounts of androgens (male hormone) and thereby not allow regular ovulation (thus the irregular periods and difficulty getting pregnant experienced by many women with PCOS)
- The excessive secretion of androgens also leads to male pattern hair growth and/or male pattern baldness (thus the increased facial, chest, and abdominal hair growth experienced by many women with PCOS) and excessive acne
- Insulin resistance leads to weight gain.
The hallmark of treatment of PCOS is the treatment of insulin resistance. This has two major components; medical and nutritional. Our nutritional program is covered separately on this site.
The current medication recommended is Metformin or Glucophage. It is very safe and is even continued during pregnancy without adverse effects to the woman or the unborn child. The only contraindication to taking Metformin is for those patients with kidney disease. Metformin works by allowing insulin to work more efficiently and by decreasing the resistance. This allows the pancreas to secrete less insulin thus decreasing the amount of insulin circulating in the blood and therefore decreasing the side effects mentioned earlier. It also appears to decrease the absorption of glucose in the intestine, which explains the most common side effect - increased intestinal gas and loose stools. If the appropriate foods are eaten, this side effect is minimal. There are many research studies on file that show there is no need to monitor blood sugar levels while on Metformin.