PCOS is one of the first endocrine disorders I consider when I am evaluating a patient of menstrual age who comes to see me for help with weight loss. PCOS differs from a disease because it produces such a wide range of symptoms. For example, you have to have low thyroid function to be labeled as having hypothyroid, but you don’t need to have cysts on your ovaries to have PCOS.
What is PCOS?
Polycystic ovary syndrome, or PCOS, is a condition that affects the hormone levels of females and how their ovaries work. It doesn’t always directly cause pain in the pelvic area, but it can, and often has other symptoms. Those with PCOS are likely to produce higher-than-normal amounts of male hormones, such as testosterone.
This hormonal imbalance causes their body to skip menstrual periods and can cause difficulties getting pregnant. It can also contribute to long-term health problems such as heart disease and diabetes.
PCOS starts with a genetic predisposition to the condition and then is fully manifested with the increase in carbohydrates and weight gain. Patients with PCOS also often have higher inflammation levels in their bodies than others, and being overweight may also increase a patient’s inflammation.
What are the main symptoms of Polycystic Ovarian Syndrome?
There are 5 factors that indicate PCOS, 3 of which are necessary to be put into this category:
- Irregular menstruation
- Sudden sensitivity to carbohydrates and weight gain, or elevated blood sugar or insulin levels
- New or excess facial hair that is thick and dark- this is known as hirsutism
- Elevated testosterone and androgen levels in the blood
- Ovarian cysts
Other symptoms patients have reported include:
- Baldness/thinning hair
- New acne
- Frequent headaches
- Darkening on patches of skin in the body creases such as under the breasts, on the neck, and in the groin
- Low libido
- Mood swings
- Trouble conceiving
When I suspect that PCOS is the cause for weight gain and/or difficulties losing weight and other symptoms, I confirm the diagnosis by putting the patient on PCOS treatment and evaluating their subsequent improvement.
We reduce their carbohydrate intake and if they lose weight, see a return to regular menstruation, their acne clears, and their blood work improves, then I am confident the PCOS diagnosis is correct.
How does PCOS affect the body?
PCOS is one of the primary causes of female infertility. To get pregnant, a patient’s body must be able to ovulate, but patients who do not ovulate regularly do not release as many eggs ready to be fertilized.
A lot of patients with PCOS are also overweight, which is dangerous as both obesity and PCOS put you at higher risk of low HDL “good” cholesterol, high LDL “bad” cholesterol, high blood sugar, and blood pressure.
When combined, these health issues are known as metabolic syndrome, and they increase a patient’s risk of diabetes, stroke, and even heart disease, so it’s worth keeping an eye on these problems.
How is PCOS diagnosed and treated?
By understanding that PCOS is a product of insulin sensitivity and that high insulin levels lead to elevated testosterone levels, we can use medications such as:
- Metformin – a diabetes drug that improves insulin sensitivity
- Spironolactone – decreases androgen levels
… either alone or together.
Treatment of PCOS should also include dietary changes, reducing the intake of sugar and carbohydrates in general – namely carbohydrates like white bread, rice, and pasta.
Who should I see if I believe I have PCOS?
Gynecologists see many patients with PCOS, as patients often first seek advice for their irregular menstruation. Gynecologists usually treat this syndrome with birth control as it masks irregular menstruation and improves acne with the androgen blocking effects of birth control.
However, by offering this treatment, the gynecologist isn’t dealing with the root of the issue, which is likely carbohydrate or insulin sensitivity, inflammation, and weight gain.
If you suspect you have PCOS, speak to your doctor. To gain full control of this syndrome, the insulin levels that feed the condition need to improve with dietary modifications and weight loss.
If the patient is not overweight, changing the diet to a plan that has fewer carbohydrates, such as the Mediterranean diet or paleo plan will often do the trick.
It is important to note that even if you experience one or more of the symptoms mentioned above, you may not necessarily have PCOS. If you suspect that you do have PCOS or a relative has a history of PCOS, go to see your doctor – your blood work will reveal whether or not you have PCOS and a switch to a low sugar and low carbohydrate diet will often help you start feeling balanced.
Dr. Nancy Rahnama, MD, ABOM, ABIM, is a medical doctor board certified by both the American Board of Obesity Medicine and the American Board of Internal Medicine. Her specialty is Clinical Nutrition, that is, the use of nutrition by a medical doctor to diagnose and treat disease. Dr. Rahnama has helped thousands of people achieve their goals of weight loss, gut health, improved mood and sleep, and managing chronic disease.