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Polycystic ovary syndrome, known as PCOS, is the most common endocrine (hormonal) disorder in women of reproductive age. It is characterized by a collection of symptoms, which include the following:
* excessive facial and/or body hair (hirsutism)
* weight gain
* adult acne or excessively oily skin
* absent or irregular periods
* difficulty getting pregnant
* hair loss (alopecia)
Other symptoms that may be associated with PCOS include the following:
* mood swings
* tender breasts
* joint pain
* pelvic or abdominal pain
In addition, women with PCOS are at greater risk of developing some longer-term health problems. These include the following:
* late-onset (type-2) diabetes
* high cholesterol levels, heart disease, and stroke
* cancer of the lining of the uterus (endometrium)
The main problems experienced by women with PCOS aremenstrual-cycle disturbances (irregular or absent periods), difficulty controlling body weight, and skin problems (acne and unwanted hair growth on the face or body). Not all women with PCOS experience all of these symptoms, and a woman's problems may change over time. In particular, if a person with PCOS becomes overweight, her problems will generally worsen.
Polycystic means "many cysts," and a syndrome indicates a collection of more than one symptom. About 30 percent of all women have multiple cysts on their ovaries, although only a smaller percentage will develop the symptoms associated with PCOS. Not all of the above symptoms need necessarily occur together to lead to a diagnosis of PCOS.
PCOS was first described by Irving Stein and Michael Leventhal in 1935. In fact, until fairly recently it was known as Stein-Leventhal syndrome. Because it was impossible in the 1930s to carry out the blood tests and ultrasound scans that we take for granted today, a diagnosis at that time was based on absent periods, hirsutism, and obesity. The combination of these three symptoms is now seen as the classic feature of PCOS. However, it is clear that the syndrome comes with a wide spectrum of possible symptoms, a fact that can make diagnosis difficult.
Various studies have shown certain symptom patterns in women with PCOS. As you can see from Table 1, irregular periods appear to be the most common symptom, closely followed by hirsutism, infertility, and being overweight.
If one looks at the statistics in another way, about 80-90 percent of women with irregular periods have PCOS, about 90 percent of women with acne have PCOS, and about 95 percent of women with hirsutism have PCOS.
Let's take a closer look at several of these symptoms.
Irregular or Absent Periods
A "regular" menstrual cycle is defined as being between 23 and 35 days from the start of one period to the start of the next; in addition, a "regular" cycle does not vary by more than two days from its average length. If your menstrual cycle, from the day you start one period to the day you start your next period, varies by more than two days it can be classified as irregular. Similarly, it is irregular if your periods occur closer together than 23 days, or farther apart than 35 days.
Having a cycle longer than 35 days is known as oligomenorrhea (infrequent menses), whereas going six months or more without a period is known as amenorrhea (absent menses). In women with oligomenorrhea, ovulation (the release of an egg from the ovary) either may be irregular or may fail to take place at all. This situation can be controlled by the use of the contraceptive pill, which is of most benefit to women who require a reliable form of contraception. Preparations of the hormone progesterone may also be used to help to regulate the menstrual cycle. (See Chapter 3 for a discussion of medications that help to regulate menstruation.) In some cases, irregular or absent periods may also be controlled by more natural means, which are outlined in Chapters 5 and 6.
The embarrassing condition known as hirsutism is defined as excessive facial or body hair, or both. The distribution commonly occurs in a male pattern; the possible areas affected include the upper lip, chin, upper and lower back, chest, upper and lower abdomen, upper arm, thighs, and buttocks.
The problem can be treated by the use of chemical depilatory creams, bleaching, laser, electrolysis, waxing, and shaving. If you do not want to become pregnant, your doctor may prescribe a contraceptive pill (such as Yasmin) to reduce the growth of unwanted hair. Since this type of therapy can take many months to show benefits, the hair-removal techniques mentioned above may be used in the meantime. (See Chapter 3 for more details on the medications that treat hirsutism and Chapter 5 for further information on hair-removal techniques.)
Fertility depends on many factors. For a start, ovulation-the release of an egg from the ovary-must occur; the male partner's sperm need to function normally; and the sperm require a normal passage to reach the Fallopian tubes, where fertilization takes place. It is a fact, though, that fertility declines with increasing age-particularly the age of the female partner. Fertility testing is usually started after a couple has been trying to get pregnant for a year, since by then it is expected that about 85 percent of young couples (those under the age of 30) should have conceived. If there is an obvious reason for reduced fertility (for example, infrequent menstrual periods and therefore few ovulations), it is reasonable to start tests and treatment right away.
The irregular ovulation often seen in PCOS is the most common reason for difficulty in getting pregnant. A woman normally releases an egg once a month and can conceive at this time. When the number of times she ovulates is reduced, the number of times she can become pregnant is also reduced. However, several medications exist that can effectively kick start the ovaries into action, and they are discussed in Chapters 3 and 4.
Sadly, women with PCOS appear to have a tendency to miscarry. Recurrent miscarriage (that is, three or more miscarriages) has been linked with PCOS. The exact cause is often unknown but may be related to hormonal disturbances and being overweight. Weight loss in overweight women with PCOS can dramatically improve their chances of getting pregnant and carrying the pregnancy to term.
The normal function of the ovaries and how the ovaries are affected by PCOS are described in detail in Chapter 2.
Weight Gain/Being Overweight
Weight-management problems are common in PCOS. Some sufferers put on extra pounds starting in puberty, when the female sex hormones can first go awry because of PCOS. In most cases, a normal body mass index (BMI) is between 20 and 25, but women with PCOS often have a higher BMI. BMI is calculated by dividing one's weight in kilograms by the square of one's height in meters. To determine your weight in kilograms, divide your weight in pounds by 2.2046. To determine your height in meters, divide your height in inches by 39.37. Therefore, a person weighing 140 pounds and with a height of five feet, five inches-or 65 inches-would calculate her BMI as follows:
Step 1 140 pounds ÷ 2.2046 = 63.5 kilograms
Step 2 65 inches ÷ 39.37 = 1.65 meters
Step 3 1.65 x 1.65 = 2.7225 (square of height in meters)
Step 4 63.5 ÷ 2.7225 = 23.32 BMI
Unfortunately, weight gain can be a double-edged sword in PCOS. Women with polycystic ovaries who would not normally develop the syndrome sometimes start having symptoms when they become overweight. And since a woman with PCOS may have a slower metabolism than normal, weight loss can be hard to achieve.
Although some women with PCOS experience no particular pattern of fat distribution, many others put on weight around their middle. Consequently, the ratio of the measurement around the waist to the measurement around the hips often increases. This is commonly known as being "apple-shaped" (as opposed to "pear-shaped").
Being overweight worsens the symptoms of PCOS-especially acne, unwanted hair, and infertility. Weight reduction will generally improve control of the menstrual cycle, reduce the heaviness of the menstrual flow, and improve fertility and the other symptoms of PCOS. A healthy eating plan combined with aerobic exercise is the only real answer for weight loss (for more information about diet and exercise, see Chapter 5). However, some drug therapies may also help (see Chapter 3). If you want to lose weight, try to enlist the support not only of your doctor, but also of your family and friends. Ask to be referred to a dietician if you feel you are unable to follow the diet recommendations in this book.
Acne is common in teenagers. However, when it persists into adult life (beyond the age of 20), the most common cause is PCOS. Acne and excessively oily skin are largely a result of the increased testosterone levels brought on by PCOS. Testosterone causes the sebaceous glands, which lubricate the skin, to go into overdrive and produce relatively large amounts of oil. The excess oil clogs the skin's pores (the tiny tunnels leading to the skin's surface). Bacteria exist on the surface of everyone's skin, but when the pores become blocked, the bacteria multiply within the sebaceous gland, causing pimples and small cysts to appear. Acne can appear on the chest and back as well as on the face.
Over-the-counter creams and lotions may be of some benefit in treating acne, as may the long-term use of certain antibiotics (erythromycin and tetracyclines-although tetracyclines must not be taken if you are trying to get pregnant). However, these products will not treat the underlying hormone imbalance that causes the acne in the first place. Again, if you do not wish to get pregnant, your doctor may prescribe a contraceptive pill, some of which offer the additional benefit of acne reduction.
Some women report a worsening of their acne when they discontinue taking the contraceptive pill. Whether you use the pill or not, the best long-term treatment for acne is probably an improved diet (see Chapter 5) and drinking lots of water. Some people find regular use of tea tree oil or hemp oil effective. These oils are applied directly to the skin. (For more information on the medications used to treat acne, see Chapter 3.)
Dealing with Embarrassing Symptoms
Women with PCOS can find themselves having to deal with a whole host of embarrassing symptoms. It is one thing to visit your doctor because you feel under the weather, and another to visit your doctor because you have hairy nipples and facial hair. Most women believe that a tendency toward excess facial or body hair is something they were born with. They are surprised to learn that this condition can be a symptom of hormonal disturbances and may therefore be treatable. It is the same with persistent adult acne. Women tend to think acne is "just one of those things"-Positive that they have drawn the short straw where zits are concerned and that they just have to come to terms with the problem.
Furthermore, who wants to see the doctor because they've been putting on weight? If they're not laughed out of the doctor's office, many believe, surely they'll simply be told to stop eating so much. Being overweight can be embarrassing, not least because onlookers may jump to the conclusion that you have been overeating-in other words, indulging yourself.
Frequently, when women tell their doctors that their periods are irregular, the problem is treated in isolation. This is generally because women don't even think to mention unwanted hair, acne, and an increase in weight; what can these other problems possibly have to do with irregular periods? It is a fact, though, that the doctor needs to see the whole picture before he or she can make a correct diagnosis. The doctor cannot know just by looking at you that you wouldn't be caught dead without your weekly application of a depilatory cream.
In the same way, your doctor will have no way of knowing that you've tried every diet ever promoted, but to no avail. It is also possible, if the doctor gives you only a cursory glance, that he or she won't realize you have acne beneath all that concealing makeup. As we said earlier, PCOS is not the easiest condition for either the patient or the doctor to recognize.
In many cases, the doctor may consider the symptoms of hair loss, weight gain, fatigue, irritability, and irregular periods as indicators of stress, for stress is known to have wide-ranging effects. Alternatively, mood swings, fatigue, pelvic and abdominal pain, and irregular periods may be attributed to premenstrual syndrome (PMS). When suffering from a condition that is as difficult to diagnose as PCOS, the patient herself may have to do some of the groundwork and then bring the condition to her doctor's attention. In the end, the responsibility for our own health lies with us-not with our doctors.
A Condition to Be Taken Seriously
To continue on the subject of embarrassing symptoms, some women are even reluctant to inform the doctor that their periods are irregular. Many of us were brought up thinking of our menstrual period as "the curse." We believe that it naturally causes moodiness, pelvic and abdominal pain, and even acne. Those with scanty periods may see the doctor, only to be told they should consider themselves lucky because a light flow is far easier to deal with than a heavier one. But long gaps between periods can lead to abnormal thickening of the uterine lining, which, in turn, can increase the risk of endometrial cancer. It is therefore essential to ensure that the lining of the uterus is shed at least once every three months to prevent abnormal thickening. Scanty or irregular periods are not always a symptom of PCOS, but they usually are.
The trouble with PCOS is that if it is left untreated, the long-term health risks mentioned at the beginning of the chapter may eventually rear their ugly heads. These health risks are discussed in more detail in Chapter 2.
Infertility is another, shorter-term side effect experienced by some sufferers of PCOS. Women tend to expect to have little or no trouble getting pregnant and so generally put off trying to conceive until the time is right-after all, pregnancy and childbirth are usually considered the most "natural" female functions of all. However, when there is no sign of a pregnancy after months or even years of trying ... well, it can feel like the end of the world. Infertility problems can cause great heartache. There are solutions, however, so keep reading.
What Does It Feel Like to Suffer from PCOS?
Although the symptoms of PCOS vary a great deal from person to person, sufferers often complain of feeling tired. They are likely to be concerned about their periods; as noted above, the periods are either heavy and frequent, scant and infrequent, or nonexistent. Consequently, sufferers of PCOS may worry about their ability to have children. Excessive facial or body hair, acne, and weight gain often arise in puberty, but women can develop these symptoms in their 20s, 30s, and even 40s. Also, because many of the symptoms rate high on the embarrassment scale, the affected woman will doubtless find her confidence shaken. It can be frightening to develop such symptoms seemingly out of the blue.
When hair loss from the head is a problem as well as hair growth in a male pattern on the face and body, some women secretly fear they are turning into men. To believe that your femininity is being threatened can be nothing less than terrifying. It doesn't even take hair loss or hirsutism for some women to feel they are losing their femininity; putting on weight and developing acne can have the same effect. Obviously, this state of affairs can lead to psychological problems. The emotional aspects of PCOS are discussed in Chapter 7.
The fact that some doctors may at first find nothing wrong or may attribute the symptoms to stress doesn't help matters. When a correct diagnosis is finally achieved, the patient may experience feelings of relief mixed with fear about what may lie ahead. However, please be assured that medications, lifestyle adjustments, and stress-management techniques can make an enormous difference in PCOS.
Excerpted from Positive Options for Polycystic Ovary Syndrome by Christine Craggs-Hinton Adam Balen Copyright © 2004 by Christine Craggs-Hinton. Excerpted by permission.
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