A comprehensive guide to polycystic ovary syndrome, from a leading authority on the condition
One in ten American women of childbearing age is affected by polycystic ovary syndrome (PCOS) to some degree, and many suffer from serious symptoms, such as infertility, early miscarriage, chronic pelvic pain, weight gain, high blood pressure, acne, and abnormal hair growth. PCOS is by far the most common hormone imbalance in women of this age group, yet few women understand the threat it poses to their health—or how to prevent it.
In A Patient's Guide to PCOS, Dr. Walter Futterweit, a foremost authority on PCOS in America, tells women everything they need to know about this condition and how to treat it. Drawing on his twenty-five years researching and treating the condition and his ongoing long-term study of more than a thousand women with PCOS, Futterweit discusses
• what PCOS is and how it affects your body
• what to eat and how to exercise to control PCOS
• all the treatment options, including the latest drug therapies
• how to reverse PCOS-induced infertility and restore
healthy skin and hair
• resources for preventing, diagnosing, and treating PCOS
This comprehensive guide contains everything women need to know about PCOS—from identifying warning signs and seeking a diagnosis to finding emotional support in recovery—to regain their health and resume their lives.
|Publisher:||Holt, Henry & Company, Inc.|
|File size:||4 MB|
About the Author
Walter Futterweit, M.D. F.A.C.E., F.A.C.P., is co-chief of the Endocrine Clinic and Clinical Professor of Medicine at Mount Sinai School of Medicine in New York City. Author of more than 100 papers and numerous textbook chapters, he lectures regularly before lay and professional groups, conducts ongoing research about PCOS, and maintains a private practice in Manhattan focused on PCOS. He is married and lives in New York City.
George Ryan has collaborated on many health books, including Before the Change by Anne Louise Gittleman and The Heart Depression Connection by Windsor Ting, M.D., and Greg Fricchione, M.D.
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A Patient's Guide to PCOS
Understanding â" and Reversing â" Polycystic Ovary Syndrome
By Walter Futterweit, George Ryan
Henry Holt and CompanyCopyright © 2006 Walter Futterweit and Lynn Sonberg Book Associates
All rights reserved.
What PCOS Can Do to You
A woman usually learns that she has polycystic ovary syndrome (PCOS) because of irregular periods, infertility, or skin and hair problems. Unfortunately she may never learn that PCOS puts her at increased risk for cardiovascular disease and diabetes. Receiving the right medical care can greatly alleviate the symptoms and serious dangers of the condition.
The approximately 6 million American women who have PCOS have ovaries that secrete excessive amounts of male hormones (mostly testosterone) into their blood. A polycystic ovary is one with many cysts — the remains of follicles that never released mature eggs. But polycystic ovaries are a symptom or sign of the problem, not the cause. Three out of four women afflicted with this kind of infertility and other symptoms do not know that PCOS is the cause. Many are misdiagnosed. Some women who come to my office have been suffering from their symptoms for years without a correct diagnosis or proper treatment. This is all the more sad because effective treatments for PCOS symptoms exist and are readily available. Considering the possible diabetic, cardiovascular, and other serious consequences of untreated PCOS, early diagnosis and immediate treatment can be of life-saving importance.
In this chapter, I'll encourage you to take a PCOS quiz and then I'll describe the condition's telltale symptoms. Look at the basic health problems involved in the condition. This should enable you to make a realistic self-assessment of whether to take the next step, which is to find a medical specialist who can make a reliable diagnosis. At the end of this first chapter you should be able to understand and discuss your health problems in a new light.
A DOCTOR'S PERSPECTIVE
You probably have already heard about PCOS and have reasons to think this condition could be responsible for your health or appearance problems. To confirm or deny your suspicions with certainty you will need a medical diagnosis from a specialist, and we discuss that process in chapter 5.
Polycystic ovary syndrome (or polycystic ovarian disease, as it was called until about twenty years ago) was originally named the Stein-Leventhal syndrome, after two Chicago gynecologists at the Michael Reese Hospital, Irving F. Stein and Michael L. Leventhal. In 1935 they published their observations of the presence of large, polycystic ovaries in women with an absence of menstrual cycles, increased body hair growth, and infertility. Portions, or wedges, of ovarian tissues were sometimes surgically removed in what were known as wedge resection biopsies. Women who had such biopsies of both ovaries started to have regular menstrual cycles, and some conceived. This procedure helped regulate the menstrual cycle and enhanced fertility for a year or two, but then irregular periods and infertility problems returned. In the early 1960s the procedure was discontinued.
If you haven't heard much about this syndrome until very recently, that's most likely because many women and some health professionals may not be familiar with it, not because the condition is rare. Let's start with a few simple questions.
The big question, of course, is whether you have PCOS. You probably have symptoms that lead you to think you might have the condition. This quiz narrows down the really important questions you need to ask yourself. But that is all the quiz does. Even if you answer yes to every one of these questions, this does not guarantee that PCOS is the cause of your symptoms.
The twelve quiz questions focus on three common problem areas.
IRREGULAR MENSTRUAL PERIODS
1. Do you have eight or fewer periods a year?
2. Have you ever gone four months or longer without having a period?
3. Do you have irregular bleeding or spotting?
4. Are you having trouble conceiving?
SKIN AND HAIR PROBLEMS
5. Do you have excessive hair on your face and body?
6. Do you have severe adolescent or persistent adult acne?
7. Do you have thinning scalp hair?
8. Do you have skin tags or velvety, dark skin patches on the nape of your neck?
9. Have you recently had a significant weight gain?
10. Do you carry excess weight around your waistline?
11. Do you feel sugar cravings, drowsiness, and sometimes light-headedness within the first few hours after a meal?
12. Do you or any close family members have type 2 diabetes?
Answering yes to five or more of these twelve questions means that you need to seek a diagnosis. If PCOS is not the cause of your problems, something else is. You need professional help.
Answering yes to even one of these questions should alert you to a possible developing health problem. Don't wait in hope that the symptom will disappear in time of its own accord. Perhaps it will, but why wait? It's certainly worth discussing with your doctor.
Janet's health problems began at the age of twelve, with her first period. Throughout her teens, her periods were erratic, occurring only every two or three months, and the bleeding lasting two to three weeks each time. Doctors could find nothing wrong with her. She continually suffered from minor ailments that disappeared in time, only to reappear or be replaced by others. One doctor thought that depression might be the underlying cause of her physical ailments and sent her to a psychiatrist. She developed high cholesterol and weight problems in her late twenties.
Finally a doctor diagnosed Janet with PCOS and explained how it led to erratic periods and unwanted facial hair. Unfortunately the doctor didn't warn her about weight gain and other health problems. At times, she had feelings of uncontrollable hunger. At other times, the smell of some foods could make her vomit. Janet often found that she couldn't stand the presence of certain people, even though they had done nothing to justify her feelings against them and she knew she would feel differently about them again in a few days.
It didn't occur to her for a long time — until she joined a support group — that these problems might be associated with PCOS.
WHAT ARE THE SYMPTOMS?
Polycystic ovary syndrome is not a disease in the sense of a single malady, but rather is a combination of various symptoms that share an underlying cause. Some women have only a few symptoms, while others have many. Your symptoms may also vary in degree and intensity.
The following are the most important symptoms to look for. Although symptoms vary from one woman to the next, all women with PCOS experience at least some of these symptoms.
Excessive hair growth on face and body
Scalp hair thinning
Excess weight, sugar craving, and inability to lose weight (plus abnormal blood lipid levels and a tendency to an apple shape)
Darkening of skin areas, particularly on the nape of the neck, known as acanthosis nigricans
Gray-white breast discharge
Depression, anxiety, sleep disturbances, and other emotional disorders
You may have blamed these symptoms on your metabolism or assumed (as some of my patients do) that they were a family trait. Some women put up with their symptoms for years, until they decide want a baby and have trouble conceiving. Or they seek professional help when their skin and hair problems become so embarrassing. Other women diligently seek professional help but are repeatedly misdiagnosed.
When I organized and chaired the Polycystic Ovary Syndrome Association (PCOSA) Annual Conference in San Diego in 2000, I was struck by the great number of women there in search of answers and appropriate treatment. Those I spoke to told the same story again and again: They had been suffering from their symptoms for years and — perhaps like you — they were done waiting for help to find them. They were ready to take control.
OVARIES AND EGG CELLS
Understanding how ovaries function in a normal menstrual cycle is essential to understanding what happens in PCOS. The ovaries are among the first organs formed in a developing female fetus. A female fetus twenty weeks old has a whopping 6 to 7 million egg cells. At birth, that number has declined to between 1 and 2 million, and at puberty, a girl has about 300,000 eggs cells. During a woman's reproductive years, about 300 of those egg cells develop into mature eggs. For every one that matures, about 1,000 do not. By menopause, just a few thousand egg cells remain.
When a girl reaches puberty, the sex hormones begin to activate some of her hitherto inactive egg cells. In each menstrual cycle, about twenty eggs in one ovary become activated. Each ripening egg develops in a fluid-filled sac, surrounded by a sheath of support cells collectively called a follicle. Only one of the twenty or so follicles becomes dominant and continues to ripen until the egg is mature, while the other follicles whither. At ovulation, the dominant follicle ruptures and the egg is released and travels through the fallopian tube to the uterus.
The "cysts" of PCOS are dominant follicles that never released their eggs and remain embedded in the ovary. Even when their periods are regular, women with PCOS often have menstrual cycles without ovulation, that is, without the dominant follicle rupturing and releasing its egg. These are called anovulatory cycles.
Why doesn't the dominant follicle release its egg? A higher than normal blood level of male hormones, mostly testosterone, is probably responsible. So what makes the ovaries secrete more male hormones than normal into the bloodstream? Many experts believe a high blood level of insulin is the culprit; in a few pages we will look at other possible causes.
HORMONES AND OVARIES
Let's look briefly at how hormones regulate the menstrual cycle. Some of this will be familiar to you from biology class, but it's probably been a while since you've focused on the details. For egg release or ovulation to occur, a menstrual cycle must take place. The cycle is initiated and regulated by hormone-secreting organs in the brain. The cycle begins with the hypothalamus signaling the pituitary gland to produce follicle-stimulating hormone (FSH), which stimulates growth of the egg follicles as well as estrogen secretion by the ovaries. Blood-borne estrogen travels to the uterus and thickens its lining (endometrium). The rising estrogen blood level signals the pituitary to reduce FSH secretion. This in turn causes the ovaries to secrete less estrogen into the bloodstream. The rising estrogen blood level also causes the pituitary to produce a surge of luteinizing hormone (LH). In a healthy woman, LH causes the dominant follicle to rupture and release its egg. In other words, the woman ovulates.
After ovulation, the ruptured follicle becomes the corpus luteum (yellow body), secreting estrogen and progesterone to build up the uterus lining. If the egg is fertilized, it becomes embedded in this lining.
When the egg is not fertilized, the rising progesterone and estrogen blood levels signal the pituitary to stop secreting LH and FSH. This results in a lowering of the progesterone and estrogen blood levels, which can no longer maintain the uterus lining. The lining is shed in menstruation, marking the end of the cycle.
The reduced FSH blood level causes the hypothalamus to signal the pituitary to secrete more of this hormone, and the cycle begins again.
A number of problems can prevent adequate hormonal signaling in this complex process. For example, secretion of the hypothalamus must be in a critical range to stimulate the pituitary to secrete FSH and start the menstrual cycle. This can be inhibited by stress and anxiety, eating disorders, and acute weight loss. Other problems can lead to a lack of ovulation (anovulation), few menstrual cycles (oligomenorrhea), or an absence of cycles for many months (amenorrhea).
Research shows that carrying extra pounds can also throw a wrench into the works. Hormone precursors to estrogen may be metabolized in fat cells. This takes place in direct proportion to body weight and is important in the well-known association between obesity and frequent anovulation.
Scientists and practicing clinicians have multiple theories about how polycystic ovaries and the polycystic ovary syndrome originate. That's not surprising when you consider the complex interaction of hormones involved in a normal cycle. Any disruption in the process leading to ovulation may lead to the same result: an ovary that doesn't release an egg. Keeping in mind that PCOS is not a disease but a series of symptoms and signs, it makes sense that different sets of symptoms may indicate different causes.
WHAT CAUSES PCOS?
Although PCOS is the most common hormonal syndrome in women of reproductive age in the world, there is much controversy about its origin and cause. There may be more than one cause, and this would account for why symptoms vary so widely. Potential causes include almost any defect that can cause excessive male hormone production and consequent (but not invariable) anovulation. Some women may inherit a predisposition to PCOS. If a woman vulnerable to it rapidly gains weight, that may be enough to trigger the syndrome — or make already irksome symptoms more severe.
The following proposed causes of PCOS are generally accepted as the most likely.
1. A defect in the hypothalamus leading to exaggerated LH pulses that stimulate the ovaries to secrete more than normal amounts of male hormones.
2. A defect in the ovarian production of testosterone and other male hormones due to abnormal enzyme action on the pathways leading to testosterone.
3. High insulin levels (hyperinsulinemia) as a result of insulin resistance, which further strengthens the effect of LH on the ovaries (see number 1).
4. Genetic causes: Forty percent of women with PCOS have a sister with PCOS, and 35 percent have a mother with PCOS.
UNDERSTANDING THE SYMPTOMS
We look now at PCOS symptoms in more detail. Hormonal conditions other than PCOS can also cause these symptoms, and such diseases, which are often easy to confuse with PCOS, will be discussed in chapter 5.
IRREGULAR MENSTRUAL PERIODS (FREQUENCY 75 TO 80 PERCENT)
With regular periods a woman sheds the lining of her uterus (endometrium) about once a month. For most women a cycle is twenty-eight days, but a normal cycle can be as short as twenty-one days and as long as thirty-five. An individual woman's cycle is usually of consistent length, unless interrupted. Her menstrual period is also usually consistent in length, from three to six days.
Nearly all women have periods by the age of sixteen. Not having periods is known as amenorrhea. Pregnancy, overly strict dieting, and major weight loss can temporarily suspend your periods. For example, women with anorexia nervosa do not have periods. By upsetting hormonal process of the menstrual cycle, extreme exercise, high stress levels, or use of corticosteroids and other drugs can have the same effect, as do thyroid, adrenal, and pituitary troubles.
Cycles longer than thirty-five to forty days fall outside the normal range, but before you chalk that up as your first PCOS symptom, you need to consider whether any of the causes just mentioned could be responsible. You also need to take into account that some women have irregular periods as part of their normal physical being. Many adolescents and women nearing menopause have irregular periods. A lot of travel causes this in some women. You need to eliminate as many of these possible causes as you can before looking at PCOS.
That said, they are a characteristic and early symptom — for example, most girls with PCOS have irregular periods within a few years of their first menstrual cycle. Martha, at seventeen, had never had more than four periods a year since reaching puberty at the age of twelve. For the first few years she had thought nothing of it — quite a few of her classmates also had irregular periods. Over time, when her friends became regular but Martha did not, her mother became concerned. Martha was an only child, her mother explained, because of her own irregular periods and difficulties conceiving.
To help your doctor assess your situation, you need to keep careful written records of the dates and durations of your menstrual cycles, as well as any premenstrual symptoms such as bloating, pelvic discomfort, body swelling, and irritability.
Women with PCOS typically have five to nine menstrual cycles a year, with intervals averaging forty to sixty-five days. Menstrual flow usually lasts four to six days. Most women with PCOS have no discomfort prior to or during the early phase of menses. Some women, however, complain of bloating, breast discomfort, mood changes, or lower abdominal distress at that time, and this can vary from cycle to cycle.
Normal twenty-eight-day intervals between menstrual flows may alternate with intervals longer than forty to ninety days. At times, a woman with PCOS may have almost regular cycles for some months.
Excerpted from A Patient's Guide to PCOS by Walter Futterweit, George Ryan. Copyright © 2006 Walter Futterweit and Lynn Sonberg Book Associates. Excerpted by permission of Henry Holt and Company.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Introduction: The Face of PCOS,
PART I Understanding PCOS,
1. What PCOS Can Do to You,
2. PCOS and Insulin Resistance,
3. PCOS and IRS,
4. A Tangled Web,
PART II Getting Well Again,
5. Getting a Diagnosis,
6. Right Foods, Right Way,
7. Let's Eat,
8. The PCOS Exercise Program,
9. Getting Pregnant,
10. Staying Pregnant,
11. Saving Your Skin and Hair from PCOS,
12. The Emotional Impact of PCOS,
References and Background Reading,
Most Helpful Customer Reviews
For me this book wasn't particularly helpful - it focused so much on weight loss and maintaining a healthy diet and exercise - if you're not obese but still suffer from PCOS, it doesn't offer much help. Some valuable insight, and more knowledge is always good, but I wish they had mentioned it was primarily targeted at overweight PCOS patients - I wouldn't have wasted my money.
I highly recommend this book for anyone suffering from PCOS!!
This book is terrible. They go into so many pointless details instead of actually writing about how to help you. I honestly do not recommend.