Polycystic Ovarian Disease

This one is complex, more so than you may realize, but it is also much more simple than many in healthcare make it out to be. As many as ten percent of women are impacted by #PCOS. It is the most common endocrine problem in childbearing women and really has significant consequence, so as clinicians, we really do need to lean into this one and help women understand their diagnosis and empower them through education.

Polycystic ovarian syndrome is both a metabolic issue, as well as endocrine. Hormone imbalance leads to higher than normal levels of #testosterone which can lead to weight gain, hair loss, and even hair growing in odd places like your chin, upper lip, even your breasts and lower belly. Cystic acne is also common and combined with the previous symptoms, can really wreck one's self-esteem. Depression and sleep apnea leave many exhausted and miserable, even disrupting one's ability to really get through their day. High blood pressure, obesity, and even cardiovascular disease and insulin resistance are additional risks.

Use to we had to take a panel of tests to confirm the diagnosis, but today, this is fairly easily diagnosed on clinical exam. Infrequent periods, more than every 35 days, and symptoms of excess androgens such as acne, hair loss, or hair in unwanted places is really sufficient. Many do have polycystic ovaries, which can be observed via ultrasound, but the absence of these does not rule out diagnosis so it is not often obtained. Findings of cysts on ultrasound does also not in itself diagnose PCOS. Infertility is common, so is dark, velvety-textured skin around the neck and in the armpits and groin, but again, not diagnostic in itself. Skin tags are also common because they also occur with insulin resistance, which is also common to PCOS.

The PCOS Imbalance

Individuals with PCOS have brains that continue to instruct the ovaries to mature follicles but because of the high androgens, these follicles aren't released. Ovulation commonly doesn't occur. Cycles don't oven occur, so menses may be very irregular. When they do occur, menses are often heavier and painful because they are so infrequent. This build up of endometrium between cycles these women at risk for endometrial cancer and heavier periods put women at risk for anemia. Of course, this makes infertility a common challenge among those with PCOS.

Insulin also causes the body to store weight, adding to the poor self-esteem, but also the potential for blood pressure and heart disease. Sadly though, #obesity is one of the more poorly addressed issues in healthcare, with lots of judgement, bias, and even fat shaming. So often weight gain is thought to be about little more than too many calories in and too few calories out, so a matter of poor will-power which invites judgement. PCOS then goes undiagnosed in more overweight women, but is also missed entirely in women who aren't overweight because this is thought of as a "fat woman's" disease.

More recently binge eating has been associated with PCOS. Women blame themselves for "weakness" and poor willpower, when it is the condition itself causing this symptom. Subclinical hypothyroidism with elevated thyroid antibodies should be evaluated as well, and keep in mind that other autoimmune diseases are also common with PCOS. Cholesterol may be increased, even fatty liver disease, and we can't overlook mental health consequence. Simply giving women a pharmaceutical bandaid doesn't fix the underlying issue, and will ultimately lead to further consequence.