The abbreviation may seem unfamiliar, but if you experience irregular menstrual periods, have trouble losing weight (especially around your middle), notice excessive facial hair, or have difficulty conceiving, you could have PCOS--or polycystic ovary syndrome.
Lise Coyle had never heard of PCOS when she was studying to become a physical therapist at a college in upstate New York, poring over textbooks to learn how she could help heal injured bodies. But when she started experiencing odd physical changes, it soon became clear that her own body was her biggest challenge. "I weighed 175 pounds, and I couldn't lose weight no matter how hard I tried," she says. Complicating her weight problem was an erratic menstrual period, sometimes lasting a day, other times dragging on for a week. "I missed four periods, even though I wasn't pregnant," she recalls. Fearing she had some type of cancerous tumor, Coyle made an appointment to see her gynecologist. The good news: no cancer. The not-so-good news: Coyle had PCOS.
With that diagnosis Coyle joined the approximately 6 million American women who have PCOS--a condition usually characterized by abnormal ovaries that can grow up to three times the size of normal ones and are covered with cysts containing immature eggs. These cysts produce an excess amount of male hormones, interrupting the normal menstrual cycle and preventing ovulation. The syndrome can start to manifest itself as early as the teen years, says Samuel S. Thatcher, M.D., Ph.D., author of PCOS: The Hidden Epidemic (Perspectives Press, 2000), and is commonly thought to have a genetic component.
While irregular periods and difficulty conceiving are common symptoms, they aren't as dangerous as PCOS's association with a condition known as insulin resistance--a prediabetic state that can lead to obesity, diabetes, and heart disease. Because of those risks, it's important to get an early, proper diagnosis and take measures to treat the associated symptoms.
"Reproductive problems are just one slice of the PCOS pie," says Walter Futterweit, M.D., author of A Patient's Guide to PCOS (Owl Books, 2006). "What's most important are the medical risk factors, such as distribution of fat in the belly, an indicator of insulin resistance that puts women at increased risk of developing life-threatening diseases." In fact, up to 70 percent of PCOS patients have high cholesterol levels, and as many as 40 percent develop type 2 diabetes by the age of 40.
High insulin levels in the blood, another indicator of insulin resistance, account for some PCOS symptoms. They may suppress ovulation (the infertility link), cause drops in blood sugar (creating food cravings), increase your risk of gaining weight (nearly half of women with PCOS are obese), and affect sex-hormone ratios (increasing levels of testosterone, causing excess facial hair and male pattern baldness). And if that's not enough, women with PCOS often develop acne. "PCOS generates a tremendous amount of anxiety about appearance as well as health," says Stephanie Kaufman, a psychoanalyst who counsels women with PCOS in New York City. "Women with PCOS often suffer from depression and low self-esteem."
It's estimated that three of four women with PCOS don't even know they have it. They may be experiencing symptoms and may even have sought medical help, but they still don't know what's wrong. Since physical symptoms and lab test results can bear a striking similarity to other medical conditions, including Cushing's syndrome and an adrenal abnormality known as congenital adrenal hyperplasia, women typically see several doctors before getting a correct diagnosis. When they do, it's usually made from a combination of clinical findings. They include abnormal menstrual cycles, suppressed ovulation, excess hair growth or loss, and obesity; an ultrasound to detect abnormalities in the ovaries; hormonal testing; and standard laboratory tests for glucose, insulin, and cholesterol levels. For the most accurate diagnosis, a woman should be off the Pill for at least three months.
The treatment options
Physicians who treat PCOS and its associated symptoms include obstetricians/gynecologists, endocrinologists, and dermatologists. According to Thatcher, it is important to ask prospective physicians whether they have a standard treatment for PCOS (the answer should be no, Thatcher says, because effective treatment plans must be individualized) and to inquire about nutrition and exercise.
While there is no one-size-fits-all solution, a variety of treatments are available to help alleviate symptoms and reduce risk factors. Sometimes a regimen of prescription medications is in order, but emerging research shows that overcoming PCOS may be as much a matter of changing habits as taking the right mix of pharmaceuticals.