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Understanding PCOS

What exactly is PCOS?

PCOS stands for Polycystic Ovary Syndrome.  It is a complex hormonal disorder that affects millions of women.  It is characterized by a combination of symptoms related to hormonal imbalances, ovarian dysfunction, and metabolic issues.

Underlying hormonal imbalances in PCOS include elevated levels of androgens, such as testosterone, and disruptions in the balance of other reproductive hormones, including luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Insulin resistance is a key feature of PCOS, with many individuals experiencing reduced sensitivity to insulin, leading to compensatory increases in insulin production. This can contribute to metabolic abnormalities such as hyperinsulinemia (high insulin levels), dyslipidemia (abnormal lipid levels), and impaired glucose tolerance, increasing the risk of type 2 diabetes and cardiovascular disease.

Symptoms

One of the hallmarks of PCOS is irregular or absent menstrual periods due to disrupted ovulation, which can lead to difficulties with fertility. Additionally, individuals with PCOS often experience symptoms such as hirsutism (excessive hair growth), acne, and male- pattern baldness/hair thinning, which are attributed to elevated levels of androgens (male hormones) in the body.  Obesity is a common symptom of PCOS, occurring in 40-80% of patients, as well as skin tags which are often found on the neck and in armpits.  Despite the name, it has been learned that while most patients with PCOS have ovarian cysts, the syndrome can exist without them.

Causes and Risk Factors

While the exact cause of PCOS is not fully understood, it is believed to involve a complex interplay of genetic, environmental, and lifestyle factors. Understanding these causes and risk factors is crucial for effective management and prevention.

Genetics

Genetics can play a significant role in predisposing individuals to PCOS, with family history often being a key indicator of risk. Several genes have been implicated in PCOS, including those involved in hormone regulation, insulin signaling, and ovarian function. However, PCOS is considered a polygenic disorder, meaning that multiple genes contribute to its development, and the exact genetic mechanisms remain complex and not fully understood.

Insulin Resistance

Insulin resistance is another critical factor in the pathogenesis of PCOS. Insulin is a hormone produced by the pancreas that helps regulate blood sugar levels by facilitating the uptake of glucose into cells for energy. In individuals with insulin resistance, the body’s cells become less responsive to insulin, leading to elevated levels of insulin in the blood. Insulin resistance is closely associated with PCOS and contributes to several metabolic abnormalities seen in the condition, including hyperinsulinemia (high insulin levels), dyslipidemia (abnormal lipid levels), and impaired glucose tolerance. Insulin resistance can also lead to compensatory increases in insulin production by the pancreas, further exacerbating the condition.

Lifestyle

Lifestyle choices, such as diet and exercise habits, also play a significant role in the development of PCOS. Poor dietary habits, including consumption of a high-calorie, high- sugar diet, can contribute to insulin resistance, weight gain, and metabolic dysfunction, all of which are common features of PCOS. Sedentary behavior and lack of regular physical activity can further exacerbate insulin resistance and contribute to weight gain, hormonal imbalances, and other symptoms of PCOS. Conversely, adopting a balanced diet rich in whole foods, low in processed sugars and refined carbohydrates, and engaging in regular exercise can help improve insulin sensitivity, promote weight management, and alleviate PCOS symptoms.

Diagnosis

 Diagnosing PCOS can be challenging due to its heterogeneous nature and overlapping symptoms with other conditions. PCOS is diagnosed based on a combination of clinical presentation, laboratory tests, and imaging studies. Healthcare professionals commonly use the Rotterdam criteria, requiring the presence of two out of three of the following: menstrual irregularities, clinical or biochemical signs of hyperandrogenism, and polycystic ovaries on ultrasound (Kim & Lee, 2022).

Menstrual irregularities, such as oligomenorrhea or amenorrhea, indicate disrupted ovulation and are often one of the first signs noted. Clinical signs of hyperandrogenism include hirsutism, acne, and male-pattern baldness, while biochemical signs involve elevated levels of androgens in blood tests. Imaging studies, particularly transvaginal ultrasound, can reveal the presence of ovarian cysts or follicles, supporting the diagnosis. Blood tests are also conducted to measure hormone levels, including testosterone, LH, FSH, and insulin, which can help identify hormonal imbalances and insulin resistance commonly associated with PCOS.

Medical Management

Conventional medical treatments for managing PCOS symptoms aim to address hormonal imbalances, regulate menstrual cycles, and alleviate associated symptoms. Hormonal contraceptives, such as combination birth control pills containing estrogen and progestin, are often prescribed to regulate menstrual cycles and reduce androgen levels. Anti-androgen medications like spironolactone and cyproterone acetate may be used to block the effects of androgens and alleviate symptoms of hirsutism and acne. Insulin-sensitizing medications, such as metformin, are commonly prescribed to improve insulin sensitivity, regulate menstrual cycles, and reduce androgen levels.

These medications can also help manage metabolic issues associated with PCOS, such as insulin resistance and glucose intolerance. In addition to medication, lifestyle modifications, including diet and exercise, play a crucial role in managing PCOS symptoms. Adopting a healthy diet rich in whole foods and engaging in regular physical activity can help improve insulin sensitivity, regulate menstrual cycles, and manage weight, thereby reducing the severity of symptoms.

Lifestyle Strategies for Managing PCOS

 Beyond medical interventions, lifestyle modifications play a critical role in managing PCOS and improving overall health and well-being. Evidence-based lifestyle strategies are essential for symptoms and improving overall health outcomes.

Dietary changes play a crucial role in regulating blood sugar levels and insulin sensitivity, key factors in PCOS management. Emphasizing whole foods such as fruits, vegetables, lean proteins, and healthy fats, while limiting refined carbohydrates and sugars, can help stabilize blood sugar levels and support weight management.

Regular exercise is equally important, as it can improve insulin sensitivity, promote weight loss, and reduce cardiovascular risk factors associated with PCOS. Engaging in aerobic activities like walking, jogging, or swimming, along with strength training exercises, can have significant benefits for individuals with PCOS.

Stress management techniques, including mindfulness, meditation, and relaxation exercises, can help reduce stress levels, which can exacerbate PCOS symptoms.

Adequate sleep is also crucial for managing PCOS, as poor sleep quality and duration can impact hormone levels and metabolism. Establishing a regular sleep schedule, creating a sleep-friendly environment, and practicing good sleep hygiene can promote restful sleep and improve overall well-being.

Additionally, maintaining a healthy weight is essential for managing PCOS symptoms and reducing the risk of associated complications. Modest weight loss of 5-10% of body weight can lead to improvements in insulin sensitivity, menstrual regularity, and fertility in individuals with PCOS (Zehravi et al., 2022).

Bariatric Surgery as a Management Options

For some individuals with severe obesity and PCOS, bariatric surgery may be considered as a treatment option to achieve significant weight loss and improve metabolic health (Lee et al., 2020). Bariatric surgery, such as gastric bypass or sleeve gastrectomy, is increasingly recognized as a treatment option for individuals with severe obesity and PCOS who have not achieved weight loss through other means.

Bariatric surgery can lead to significant and sustained weight loss, which in turn improves insulin sensitivity, regulates menstrual cycles, and reduces symptoms of hyperandrogenism in individuals with PCOS. Studies have shown that bariatric surgery can result in remission or improvement of PCOS symptoms, including menstrual irregularities, hirsutism, and infertility, as well as a reduction in cardiovascular risk factors associated with PCOS, such as insulin resistance and dyslipidemia.  According to Cleveland Clinic Journal of Medicine, patients with PCOS experience an average of 79% resolution of hirsutism and 99% resolution of menstrual dysfunction. 

Overall, the management of PCOS typically involves a multidisciplinary approach that may include a combination of medical treatments, lifestyle modifications, and supportive therapies tailored to the individual needs and goals of each patient. Remember, every journey is unique, and finding what works best for you may take time and patience. At Sage Bariatric, we’re here to support you every step of the way.

Resources:

Kim, C.-H., & Lee, S.-H. (2022). Effectiveness of lifestyle modification in polycystic ovary syndrome patients with obesity: A systematic review and meta-analysis. Life, 12(2), 308. https://doi.org/10.3390/life12020308

Lee, R., Joy Mathew, C., Jose, M. T., Elshaikh, A. O., Shah, L., & Cancarevic, I. (2020). A review of the impact of bariatric surgery in women with polycystic ovary syndrome. Cureus. https:// doi.org/10.7759/cureus.10811

Zehravi, M., Maqbool, M., & Ara, I. (2022). Healthy lifestyle and dietary approaches to treating polycystic ovary syndrome: A Review. Open Health, 3(1), 60–65. https://doi.org/10.1515/ openhe-2022-0008

Brethauer SA, Chand B, Shauer PR. Risks and benefits of bariatric surgery: Current evidence.  Cleveland Clinic Journal of Medicine 2006; 73:1-15.