I recently attended a PCOS conference where physicians argued whether the name PCOS best describes this condition that affects so many women. Over the years, caring for women seeking solutions for their PCOS related symptoms, I’ve heard stories from women who’ve seen many physicians trying to find answers. They’ve gone to gynecologists, endocrinologists, internists, dermatologists, surgeons and reproductive endocrinologists seeking solutions to dealing with periods, pre-diabetes, blood pressure, acne, hair loss, obesity and infertility. Traditional medical care has drawn borders allowing each specialty to operate in isolation. If you wanted to deal with PCOS, you were required to have a team of medical experts to deal with each of the PCOS related symptoms. But, PCOS has a mind of its own and does not recognize these borders and is happy to interfere wherever it sees fit.
Unless you have a personal Mayo Clinic at your beck and call, a new approach seems appropriate. In searching for this new approach, I’ve been fortunate to speak with many women who’ve shared their stories. I was convinced that in these stories, I’d find a common thread that would help me better serve my patients. Some of the things I’ve noticed:
- PCOS can be noted at the onset of puberty or following a delivery
- For many women, PCOS onset is associated with weight gain
- Some women with PCOS present with a history of repeated miscarriage
- Women with PCOS often have family members with Type II diabetes, hypertension or cholesterol abnormalities. These symptoms are not limited to female relatives
- PCOS is frequently diagnosed in women who have experienced gestational diabetes
- Some women with PCOS are lean; about 60% are obese
- PCOS may be more prevalent in daughters and sisters of those with PCOS
After this conference, I saw my internist for a physical and was advised that my weight, blood pressure and cholesterol were creeping up and my insulin levels were dramatically elevated, suggesting metabolic syndrome and insulin resistance. While fertility problems or menstrual disturbances were not an issue, I was struck by how the metabolic disturbances my physician reported seemed identical to what I was seeing in my PCOS patients. I realized that almost everyone in my family had to deal with hypertension, cholesterol abnormalities, diabetes or irregular menses. Whatever PCOS genes might exist, members of my family, both men and women, likely carried these genes. So, when it comes to managing my personal health, I needed to heed the advice I offered my patients.
My patients are advised that they can get the best results by treating the underlying factors contributing to this condition and focusing less on the symptoms. My first step was to evaluate my diet. I attended courses on nutrition at the Culinary Institute of America and I learned the necessary skills to plan and create healthy low glycemic alternatives. I learned that two hours per week participating in a high intensity interval strength training exercise program, building muscle, offered greater weight loss and cardio-protective benefit than spending hours doing aerobic exercises. I incorporated the insulin sensitizer metformin into my personal metabolic syndrome-diabetes prevention-PCOS plan. A comprehensive management plan may also include nutritional supplements. Although well designed clinical trials are not yet available to support each of these supplements, research suggests that maitake mushroom extract, cinnamon, Myoinositol, N-Acetyl Cysteine and low dose aspirin or fish oil may be useful.
Most women dealing with PCOS feel alone and frustrated finding the information and healthcare they desire. It’s my hope to promote the awareness that while PCOS affects only women, the underlying metabolic abnormalities are seen in both men and women, so PCOS is no longer just about women!