Earlier this year, our managing editor shared her story about living with PCOS—a condition that affects between 10 to 15 percent of women. PCOS is one of the most common reasons women experience fertility issues in their child-bearing years, so we wanted to dive even deeper into the facts, symptoms, and treatments since so many women live with this every day. We spoke to Clinical Nutritionist and Obesity MD, Dr. Nancy Rahnama, about what it’s really like for women to live with PCOS and how they can manage their symptoms.
What Is PCOS?
“PCOS, aka polycystic ovarian syndrome, is one of the first endocrine disorders I consider when evaluating a new patient in her menstrual age who comes to see me for weight loss,” she said. What differentiates a syndrome from a disease, is that you don’t need to have one defining factor to have the condition. “For example, someone has to have low thyroid function in order to be labeled as hypothyroid, but, you don’t need to have cysts on your ovaries in order to have PCOS,” she explained.
The 5 Factors
This syndrome consists of five possible factors, of which three are necessary to be put into this category.
- Irregular menstruation.
- Excess facial hair that is thick and dark and/or acne.
- Sensitivity to carbohydrates and weight gain or elevated blood sugar or insulin levels.
- Elevated testosterone and androgen levels on blood work.
- Cysts on the ovaries.
However, you don’t need to have all of these conditions to be considered a PCOS patient—three would suffice.
“When I suspect PCOS as the cause for weight gain and other symptoms, I confirm the diagnosis by evaluating improvement with the appropriate PCOS treatment,” she said. “PCOS starts with a genetic predisposition to the condition, and is then fully manifested with the increase in carbohydrates and weight gain.”
If the patient responds well to weight loss with the decrease in carbohydrate intake and soon has regular menstruation with the clearing of acne and improvement in blood work, I am confident that my diagnosis of PCOS was correct.
Insulin and PCOS
“By understanding that this condition is a product of insulin sensitivity and high insulin levels leading to elevated testosterone levels, we’re able to facilitate the success of the patient with either Metformin, which is a diabetes drug that improves insulin sensitivity, and/or with spironolactone, which helps decrease androgen levels,” she said.
“This is why spironolactone is often the drug of choice for dermatologists who treat acne. Gynecologists see many patients with PCOS, as the patient often first seeks treatment with them due to the irregular menstruation.” Most often gynecologists treat this syndrome with birth control, which will mask the irregular menstruation and improve acne with the androgen-blocking effects of the birth control. “However, they’re not dealing with the root of the issue, which is carbohydrate sensitivity and weight gain,” she explained.
In order to truly control this syndrome, the insulin levels that feed the condition need to improve with dietary modifications and weight loss. If the patient is not overweight, changing their diet to a plan that has fewer carbohydrates, such as the Mediterranean or paleo plan will often suffice.
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