Is PCOS a Syndrome or a Disease?
PCOS is generally considered a syndrome rather than a disease (though it is sometimes called Polycystic Ovary Disease) a disorder more or like because it occurs with a group of signs and symptoms which can occur in any combination. it does not have just one known cause or presentation.
Are there are other names for PCOS?
Other names for Polycystic Ovary Syndrome are Stein-Leventhal Syndrome, hyperandrogenic chronic anovulation, functional ovarian hyperandrogenism, and Polycystic Ovary Disease.
What causes PCOS?
The exact cause of PCOS is unknown. There are studies being conducted to see if there may be a genetic link — that PCOS is passed along in families. Just as one might have a genetic predisposition to diabetes, one might also have a disposition to PCOS.
The above analogy to diabetes seems appropriate as many current studies into PCOS are focusing on the body's ability to process insulin. A growing collection of data suggests that elevated insulin levels are unhealthy and contribute to increased androgen production, worsening PCOS symptoms from cosmetic issues to infertility, and eventually increasing the risk of certain cancers, diabetes and heart disease.It is also possible that PCOS may be caused or worsened by valproate, a medication used to treat seizures, but it is hard to say if it is the epilepsy per se or the agent used to treat it that brings about the PCOS symptoms in some women. The condition may be improved by switching to another medication.
The above analogy to diabetes seems appropriate as many current studies into PCOS are focusing on the body's ability to process insulin. A growing collection of data suggests that elevated insulin levels are unhealthy and contribute to increased androgen production, worsening PCOS symptoms from cosmetic issues to infertility, and eventually increasing the risk of certain cancers, diabetes and heart disease.It is also possible that PCOS may be caused or worsened by valproate, a medication used to treat seizures, but it is hard to say if it is the epilepsy per se or the agent used to treat it that brings about the PCOS symptoms in some women. The condition may be improved by switching to another medication.
Is there a cure for PCOS?
No, it is a condition that is managed, rather than cured. Treatment of the symptoms of PCOS can help reduce risks of future health problems and prognosis .
What kind of doctor can diagnose and treat PCOS?
Any type of doctor familiar with PCOS might make the diagnosis, but the disorder is complicated and may be best treated by a specialist. Preferably visiting OBGYN and a doctor who is familiar with your family history should be considered. Those having difficulty getting pregnant should see a reproductive endocrinologist, while long-term management by an endocrinologist should be considered. A general practitioner or an OBGYN may treat some women with the syndrome, but someone who specializes in endocrine disorders may be more familiar with treatment options and recent studies on PCOS.
How should one prepare for initial medical appointment to discuss PCOS?
- Write down any questions before the appointment. It is usually faster and more orderly to have a list, no matter how long it may get. Many questions will be answered in the general course of conversation.
- Gather up any appropriate or requested medical records — follow through and make sure the doctor gets them before the appointment, or bring them. (Sending in advance is generally preferred.) If the visit is for fertility reasons and one has already done a hysterosalpingogram (HSG, x-ray test of the uterus and tubes), a copy of the actual film is preferred to the printed interpretation or report.
- Be ready to supply family history, especially about insulin resistance, diabetes, lipid abnormalities such as high cholesterol, obesity, high blood pressure, heart disease, and infertility. Include information from both parents and their families. PCOS characteristics may be passed down from either side of the family.
- Familiarize oneself with the symptoms of PCOS and discuss any concerns with the doctor.
- If looking for help in getting pregnant, consider bringing in basal body temperature (BBT) charts to initial evaluation.
- See if it would be helpful to arrive for the doctor's appointment in a fasting state, and clarify any other requirements.
What are some questions to ask the doctor?
The purpose of the following list of questions, and this entire FAQ, is to help women have better communication with their doctors, not to substitute for diagnosis, treatment, and frank discussion with one's own physician.
- What specific tests are used to confirm PCOS?
- What tests are done to confirm insulin resistance and/or diabetes?
- Are insulin-sensitizing medications prescribed for insulin resistance, or only for diabetes?
- What recommendations or medications, if any, are typically given for the symptoms of PCOS, such as weight gain/obesity, acne, hirsutism, balding, lack of menses, high cholesterol, high blood pressure, and insulin resistance?
- After initial diagnosis of PCOS, what kind of future monitoring is recommended?
- Is treatment of PCOS similar among different doctors in this practice?
- Will diet and exercise information and support be provided?
- What kind of birth control is recommended for women with PCOS?
- What kind of treatment is offered to women with PCOS who are trying to conceive?
- Is weight loss in obese patients a requirement before any stage of fertility treatment? For example, would one be allowed to try Clomid, but not allowed to pursue in vitro fertilization?
- Can insulin-sensitizing medications be used while trying to conceive?
- Can insulin-sensitizing medications be continued in pregnancy?
- Which medications used to reduce PCOS symptoms, such as those for acne and hirsutism, can be continued while trying to conceive or when pregnant?
Is it possible to have polycystic ovaries without having the syndrome?
About 20-30 percent of women will have the appearance of polycystic ovaries, while only an estimated 5-10 percent of women would be diagnosed as having Polycystic Ovary Syndrome as based on signs and symptoms. It may be best to consider the finding of polycystic ovaries as a possible sign of PCOS, but not to rely on this as the sole criterion in making a diagnosis. A large percentage of women with polycystic ovaries have at least some subtle hormone alterations, even if they do not clearly exhibit other signs of the syndrome.
Is it possible to have PCOS without having cysts?
This is another area of some disagreement among medical professionals. Most women with PCOS will in fact have the polycystic ovaries for which the syndrome is named, but it is possible to be diagnosed with the syndrome without this particular symptom. Some doctors diagnose PCOS based on the appearance of other physical symptoms or hormone abnormalities, regardless of ultrasound findings. It is difficult to make a firm diagnosis of PCOS without the presence of either an increased number of small cysts or ovarian enlargement. Polycystic ovaries may not have been recorded as an official finding on an ultrasound even though they were seen. Often ultrasounds have been performed to exclude pathology and may not have diagnosed minor increases in cystic structures or ovarian enlargement. Some ultrasonographers may consider the milder forms of PCOS as variations of normal. Ovarian enlargement is not always associated with ovarian cyst development, but still can be a variant PCOS. In other words, if one has the signs and symptoms of PCOS it is likely that there is some alteration in the appearance of the ovary, even if it has not been recognized.
What kind of monitoring is recommended?
Even if pregnancy is not desired, women with PCOS should be sure to have their blood sugar, insulin, cholesterol and triglycerides checked once per year. Those who are also hypothyroid should also monitor TSH to make sure medications are working properly.
Do all women with PCOS suffer from infertility?
The answer to this depends on the criteria used to diagnose PCOS. If a main criterion is anovulation, then by definition women with PCOS would have fertility problems. It is possible to have the appearance of polycystic ovaries and be fertile, but having the syndrome usually does impact fertility adversely.
Is it possible to have regular cycles without ovulating?
Yes, but the reasons for this happening are poorly understood. Some women seem to have a regular bleed regardless of ovulation, so one should look beyond cycle length to determine ovulation.
Will losing weight jumpstart fertility in overweight patients with PCOS?
It may, but it doesn't always. There are lean women with PCOS. Weight loss may help reduce insulin resistance, resulting in spontaneous or improved ovulation. Quick weight loss may cause more harm than good, so slow weight loss is best. Losing 10 percent of one's body weight should be enough to show some improvement in symptoms.
Is the miscarriage rate higher in women with PCOS?
There does appear to be a higher miscarriage rate in women with PCOS, but the exact reason is still under investigation. According to some studies, the risk of miscarriage in women with PCOS is 45 percent or more. One possibility is that early loss is associated with elevated levels of luteinizing hormone — and women with PCOS often have elevated LH levels — but the reason why it relates to miscarriage is not understood. Another possibility is that elevated levels of insulin or glucose may impede implantation or cause problems with the embryonic development. There is a clear association between uncontrolled blood sugar and pregnancy loss, but the issue of insulin resistance and elevated insulin levels is relatively new and in need of further study. There is a possibility that insulin resistance reduces egg quality. That leads to another possibility — that late ovulation (after cycle day 16) may be associated with poor follicle development and decreased egg quality.
Are birth control pills safe for women and adolescents with PCOS?
There is no one best oral contraceptive for all women with PCOS, but there are lots of different theories. One concern about the triphasic pills is that the low starting dose may not be enough to inhibit follicle production, and the small follicles produced can contribute to the appearance of polycystic ovaries. The monophasic pills may be more likely to halt follicle production while also reducing androgen levels, but some women do experience more unpleasant side effects on them.
What is a low-carbohydrate diet?
There are various forms of low-carbohydrates diets, but the basic premise is to reduce carbohydrates to below the recommended dietary allowance of 300 grams for a 2000-calorie per day diet. How much of a reduction depends on the plan followed. Possible risks of very low carbohydrate diets include kidney problems, gallstones, and ketonuria (spilling ketones in urine) The best way to lose weight is slowly with a lifestyle change as opposed to a transitory diet one expects to end at some point. It is healthiest to lose the weight slowly, and one is more likely to keep it off this way as well. When trying to get pregnant, it is important to consider nutritional standing before pregnancy, and whether or not a food plan can be continued once pregnancy is achieved. A diet in which ketones are spilled often, or continuously, could be harmful to the fetus.
Are depression and anxiety common in women with PCOS?
This is an area where more research is needed. It does appear that many women with PCOS suffer some physical or psychological manifestations of depression. There is some medical literature suggesting a link between diabetes and depression, and perhaps that might be extended to early stages of insulin resistance. It may be that the hormone imbalances, including hyperinsulinemia and hyperandrogenism, create a physical source for depression. Medications that help restore proper hormone ratios or antidepressants may help reduce depression and anxiety attacks. Another possible source of depression is the effect that PCOS symptoms may have on self-esteem. Skin, hair, and weight can each cause discomfort in one's appearance that damage confidence. Infertility may also lead to frustrations with one's body and the feeling it can't do anything right, or perhaps a notion that one is being punished for some past action. Miscarriages are common in women with PCOS, and the grief associated with this type of loss can be far-reaching. Anyone who feels she is showing signs of depression should consult her doctor as well as consider seeking emotional support. Be sure to find a doctor who is willing to listen to concerns and not dismiss this potential side effect of PCOS.
references :
http://www.inciid.org/faq.php?cat=infertility101&id=2
references :
http://www.inciid.org/faq.php?cat=infertility101&id=2