57. PCOS 101: Symptoms, Risks and Health Concerns

In this episode, Dr. Monica Minjeur kicks off a series on Polycystic Ovarian Syndrome in honor of National PCOS Awareness Month. Learn about the common symptoms, risk factors, and health concerns associated with PCOS, including irregular periods, weight gain, and infertility. Dr. Minjeur shares insights on why proper diagnosis and treatment are crucial, beyond just prescribing birth control. Tune in to understand the impact of PCOS on women's long-term health and fertility.

Transcript

Monica: 0:02

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles to improve health and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you're listening today. On today's episode, we begin a series of episodes for the remainder of this month focused on PCOS. or polycystic ovary syndrome. Now September is National PCOS Awareness Month and my hope is to create educational content in an area that is so lacking right now in the medical community. PCOS is often not appropriately diagnosed nor treated and in many clinics the supposed standard of care is just prescribing oral contraceptive pills rather than treating the root cause and addressing other factors. On today's episode, we are going to specifically talk about symptoms, risk factors, and overall health concerns related to PCOS so that you know if you should seek further evaluation. In the coming weeks, we are going to dive more into discussing appropriate diagnostic and treatment strategies, as well as the implications for PCOS on fertility. So make sure you tune in for the next episodes if you still have questions after today. So as always, we're going to get started with a patient story about a client of mine who we'll call Jasmine. Now, Jasmine came to see me when she was about 19 years old. She had started her periods when she was about 12 and the entire time for the past seven years, she had very irregular cycles. This means that in her case, they were never just a month apart. She typically would only have a period every two to four months. She had gone as long as eight months without having a cycle at all. And although this would otherwise seem fine to a teenage girl to not have a period all that often, she did notice that about two years after her period started, she started to have some significant problems with rapid weight gain. She was hungry all the time. She was constantly craving carbohydrates or sweets. And although she was still exercising regularly and very active with sports and school activities, the weight continued to increase significantly. She made some major dietary changes and worked with a dietician, but she still gained weight. She began noticing facial hair growth and was dealing with some significant acne on her chin, chest, and back. And this is the time that she started to come to see me because she was just finished with all of these other symptoms and knew something else must be wrong. So, as we do in all cases, we started Jasmine with some charting instruction and got a thorough history from other medical concerns. We also did a complete evaluation, including lab work and an ultrasound, and we'll talk more about that in next week's episode. But after looking at all of the pieces and pictures, we gave her the diagnosis of PCOS after ruling out other concerns given her age. Now, it's really important to make sure that we are ruling out other congenital problems, especially in women who are younger, as there may be certain issues regarding the endocrine system that don't show up until you start having your periods and metabolic and hormonal changes happen. So Jasmine asked me, she says, why did this happen? None of my friends are dealing with PCOS. None of them struggle with weight. And so we had the following discussion about risk factors, symptoms, and health concerns that would be important to manage as we went along our journey of working together. So Jasmine and I started to talk about what are the risk factors. So one of the things we know is that PCOS affects roughly 1 in 10 women. And there is a significant risk if you have a genetic link. So especially if you have a mom or sister who is diagnosed with PCOS, there is a chance that 40 50 percent of the time you will also have PCOS. Other than genetics, there are also other lifestyle factors that can impact your development of PCOS. In general, women that have a higher weight or have lifestyle choices that are more sedentary or a poor diet are at increased risk for developing PCOS. What happens is that as women gain weight, it worsens their insulin resistance. So when they're eating foods, they're secreting an excess amount of insulin to try and bring those blood sugar readings down. Insulin resistance will actually worsen your androgen. So it will increase your testosterone and your other male hormones, but and insulin resistance also leads to ovarian dysfunction. And so we know that if you have ovarian dysfunction, if you're not ovulating regularly, this can cause an ovulation and which then can lead to these prolonged cycles, which then gives that increased risk for a PCOS diagnosis. The other area that is starting to be studied more is factors that would have happened while you were in utero, so while you were inside of your mother. Increased risk factors include a low birth weight, if your mother was overweight during pregnancy, or if your mother smoked during pregnancy. All of these things can also increase your risk of PCOS. So what are some of the symptoms that would lead you to think maybe I have PCOS or maybe I should get evaluated or talk to my doctor about it? Now the most common things we see, especially in younger women, is irregular periods. And this often is happening because you are not ovulating regularly. This is also called amenorrhea, so meaning that you may have periods and then they stop all of a sudden. Now the big difference to make sure that we're paying attention to here is that as a Teenager or as a young woman when you first start your periods it can be completely normal To have irregular cycles for two or even up to three years. However, if you have gone more than three years since you started having your periods and your cycles are still irregular, so still happening More than every 35 to 40 days apart that would be considered irregular and that's when we want you to seek evaluation Other common symptoms we see with women who have PCOS include excess facial or body hair. Now there is a scoring system here called the Ferriman Galway scoring. And what this does is it scores hair growth in nine different areas on your body. So the most common areas we see that women have increased facial hair growth as well as increased growth of hair around their belly. or their back or even their chest. But there are different areas and there's different scores that help to determine if this is an excess or if this is just a normal variant. Other symptoms of PCOS can include severe acne. Now I most commonly will see people that have acne on their chin, on their chest, and on their upper back. And this is going to often be from that excess testosterone that you have. That can really just add to that inflammatory acne. And for many women, it's not specific just to a certain time of their cycle. It may be there all the time. If you are somebody who has had an ultrasound done of your pelvis or the uterus area, then we oftentimes will see where you have small cysts on your ovaries, or even an increased volume or size of those ovaries. Now, importantly, if you are on birth control and you have those small cysts, this is not diagnostic for PCOS. And we'll talk about this a little bit more in next week's episode when we review diagnosis. But really we're looking here for if you are not on any sort of hormone therapy and we see multiple cysts on the ovaries, that can be a sign of PCOS, but it is not diagnostic for PCOS in and of itself. Other things as we noticed in Jasmine's case is that if you have faster than normal weight gain, so it is normal obviously for young women to gain weight as they grow taller, as they're going through puberty, but especially if we're noticing increased weight gain around your midsection, your thighs, your backside, all of those areas where we store excess estrogen, and that oftentimes goes hand in hand with that insulin resistance. So we can start to see troubles with impaired blood sugars, with certain food cravings, as well as some other concerns as far as what your diet is. Another common thing that we see is that women who are dealing with infertility, especially if you have untreated anovulation or irregular cycles, that can be a symptom of PCOS. Interestingly enough, you can still be having normal cycles and still have a diagnosis of PCOS. So it's important to get this evaluated and make sure that the healthcare professional you are working with is thinking about PCOS as a potential cause for your infertility, even if your cycles are regular. The other two that we can see as far as symptoms include some male pattern hair loss, so thinning at your forehead and your temples, as well as mental health changes, especially anxiety and depression. Now, sometimes it's hard to know if the anxiety and depression are because of the irregular cycles and the acne and all of the other physical symptoms you're having, or if it's independent of itself. However, we do oftentimes see that women with PCOS have a are struggling more consistently with both anxiety and depression. So why does this even matter? What if I have PCOS? Can't I just let it do its thing? I'm not interested in getting pregnant and I really don't care how often my cycle comes. What we know is that women that have PCOS have a significant change as far as their overall health. So this goes well beyond just what's happening with your menstrual cycles or what's happening with your fertility. For example, approximately 50 percent of women with PCOS will end up developing type two diabetes. or prediabetes before the age of 40. Now think about that. That's really significant. This is regardless of how much they weigh. And so what we find is that even if you are a normal weight, you can still have this development of diabetes or prediabetes because of the insulin resistance. The other big risk factor with PCOS is an increased risk of cardiovascular disease. So this is going to include things like heart attack, stroke, high cholesterol, all things that are very, very impactful when it comes to your longterm health. Another big risk factor that we pay attention to is cancer risk. We know that women with PCOS are three times more likely to develop endometrial or uterine cancer. Now, this happens because if you are not having regular cycles, you have that unopposed estrogen exposure. So you can have significant estrogen dominance. That estrogen dominance leads to a thicker endometrial wall or a lining of the uterine wall called endometrial hyperplasia. Endometrial hyperplasia, if left untreated, can then turn into cancer. And so this is why it's incredibly important to treat PCOS. Other coexisting disorders along with PCOS include obstructive sleep apnea and up to 50 percent of women that have PCOS will also have sleep apnea. Now oftentimes this is going to be a weight based situation and so if we're able to help with getting the weight back off again that can help it but many women still have the sleep apnea despite losing the weight or despite being overweight in the first place. Again, as I mentioned previously, women with PCOS oftentimes also have an increased comorbidity with psychiatric disorders like depression and anxiety. We know that PCOS also can lead to an increased risk of non alcoholic fatty liver disease. Now, this is primarily going to be in women who struggle more with the insulin resistance and metabolic syndrome, but again, liver disease on top of all these other risk factors just adds to those comorbidities. And then the final category we talk about is pregnancy complications. Now, we will talk in a later episode as far as PCOS and its implications regarding fertility, but we know that women with PCOS do generally have increased risk during pregnancy of gestational diabetes. preeclampsia, or high blood pressure during pregnancy, as well as preterm birth. And so this is why it's so important to make sure that we're treating those underlying conditions that are adding to that PCOS so that we can help minimize those pregnancy complications before you even think about getting pregnant. So overall, all of these health concerns come into play when it comes to PCOS. So this is why I'm so passionate about making sure that you know if you are at increased risk for PCOS. If you have any of these symptoms, please get evaluated because again, we're not just paying attention to only your menstrual cycles and your fertility, but these are health concerns that will impact you for the entire rest of your life. More importantly, when PCOS is treated well and we are addressing all of the other factors that come into play, we can significantly decrease your risk of all of these factors and the increased health risks that you have if you are not treating PCOS. So imagine if you got the right evaluation to determine if you have PCOS. Now that you know the symptoms and the risks, Please get appropriate evaluation from a healthcare professional who understands PCOS further to improve both your health and promote fertility. Make sure to tune in next week when I will go into the details of how to get evaluated for an appropriate diagnosis of PCOS, and also determine what subtype of PCOS you may have, which makes all the difference when it comes to understanding your risk factors and treatment options. If you're ready to work with our elite team of healthcare professionals, go to our website, radiantclinic. com, to schedule a free discovery call with me and learn more about our package based pricing for comprehensive care. We are currently able to see people for in person appointments in the Cedar Rapids, Iowa area, or can arrange for a telehealth visit if you live in the state of Iowa, Illinois, or Minnesota. Thank you so much for listening to this episode. 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