When I’m at my parent’s house, I always make a trip to the bathroom to use my mom’s fancy, high-tech magnifying mirror. Here, a few times a year, I tweeze the unibrow hairs my studio bathroom lighting doesn’t pick up. But the last time I went to pluck, I noticed something different—there were a few dark hairs on my chin and jaw. After some online research, I learned this type of hair growth can be a symptom of polycystic ovary syndrome (PCOS).
Before I went further down the Internet rabbit hole, I decided to consult a few experts to learn more. Whether you share my hairy predicament or not, according to the US Department of Health, PCOS affects one in ten women of childbearing age.
Considering it impacts approximately five million women in the United States, why isn’t PCOS more openly discussed? Consider this your starting point for learning more.
What is PCOS?
“PCOS is a disorder that occurs in women of reproductive age,” explains Dr. Kristy Vermeulen, a Naturopathic Doctor in San Francisco, CA who specializes in endocrine disorders like PCOS and authored the book Happy Hormones. “The symptoms of PCOS can include irregular or absent periods, cysts on the ovaries (hence the disorder name), excess hair growth in places like your face, chest, back, and arms, weight gain, and infertility.”
What’s the culprit behind these symptoms? According to Dr. Vermeulen, it’s due to hormonal imbalances in the body. “Though male hormones—known as androgens—are naturally present in women at lower levels, those with PCOS tend to have a higher level of androgens. Additionally, the hormone insulin is usually elevated in patients with PCOS.”
“Androgens also disrupt the menstrual cycle and impede the ovaries’ ability to mature follicles into eggs and ovulate, hence the absent or irregular periods and difficulty getting pregnant,” adds Dr. Kristin Daniel, an OB-GYN in Nashville, Tennessee with 10 years of experience. “When follicles stop mid-maturation and can’t fully develop into an egg, cysts form on the ovary.”
But how these androgen and insulin imbalances come to be is still unknown for the most part. Vermeulen says, “Though there’s more research coming out and needed, we do know that PCOS tends to run in families.”
Daniel adds that diabetes and obesity may also be contributing factors. “PCOS typically clusters in families where type II diabetes is common or in some cases is caused by obesity.”
How do I get diagnosed with PCOS?
The Rotterdam criteria is used to diagnose PCOS. “This was decided upon in 2003 at a conference of endocrinology experts in Rotterdam, a city in the Netherlands,” explains Daniel. To be diagnosed with PCOS, a woman must meet two of the following three criteria:
- Infrequent menstruation or anovulation (a fancy word for total absence of menstruation)
- Having signs or laboratory values of excess androgens
- Polycystic ovaries (polycystic translates to “many cysts”)
Previously, the diagnosis for PCOS was much more strict. “One of the primary innovations in PCOS is that the diagnosis is becoming more fluid,” says Vermeulen. “Not that long ago, women had to test positive for all three criteria, causing many to go undiagnosed.”
But Vermeulen emphasizes there is room for diagnosis improvement. “PCOS can be more complicated than simply meeting two out of the three Rotterdam criteria,” she says. “A patient I’ve diagnosed with PCOS may ovulate every other month, not have polycystic ovaries, and isn’t showing high levels of androgens, but is having a tough time getting pregnant. She only meets one Rotterdam criteria, but there are other factors, like infertility, I take into consideration.”
This is why it’s critical to see a doctor or specialist who is very familiar with PCOS, hormones, or endocrine functionality. If you choose to seek a diagnosis, the doctor will likely run blood tests to check for a surplus of androgens in the body. A doctor may test Free and Total Testosterone, DHEA-Sulfate, hemoglobin (or HgbA1C) and perform a pelvic ultrasound to check for polycystic ovaries. In terms of payment, both Vermeulen and Daniel note that insurance plans usually help cover these fundamental tests to diagnose PCOS.
AMH and PCOS Innovation in PCOS diagnosis
Anti-Mullerian hormone levels (AMH) don’t fall into the Rotterdam criteria but can be useful when a doctor is on the fence regarding a PCOS diagnosis. This hormone is produced by ovarian follicles and helps them mature into eggs. “When diagnosing for PCOS, AMH levels will be high. You have a lot of follicles, but they aren’t developing into eggs. When you have a buildup of follicles in the ovaries, this creates higher AMH levels and potentially cysts.”
That said, there is no diagnostic “cut off” for AMH and PCOS yet. But it may be coming. According to Vermeulen and Daniel, not many physicians use the AMH hormone test for PCOS. “AMH is not a recognized test, though it is being used by some specialists to elucidate the PCOS diagnosis in more subtle cases,” says Daniel. In my experience, AMH tests are not well covered by insurance, unlike other hormone tests and a pelvic ultrasound.”
Side note: Modern Fertility tests for AMH and is making this information more accessible.
The long-term impact of PCOS and symptom management
Women with PCOS are at risk for insulin resistance and elevated blood sugar levels. That means that they are also at a higher risk for type 2 diabetes and cardiovascular disease, according to both doctors. However, there are strategies to manage blood sugar, as well as other PCOS symptoms, to positively impact both short-term and long-term effects.
For women who are not actively trying to conceive, oral contraceptive pills are the “mainstay” treatment for PCOS.
Diet and lifestyle are also simple yet powerful ways to cope with PCOS. Vermeulen says, “You can keep your blood sugar levels in control by reducing refined sugar, carbohydrates, and flour products—which will also help with acne and weight maintenance. Exercise is also helpful for weight management. Every woman with PCOS needs to be doing these things.”
The important thing to remember is that you have options, whether you want to take a more lifestyle or clinical approach (or a combination of both). “While you can’t actually cure yourself from PCOS, you can decrease the symptoms to the point where they no longer negatively impact you,” says Vermeulen.
Talking with Vermeulen and Daniel left me feeling more empowered than anxious—which I can’t say would be true if I continued my own online research. While the forest on my chin points to a higher presence of androgens, I still have regular periods. My next step will be calling my OB-GYN to talk about my options. I’ll ask her if I should get a pelvic ultrasound to check for cysts and get my insulin, androgen, and AMH hormone levels checked.
Regardless of the outcome, I feel more calm and confident because I understand the “why” behind my symptom and what my many options are if I do have PCOS.
English Taylor is a San Francisco-based women’s health and wellness writer. English covers everything from tampons to taxes (and why the former should be free of the latter). Follow Englishand her work at https://medium.com/@englishtaylor.
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