Exploring PCOS

Transcript

Maggie McKay (Host): If you’re a woman trying to get pregnant and have never heard of PCOS or polycystic ovary syndrome, today, we’ll find out all about it with Dr. Chelsea Fox, OB/GYN and reproductive endocrinologist with the Fertility Center of the Carolinas. Welcome to Flourish, a podcast from Prisma Health. I’m your host, Maggie McKay. Thank you so much for being here today, Dr. Fox.

Dr Chelsea Fox: Thank you so much for having me. I’m so excited to talk about PCOS.

Host: Absolutely. I have to say or admit that I have never heard of PCOS, so I’m really interested to hear more. What is it and how do you know if you have it?

Dr Chelsea Fox: Well, it’s actually one of the more common reproductive endocrine disorders that we see. It actually affects up to 15% of reproductive age women, so it’s fairly common. It’s also the primary reason that females who don’t ovulate regularly and don’t have regular menstrual periods, it’s the primary condition causing those period irregularities. So, it’s something we also see in the fertility office quite frequently.

And what is it? It’s a combination of three different symptoms. We actually use a criteria called the Rotterdam criteria to diagnose someone with PCOS. There’s three criteria. And if you’ve got two of the three criteria, you’ve got the diagnosis. It’s also a diagnosis of exclusion. There’s a lot of different conditions that can sort of mimic PCOS. So, make sure your OB-GYN or primary care provider is ruling out other things like thyroid problems, prolactin issues, et cetera. But assuming those have been ruled out, the three symptoms that we see with PCOS are signs of elevated testosterone, and testosterone is a hormone that’s usually seen in more of like a male type of symptomatology where you see hair growth on your face, your chest, your back, you see acne. Sometimes you can even see like male pattern baldness. We call that androgenic alopecia. That’s frequently seen in women with PCOS because their ovary is making increased amounts of testosterone.

The second thing that we see in women with PCOS is their periods are irregular. Usually, they see infrequent periods, sometimes no periods at all, but sometimes just going over 35 days without a menstrual cycle can signal that you might have PCOS.

And then, the final criteria is this characteristic appearance of the ovaries on an ultrasound. So, the term polycystic ovary syndrome actually correlates with what we see on ultrasound. The ultrasound of women with PCOS show the ovaries with lots of these tiny black circles on them. Those black circles are called follicles and inside each one of those follicles is an immature egg. And the reason women with PCOS have more follicles on their ultrasound is because they’re not releasing those eggs in a regular fashion because they’re not ovulating. So therefore, they’ve got more follicles, not entirely appropriately termed cysts. I think cysts causes more concern than it’s worth, but that’s where you get that term. And if you’ve got two out of those three criteria, you’ve got the diagnosis.

Host: Does PCOS run in families?

Dr Chelsea Fox: It does, actually. The inheritance pattern is very complex, so we don’t have an actual genetic test to look for PCOS, but it certainly runs in families. Similar to how you see cardiovascular disease or type 2 diabetes runs in families, we see that with PCOS. So if you’ve got any first-degree relatives with PCOS, it puts you at an increased risk. It’s complex though, because there’s also significant lifestyle interactions, so things like your diet and exercise level and the presence or absence of obesity can really change the way females experience their PCOS syndrome, so it’s very complex the way it’s inherited.

Host: Dr. Fox, how is PCOS treated and can it be cured?

Dr Chelsea Fox: Unfortunately, PCOS is a chronic condition, and so there’s no cure per se. But the good news is that we’ve got very effective treatment strategies that are aimed at treating a patient exactly where they are in their reproductive life, based off of what their primary symptoms are. PCOS is a highly variable condition. Some women experience a lot of hirsutism or that hair growth that I mentioned. Some don’t experience any of that. Some just experience period irregularities or infertility, problems losing weight, difficulty losing weight. And so, what we try to do is we aim to see what is the patient’s individual presentation, what symptoms bother them the most, and then we hone in on those and have a patient-centered, tailored approach to that. So if they’re having infertility issues, we help them ovulate. If they’re having hirsutism, we help with medications that can block the testosterone production from the ovaries. If their periods are irregular, we can help them with that. If they’ve got difficulty losing weight, we can help them with that. So, it’s really individualized to the patient.

Host: And what about supplements or herbal treatments? Can those help with PCOS?

Dr Chelsea Fox: There are some over-the-counter supplements that have shown some efficacy with PCOS. The magnitude of their impacts are not as great as other medications that are prescribed, but things like, I don’t know if you’ve heard of myo-inositol before, but that is an over-the-counter supplement. dietary supplement that’s been actually pretty well studied in PCOS and women who took myo-inositol that had PCOS showed an improved glucose tolerance, like the insulin resistance that we see with PCOS improved when they were on myo-inositol. They had less difficulty losing weight and they actually had more frequent ovulatory cycles. So, myo-inositol is a good treatment to think about in addition to whatever therapies that your primary provider or OB-GYN has recommended. If you’re trying to conceive, there’s also some supplements that can help with egg quality, really regardless of if you’ve got PCOS, supplements like coenzyme CoQ10 are really good for egg quality. And most women of reproductive age are vitamin D deficient. And so if you’re vitamin D deficient, taking additional vitamin D can also be helpful.

Host: Is it possible to get pregnant naturally if you have PCOS?

Dr Chelsea Fox: It is. Like I said, PCOS is variable. So, some women with PCOS ovulate on their own. And so certainly, they can conceive spontaneously, because they’re ovulating without any assistance. But there are some patients with PCOS who ovulate very irregularly or not at all. And that does make it harder to conceive.

Things that can help with getting pregnant naturally if you’ve got PCOS are things like watching your diet, frequent exercise, trying to lose weight if you fall into the obese category. But even with those type of lifestyle adjustments, because of that genetic component that we were talking about, some women still don’t ovulate despite having all the right lifestyle adjustments. And if that’s the case, then certainly there’s some medications that can be prescribed that can help women with PCOS ovulate and then conceive on their own.

Host: And Dr. Fox, what would be your recommendation for listeners who think they might have PCOS?

Dr Chelsea Fox: Yeah. If you think you might have PCOS, it’s quite common. And I’d urge you to speak with your PCP or your OB-GYN, or even a reproductive endocrinologist like myself to be further evaluated. We do know that a lot of women with PCOS unfortunately experience delays in their diagnosis and a lot of confusion around their diagnosis. So also, if you think you might have it, make sure you feel empowered to ask the right questions to your doctor and be your own advocate.

Host: In closing, is there anything else you’d like to add that people should know?

Dr Chelsea Fox: PCOS is just one of the conditions that I love treating, because it’s very complex and a lot of patients come to our office with that sense of frustration that they haven’t gotten the answers that they’ve been looking for. And while it is a complex condition, there are very effective treatment strategies. And so, don’t hesitate consult a reproductive endocrinologist if you are experiencing any frustrations with your diagnosis.

Host: Thank you so much for sharing your expertise and sharing this useful information with us. We appreciate your time.

Dr Chelsea Fox: Absolutely. Well, this was very fun and let me know if we can ever come on again.

Host: Awesome. Absolutely. We’d love to have you. Again, that’s Dr. Chelsea Fox. And if you’d like to find out more, you can visit PrismaHealth.org/Flourish. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I’m Maggie McKay. Thanks for listening to Flourish, a podcast from Prisma Health.

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