Disruptions in a woman’s menstrual cycle can signal polycystic ovary syndrome.
As a teenager, Lizmari Collazo of Ames, Iowa, was quite happy when her period disappeared. Her endocrinologist, who was treating her for hypothyroidism, was not. Her doctor referred her to a gynaecologist, who discovered Lizmari had very enlarged ovaries and cyst formations — two hallmark signs of polycystic ovary syndrome, or PCOS.
The condition is not life-threatening, but it can cause frustrating and profound consequences for the 5 million women in the United States who have it. Classified as an endocrine disorder because it relates to the body’s hormones, PCOS is the No. 1 cause of the inability to conceive. Experts have been unable to determine what causes PCOS; researchers believe it is largely genetic.
Many women with PCOS are diagnosed in adolescence, around the time they start menstruating. Irregular periods is one of the main symptoms, as well as heavy bleeding, infertility, acanthosis nigricans (thickening and darkening of skin, especially around the neck, armpits, and groin), sudden excessive weight gain, and hirsutism (excessive hair where hair normally doesn’t grow.
Although the cause continues to be a mystery, women with PCOS have higher-than-normal levels of androgen hormones—the male hormones like testosterone.
Excess androgens affect the development and maturation of a woman’s eggs, preventing the eggs from being released down the Fallopian tubes. Instead, the eggs can remain in the ovaries as cysts. Women with PCOS often miss their periods, and the lack of ovulation can make becoming pregnant impossible. Women with PCOS also have a higher rate of miscarriage.
The link between diabetes and PCOS
Almost 20 years after learning she had PCOS, Lizmari was diagnosed with type 2 diabetes. Insulin resistance can play a major role in both conditions: 50–70 per cent of women who have PCOS also have insulin resistance; 45–50 per cent of women who have PCOS are eventually diagnosed with type 2 diabetes or prediabetes.
Research suggests the high levels of insulin that result from insulin resistance may cause the body to also increase production of androgens, perpetuating the cycle.
“The pancreas is in overdrive mode trying to keep blood sugar down,” says Martha McKittrick, RD, CDE, who specialises in PCOS. The beta cells that make insulin in the pancreas eventually start to wear out, she says.
The connection between PCOS and type 1 diabetes is less clear. Researchers theorise that high levels of injected insulin cause the same overproduction of androgens in women who are genetically susceptible.
There are also a number of women with PCOS who do not have insulin resistance.
There is no cure for PCOS, but it can be managed with healthy eating, weight loss, and, often times, medication. After her PCOS diagnosis, Lizmari, now 37, started taking metformin and birth control pills. “I was told to take birth control pills until I wanted to have children,” she says.
Birth control pills are often prescribed to help regulate menstrual cycles and reduce androgen hormone levels. For women who want to become pregnant, additional fertility drugs, such as Clomid (clomiphene), may be necessary.
Metformin is often the first medication of choice because it treats insulin resistance. Some research also indicates that metformin may help with fertility issues. One study showed that metformin may increase the number of ovulations a woman has, but the study also showed that the likelihood of a successful pregnancy was no different with metformin than in women who did not take metformin.
A healthy eating plan can be important in managing both PCOS and type 2 diabetes. “Even losing 5–10 per cent of your body weight (about 10-20 pounds for most overweight women) can have a significant effect of decreasing symptoms of PCOS and inducing ovulation,” McKittrick says. She recommends women with PCOS eat an anti-inflammatory diet low in refined carbs and includes heart-healthy fats, such as nuts and olive oil; lean protein, fat-free or low-fat dairy; plenty of vegetables; and lower-glycaemic fruits and grains. Regular exercise also improves insulin resistance, decrease blood sugar, and reduce heart disease risk.
“When I started treating my PCOS, some immediate differences I saw were a lightening of my skin, better moods, and an easier time losing weight,” Lizmari says. Her acne also improved and hair growth in places she didn’t want it lessened.
Even though PCOS can bring heartache to women struggling with conception, researchers are learning more about treating it. Progress has been made.
“Don’t lose hope,” Lizmari says.
By Allison Nimlos | illustrations by Richard Faust