Polycystic Ovary Syndrome or PCOS is one of the most common hormonal endocrine disorders in women.
5-10% of women of childbearing age are affected by PCOS, with less than 50% of women diagnosed.
The good news is that early diagnosis and proper education can help women lower risk factors and live a happy, healthier life.
Obstetrics and gynecology physician, Dr. Kim Fischer is here today to uncover the facts of PCOS.
Selected Podcast
The Mysteries of Polycystic Ovary Syndrome
Featured Speaker:
Kim Fischer, MD – OB/GYN
Dr. Kim Fischer specializes in obstetrics and gynecology at the Allina Health Shoreview Clinic. She has professional interests in urinary incontinence, pelvic organ prolapse and robotic surgery. In her free time she enjoys spending time with her husband and two sons, and their beloved family dogs. Transcription:
The Mysteries of Polycystic Ovary Syndrome
Melanie Cole (Host): Polycystic ovary syndrome or PCOS is one of the most common hormonal endocrine disorders in women. Five to 10 percent of women of childbearing age are affected by PCOS, with less than 50 percent of the women diagnosed. The good news is that early diagnosis and proper education can help women lower their risk factors and live a happy, healthier life. My guest today is Dr. Kim Fischer. She’s an obstetrician and gynecologist with Allina Health Shoreview Clinic. Welcome to the show, Dr. Fischer. Tell us, what is polycystic ovary syndrome?
Dr. Kim Fischer (Guest): Hi, Melanie. It’s great to be here. Polycystic ovarian syndrome is a situation where the hormones are in imbalance with women, and they can often have low levels of follicle-stimulating hormones and high levels of androgens. Androgens are what we think of as male-type hormones.
Melanie: Is this something that is genetic? What causes these lower levels of hormones?
Dr. Fischer: Well, what can be frustrating for patients is that we don’t know specifically what causes the hormone changes. We know what kind of effects they have on us. We know that it’s also hereditary, so if someone’s mom or sister has PCOS, they might have a more likely chance of having it. They’re doing research to see whether or not maybe there are genes that are specifically linked to PCOS, but part of what the problem is is dealing with the symptoms that can be frustrating for patients. Symptoms can be lots of excess hair growth where you don't want it—say, on your face, your lower abdomen. Many women struggle with not being able to lose weight when they want to lose weight. Their periods can be irregular or not at all. When patients don’t have periods at all for three months or more, that can put an increased risk of pre-cancer of the uterus or cancer of the uterus. I talk with my patient that although you might enjoy not having a period, as many of my patients do, it’s not always a healthy thing if we’re not controlling it with external hormones.
Melanie: If we women are noticing these symptoms, that’s the time to come in and see our gynecologist because these symptoms could be alarming, plus we have so many symptoms and we have so many things that go on that we tend to brush some of them off. What do you do to diagnose it?
Dr. Fischer: Well, there’s many different ways to diagnose it. Sometimes, you can diagnose it with ultrasound, but ultrasound isn’t the be-all. Sometimes there are many, many little cysts around the outside of the ovary that can sometimes be a diagnosis. If you don’t have that, it’s not an absolute diagnosis. Sometimes we can check the hormones in the body called the free testosterones. We know that insulin resistance is common. Sometimes we will check the insulin levels. You can just look at the patient. Sometimes if they’re overweight—they’re not always overweight—if they have excess hair growth and they’re not having regular periods, or they’re not having periods at all, those are all signs and symptoms of having PCOS.
Melanie: Then what is the next step? If you determine that that is what we have, what are the treatments?
Dr. Fischer: Specifically, if a patient is not wanting to get pregnant, then we talk about putting them on birth control, whether that’s a pill, whether that’s an IUD, or whether that’s a ring. Part of the reason for that is to protect the uterus, as we said, from pre-cancer or cancer. It’s also to regulate their periods, and it also helps with acne. The frustrating thing is when you see a lot more acne with that. The hormones that we give will help decrease the testosterone level in a woman. Women all have testosterone; it’s just higher in some than others. We also work with them to help with their weight loss. If their insulin is high or if the glucose levels are high, we work with putting them sometimes on a medicine called metformin that will help to regulate those levels. Oftentimes, that helps. If the hair growth is bad enough, sometimes we have to offer treatments for the hair growth. Now, in the woman who is trying to get pregnant, I let women know that -- they’re scared because they’re not having periods; they’re scared because how am I ever going to get pregnant when I don’t have periods. I tell people this is one of the easiest situations to get people pregnant because we take them off their birth control pills and we often give them a medication called Clomid. Clomid helps in that you ovulate. I see lots and lots of women with PCOS that do go on to get pregnant. It’s a common and understandable fear that they won’t get pregnant with PCOS.
Melanie: It doesn’t necessarily affect fertility, and if it does, you help them with that. Does it affect pregnancy?
Dr. Fischer: Typically, the realm where it would affect pregnancy would be primarily if you have someone who has had severe enough PCOs that they now have high blood pressure, that they have diabetes. Then that’s where the preexisting medical problems could affect PCOS. But PCOS itself doesn’t affect pregnancy. It’s just the complications from PCOS that can affect the pregnancy.
Melanie: Are there things you’d like women to know about maybe things they can do at home—behavior, lifestyle modifications, alternative or complementary medicine—to treat their PCOS, or even to prevent it in the first place?
Dr. Fischer: I think one of the main things is being sure to try and have a healthy diet, avoiding processed foods, and then getting lots of good exercise. Thirty minutes a day of just walking is really healthy for us. In this really busy world, sometimes we forget about that. The weight loss is one of the biggest things that you can do. Oftentimes when the woman loses the weight, you’ll see the periods come back, the acne gets better, the high blood pressure, the glucose elevation. You’ll see that all of that gets better. But as we all know, that’s not always easy. Thirty minutes a day of walking at a minimum, avoid processed foods. Anything that can last on yourself for more than two weeks, you can think about not eating and instead eating fresh fruits and vegetables. It’s a lot healthier. I also talk to my patients about avoiding soda and just trying to drink lots more water, because I think sometimes we forget about that in our busy life.
Melanie: Are there any hormones that we should be worried about out there in the world, and we see so many of these hormones: “Take this and it will help you.” Are there any of those we should be worried about—soy products? Do any of these contribute to PCOS?
Dr. Fischer: Not to my knowledge. Part of what you’re talking about is difficult in my position because when you hear about these alternative medicines, I’m not saying they’re right or wrong, but what I am saying is that they’re not technically FDA-approved. Although your herbal medications may say that they will help with PCOS, the problem is that they haven’t been strongly studied by randomized trials. And so, from my line of work, I can’t for sure tell you that the medical evidence supports that. That doesn’t mean refuse it, but I can’t say a hundred percent support it. In my role, in my position, what I can say is that things like birth control pills to help regulate the hormones, things like metformin can help with the PCOS, but I don’t think that I am educated enough and it’s not in my realm of practice to say whether or not the herbs and the soy and whatnot is good versus bad.
Melanie: Well, that’s great information, and you succinctly put it. Please, in the last couple of minutes, if you would, Dr. Fischer, wrap it up for us about PCOS and what you really want women to know when they come into your office asking these questions.
Dr. Fischer: I think the first thing to know is don’t be scared you can’t get pregnant. Just because you have PCOS, it doesn’t you can’t get pregnant. We can help you. There are ways to help you. The second thing to know is although many of my patients don’t like coming to the doctor—I get that, I personally growing up didn’t like coming to the doctor—this can have serious consequences. If you have PCOS and you don’t come to your doctor, and you go six months, 12 months, two years without ever having a period and you’re not on any hormones to stop that period, there can be dire consequences. I don’t want to see you end up with pre-cancer or cancer of the uterus. It can be that serious. The third one is that there are ways that we can help you. You’re frustrated with not losing weight, you’re frustrated with acne, you’re frustrated with not knowing when your periods come, there are things that we can do to help you out. It’s something that’s very treatable.
Melanie: Thank you so much, Dr. Kim Fischer. You are listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.
The Mysteries of Polycystic Ovary Syndrome
Melanie Cole (Host): Polycystic ovary syndrome or PCOS is one of the most common hormonal endocrine disorders in women. Five to 10 percent of women of childbearing age are affected by PCOS, with less than 50 percent of the women diagnosed. The good news is that early diagnosis and proper education can help women lower their risk factors and live a happy, healthier life. My guest today is Dr. Kim Fischer. She’s an obstetrician and gynecologist with Allina Health Shoreview Clinic. Welcome to the show, Dr. Fischer. Tell us, what is polycystic ovary syndrome?
Dr. Kim Fischer (Guest): Hi, Melanie. It’s great to be here. Polycystic ovarian syndrome is a situation where the hormones are in imbalance with women, and they can often have low levels of follicle-stimulating hormones and high levels of androgens. Androgens are what we think of as male-type hormones.
Melanie: Is this something that is genetic? What causes these lower levels of hormones?
Dr. Fischer: Well, what can be frustrating for patients is that we don’t know specifically what causes the hormone changes. We know what kind of effects they have on us. We know that it’s also hereditary, so if someone’s mom or sister has PCOS, they might have a more likely chance of having it. They’re doing research to see whether or not maybe there are genes that are specifically linked to PCOS, but part of what the problem is is dealing with the symptoms that can be frustrating for patients. Symptoms can be lots of excess hair growth where you don't want it—say, on your face, your lower abdomen. Many women struggle with not being able to lose weight when they want to lose weight. Their periods can be irregular or not at all. When patients don’t have periods at all for three months or more, that can put an increased risk of pre-cancer of the uterus or cancer of the uterus. I talk with my patient that although you might enjoy not having a period, as many of my patients do, it’s not always a healthy thing if we’re not controlling it with external hormones.
Melanie: If we women are noticing these symptoms, that’s the time to come in and see our gynecologist because these symptoms could be alarming, plus we have so many symptoms and we have so many things that go on that we tend to brush some of them off. What do you do to diagnose it?
Dr. Fischer: Well, there’s many different ways to diagnose it. Sometimes, you can diagnose it with ultrasound, but ultrasound isn’t the be-all. Sometimes there are many, many little cysts around the outside of the ovary that can sometimes be a diagnosis. If you don’t have that, it’s not an absolute diagnosis. Sometimes we can check the hormones in the body called the free testosterones. We know that insulin resistance is common. Sometimes we will check the insulin levels. You can just look at the patient. Sometimes if they’re overweight—they’re not always overweight—if they have excess hair growth and they’re not having regular periods, or they’re not having periods at all, those are all signs and symptoms of having PCOS.
Melanie: Then what is the next step? If you determine that that is what we have, what are the treatments?
Dr. Fischer: Specifically, if a patient is not wanting to get pregnant, then we talk about putting them on birth control, whether that’s a pill, whether that’s an IUD, or whether that’s a ring. Part of the reason for that is to protect the uterus, as we said, from pre-cancer or cancer. It’s also to regulate their periods, and it also helps with acne. The frustrating thing is when you see a lot more acne with that. The hormones that we give will help decrease the testosterone level in a woman. Women all have testosterone; it’s just higher in some than others. We also work with them to help with their weight loss. If their insulin is high or if the glucose levels are high, we work with putting them sometimes on a medicine called metformin that will help to regulate those levels. Oftentimes, that helps. If the hair growth is bad enough, sometimes we have to offer treatments for the hair growth. Now, in the woman who is trying to get pregnant, I let women know that -- they’re scared because they’re not having periods; they’re scared because how am I ever going to get pregnant when I don’t have periods. I tell people this is one of the easiest situations to get people pregnant because we take them off their birth control pills and we often give them a medication called Clomid. Clomid helps in that you ovulate. I see lots and lots of women with PCOS that do go on to get pregnant. It’s a common and understandable fear that they won’t get pregnant with PCOS.
Melanie: It doesn’t necessarily affect fertility, and if it does, you help them with that. Does it affect pregnancy?
Dr. Fischer: Typically, the realm where it would affect pregnancy would be primarily if you have someone who has had severe enough PCOs that they now have high blood pressure, that they have diabetes. Then that’s where the preexisting medical problems could affect PCOS. But PCOS itself doesn’t affect pregnancy. It’s just the complications from PCOS that can affect the pregnancy.
Melanie: Are there things you’d like women to know about maybe things they can do at home—behavior, lifestyle modifications, alternative or complementary medicine—to treat their PCOS, or even to prevent it in the first place?
Dr. Fischer: I think one of the main things is being sure to try and have a healthy diet, avoiding processed foods, and then getting lots of good exercise. Thirty minutes a day of just walking is really healthy for us. In this really busy world, sometimes we forget about that. The weight loss is one of the biggest things that you can do. Oftentimes when the woman loses the weight, you’ll see the periods come back, the acne gets better, the high blood pressure, the glucose elevation. You’ll see that all of that gets better. But as we all know, that’s not always easy. Thirty minutes a day of walking at a minimum, avoid processed foods. Anything that can last on yourself for more than two weeks, you can think about not eating and instead eating fresh fruits and vegetables. It’s a lot healthier. I also talk to my patients about avoiding soda and just trying to drink lots more water, because I think sometimes we forget about that in our busy life.
Melanie: Are there any hormones that we should be worried about out there in the world, and we see so many of these hormones: “Take this and it will help you.” Are there any of those we should be worried about—soy products? Do any of these contribute to PCOS?
Dr. Fischer: Not to my knowledge. Part of what you’re talking about is difficult in my position because when you hear about these alternative medicines, I’m not saying they’re right or wrong, but what I am saying is that they’re not technically FDA-approved. Although your herbal medications may say that they will help with PCOS, the problem is that they haven’t been strongly studied by randomized trials. And so, from my line of work, I can’t for sure tell you that the medical evidence supports that. That doesn’t mean refuse it, but I can’t say a hundred percent support it. In my role, in my position, what I can say is that things like birth control pills to help regulate the hormones, things like metformin can help with the PCOS, but I don’t think that I am educated enough and it’s not in my realm of practice to say whether or not the herbs and the soy and whatnot is good versus bad.
Melanie: Well, that’s great information, and you succinctly put it. Please, in the last couple of minutes, if you would, Dr. Fischer, wrap it up for us about PCOS and what you really want women to know when they come into your office asking these questions.
Dr. Fischer: I think the first thing to know is don’t be scared you can’t get pregnant. Just because you have PCOS, it doesn’t you can’t get pregnant. We can help you. There are ways to help you. The second thing to know is although many of my patients don’t like coming to the doctor—I get that, I personally growing up didn’t like coming to the doctor—this can have serious consequences. If you have PCOS and you don’t come to your doctor, and you go six months, 12 months, two years without ever having a period and you’re not on any hormones to stop that period, there can be dire consequences. I don’t want to see you end up with pre-cancer or cancer of the uterus. It can be that serious. The third one is that there are ways that we can help you. You’re frustrated with not losing weight, you’re frustrated with acne, you’re frustrated with not knowing when your periods come, there are things that we can do to help you out. It’s something that’s very treatable.
Melanie: Thank you so much, Dr. Kim Fischer. You are listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.