Amanda Wilde (Host): Welcome to BayCare HealthChat. I'm Amanda Wilde. Polycystic ovary syndrome is better known as PCOS. PCOS is very common, but sometimes goes for a while undiagnosed. So, we'll talk about diagnosis and treatment of PCOS with Dr. Sarah C. Smith, family medicine physician at BayCare. Dr. Smith, great to have you here today.

Sarah C. Smith, DO: Thank you so much for having me, Amanda.

Host: Polycystic ovary syndrome, PCOS, what exactly is that? Let's break down that title.

Sarah C. Smith, DO: So, PCOS is a common hormonal disorder that affects women. It typically occurs between the ages of 18 to 35, and it causes irregular menstrual periods, excessive hair growth, acne and infertility. It occurs when the ovaries create excess hormones called androgens, and that causes an imbalance in the reproductive hormones. And so, that causes the irregular cycles and the missed periods and the unpredictable ovulation.

Host: And we say polycystic, so are these cysts in the ovary?

Sarah C. Smith, DO: Yes. So if you did ultrasounds on these women, many would have these cysts on the ovary, but it doesn't always show on ultrasound. But typically, yes, they are on the ovary.

Host: Now, why is it important for us to know about PCOS?

Sarah C. Smith, DO: Well, PCOS is one of the most common causes of infertility. And it can also increase your risk of other health conditions. It increases your risk of diabetes and high blood pressure and endometrial hyperplasia and endometrial cancer and anxiety and depression and other health conditions.

Host: Wow. So, it just really makes you susceptible to all those things. So, what are the signs and symptoms then of PCOS? I mentioned it often goes undiagnosed.

Sarah C. Smith, DO: Number one, irregular periods. So, some people miss periods or some people just don't have a period at all. And then, another common symptom is abnormal hair growth. For example, the hair growth is like excessive facial hair, or like heavy hair growth on your arms or chest or abdomen. It's not necessarily just hair growth on your head, it's what we call in the medical world like hirsutism. So, it's almost like a male pattern hair growth that's caused by the androgens. And then, acne and especially severe acne, and it's usually more severe than just on your face. It's also typically like on the back or chest. Obesity can be associated with PCOS. And then, there are other symptoms as well. There can be darkening of the skin in patches, especially like in the folds of your neck or in your armpits or in your groin. And the medical term for that is acanthosis nigricans. And then, another sign is that those cysts that we were talking about on the ultrasound. So, there are many different symptoms. And some people may have some of these and not necessarily all of them.

Host: Which makes it a little harder to diagnose. So, I'm thinking some of these things women might go through and think, "Well, this is just part of my female hormones," irregular periods or even facial hair or acne. When should PCOS be suspected?

Sarah C. Smith, DO: If your periods are irregular, like you're having few periods or you miss several months at a time. Some women typically miss one month or so, and that's not necessarily like a red flag. But if you have several missed periods or you go months without a period or your periods are always more than a couple months apart, or if you have trouble getting pregnant, or if you have this excess facial hair or other types of hair patterns, then those are reasons to talk to either your family doctor or your gynecologist about looking for PCOS.

Host: I was just going to ask that. So, someone comes into your office with a couple of those symptoms, then how is it diagnosed?

Sarah C. Smith, DO: First, we will take a history and go over all of those questions and do an exam. And then, typically, more hormone testing and other blood tests will be ordered and possibly an ultrasound of the pelvis.

Host: So, you mentioned history. Just wondering, is there a genetic component to this?

Sarah C. Smith, DO: Yes. So. It can occur in families. And sometimes if there's a family history of diabetes or other kinds of metabolic syndrome or obesity, it can be associated with those diseases as well.

Host: Actually, I was just going to ask what other conditions may be associated with PCOS. Are there other medical conditions that are sometimes part of having PCOS?

Sarah C. Smith, DO: There's so much overlap in these conditions, so that's a great question. The insulin resistance that is associated with diabetes and the metabolic syndrome and obesity are all kind of tied together with this. And then due to that, there's also the risks of heart disease and if someone's not having a period every month and their endometrial lining builds up, there's an increased risk for endometrial cancer. And then, due to all of these other issues, there's also the mood disorders that are associated, such as the anxiety and depression. And PCOS can cause issues with gestational diabetes and pregnancy complications.

Host: Yes. So, we were talking about people having trouble getting pregnant because of irregular periods. Does PCOS lead to infertility?

Sarah C. Smith, DO: So if you're not ovulating, it's hard to get pregnant. So, it can cause ovulatory infertility. And up to 80% of people who have had PCOS can experience fertility challenges. But the good news is that ovulation problems can be corrected and are often easier to treat than other types of infertility. Usually with medication, people can be able to ovulate and conceive, and some people can make lifestyle changes that can make them more able to ovulate.

Host: Well, what are the treatment options for people with PCOS once we've identified it?

Sarah C. Smith, DO: The treatment options are focused on what are the issues that are concerning you. One big question is whether or not someone wants to get pregnant. So if someone does not want to get pregnant, there are medications that can regulate your cycle such as combination birth control pills. So, that would regulate your hormones, lower your risk of endometrial cancer, correct the irregular bleeding and the excess hair growth and the acne. But if someone wants to get pregnant, then there are other types of medications that can help you ovulate.

Metformin is a diabetes medication that is also used in PCOS and it lowers insulin levels and can make someone more likely to ovulate. And then beyond that, there are also other oral medications, anti-estrogen medications or aromatase inhibitors, which help people ovulate. Those are typically prescribed by a gynecologist when someone has had an infertility workup and all of the simpler, easier things have been tried.

Everyone can benefit from the lifestyle changes. Weight loss through diet and exercise. Even like a mild weight loss might improve your chances of ovulating, and that can help with the infertility as well. And then, obviously, if you've got other issues or other complaints, like with the hair growth or the acne, there are so many other treatments for that, such as laser hair or prescription creams, or acne medications, creams, gels, and that sort of thing.

Host: This is great information. I think a lot of us have heard the term PCOS, but didn't really know what that term means. So, thank you for explaining that and for your insights on how to address it.

Sarah C. Smith, DO: You're welcome. It's so common, so I think it's important to highlight if someone is not having regular periods. This should be something that is discussed with their doctor.

Host: That was Dr. Sarah C. Smith, family medicine physician at Baycare. Go to baycare.org for more information and to get connected with one of our providers. For more health tips and updates, follow us on your social channels,. And if you found this podcast informative, please share it on your social media, and be sure to check out all the other podcasts in our library. That wraps up this episode of BayCare HealthChat. Thanks for listening.