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Scott Webb (Host): Polycystic ovary syndrome or PCOS, is a condition or syndrome in which a woman's ovaries produce an abnormal amount of androgens resulting in acne, unwanted hair growth and male pattern baldness in women. And joining me today to help us understand the diagnosis and treatment of PCOS is Dr. Ashley Perkins. She's a Board Certified OB GYN Physician with the Franciscan Physician Network. This is the Franciscan Health Doc Pod. I'm Scott Webb. So Doctor, thanks so much for your time today. We're talking about polycystic ovary syndrome, which we'll abbreviate as PCOS as we go along here. As we get rolling, what are the symptoms of polycystic ovary syndrome?

Ashley Perkins, DO (Guest): Well the first thing to realize about this is it, it truly is a syndrome. So that means it doesn't look exactly the same for every patient. There are clusters of signs and symptoms that we usually see. And some patients may have all of them and some patients may have two or three of them. But the most common things that we see that patients are coming into the offices for and asking questions about or noticing themselves are menstrual irregularities, increased hair growth in areas that women generally don't want hair to grow or male pattern hair loss. We can see acne, as well as infertility and obesity.

Host: Yeah, so good to know. It's not a sort of a one size fits all. It really is truly a syndrome, as you say. How is PCOS diagnosed?

Dr. Perkins: As far as diagnosing PCOS, there are multiple criteria that can be used. One of the more common ones is a criteria set of three, and a patient has to meet two out of three of those criteria to meet the diagnosis. The first one of those would be irregular periods. And that is something that we call oligo ovulation or anovulation in which a woman is actually not ovulating and has irregular periods less than eight periods a year, or may not even be having periods at all.

The second criteria would be signs of what we call hyperandrogenism. They're essentially increased testosterone. They lead to those things like the increased hair growth or male pattern hair loss that we can see either physically on the exam or sometimes with blood work, we see those elevations and in those specific hormones. The third criteria would be ovaries that actually appear polycystic and have multiple small follicles on an ultrasound or the ovaries that are just generally increased in their size compared a normal ovarian volume. And so it's two out of those three criteria that we use to make that diagnosis.

Host: All right. Got it. So it's two out of the three and good to know that it sounds like a fairly comprehensive process for diagnosing PCOS. And what are the treatment options? Are there some medications that women can take?

Dr. Perkins: There are multiple medications that we use to help manage these signs and symptoms. And it really depends on which symptoms a woman has and where she is in life with her current lifestyle goals, family planning goals. So, we take a look at that individual, but certainly getting their periods under control and really regulating those. That's important from a standpoint of making sure that they're operating, but also making sure that we're not allowing them to go down a path that could even potentially lead them to an endometrial cancer. So, using cycle control medications, using hormones to help regulate that and balance out those hormones is often one of the mainstays of treatment.

We can also use another oral medication, to help minimize those male hormones per se, that hyperandrogenism, there's some medication that we can use for that as well. There are also some oral medications that are often used with type two diabetes and pre-diabetes to help balance out the insulin resistance as well. For women that are seeking pregnancy, there's a set of medication that we can use to help them with their family planning journey also.

Host: Yeah, I wanted to ask you, what's the connection between PCOS and infertility? Does it in any way, cause infertility, can women still have successful pregnancies even after they've been diagnosed with PCOS?

Dr. Perkins: It certainly presents a challenge for those patients. Because of those irregular menstrual cycles and those irregular periods that really is driven by the fact that they're not ovulating every month. Generally, that next cycle is triggered after that ovulation occurs. And so when that's not happening, women aren't going to have a period and they aren't going to be able to conceive on their own.

And that's where we start looking at their hormone levels, looking at what their cycles are doing are they ovulating some months but not others. And we can use medications to help those women ovulate on their own. There are some surgeries as well, that have been used more frequently in the past, but we've really found that a lot of these oral medications can really help women achieve ovulation and achieve pregnancy.

Host: Well, that's good to hear. And along the way here, we've identified a, I think I've heard you say lifestyle. And so I'm wondering, how does lifestyle factor into this? Is there a way for women to prevent PCOS or help manage along with the other therapeutics that you've mentioned here? I guess I'm asking, are there some lifestyle changes that women can make that'll help them, manage PCOS?

Dr. Perkins: Certainly, lifestyle factors and lifestyle modifications are usually our first line. A lot of times by the time a patient reaches my office, they've tried those things. And we are talking more about medications, but because there is such a high association with obesity and insulin resistance and diabetes, fatty liver, there's a whole constellation of associations with these other medical conditions; it does come back to lifestyle factors. So, for most women, those lifestyle factors won'r keep them from having PCOS, but it can modify and decrease some of the symptoms that they may have from that. So regular exercise and maintaining a healthy BMI or body mass index and weight really are one of the first lines of treatment that we look at and talk to patients about.

Host: Yeah. And it's always good to know that we have options, right. So, staying mentally and physically well, and a combination of exercise, keeping BMI down within the normal nominal range. You've mentioned the drug therapeutics and options, possibly surgery, but as you've said, the drugs that are available now make it so those maybe aren't really an option or you don't really have to take that step with a lot of women, which is great. As we wrap up here, doctor, this has been really educational. I told you before we got started, I don't know much about PCOS, so great to have an expert on. What are your final takeaways for women, for listeners? What do they most need to know about PCOS, about how it's diagnosed, treated, and really just what's the outlook for them to be able to live healthy lives with polycystic ovary syndrome?

Dr. Perkins: Yeah, I think most often I see women in my office and a lot of times it is when they're ready to start their families and start having babies. And, you know, they come in and they've had a history of irregular periods, or maybe they've had this acne that hasn't really been treated, but it's acne. So, they didn't really put it at the top of their list. And I think, you know, anytime you have this constellation of symptoms or something that just doesn't seem normal, it's always a good idea to come in and establish care with a physician that, that you're comfortable with, that you can ask these questions about, and really look at those outcomes and how that's going to impact your life and try to minimize how this is really going to impact your life.

So, whether it's your periods, whether it's your skin or your hair, you know, it's always a good idea to find that physician that you can really connect with and really ask ask those questions too.

Host: Yeah. And that's just great advice from an expert today. I think you're right, that we all tend to do that we all tend to minimize things well, this acne, but it's probably just acne. Well, it might be, but it could be a part of something bigger, like PCOS so great to reach out and speak openly and honestly, with your primary, to seek the advice of a specialist like yourself. So, doctor, thanks so much for this education today. I really appreciate it And you stay well.

Dr. Perkins: Thank you so much for having me.

Host: Find an OB GYN or endocrinology physician at franciscandocs.org. And if you find this podcast to be helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.