Disclaimer: This podcast is for informational purposes only and is not intended to be used as personalized medical advice.

Cheryl Martin (Host): We're talking women's health today with OB-GYN, Dr. Daniela Arbreu. She's here to break down polycystic ovary syndrome or PCOS, what it is, the symptoms women should recognize, current treatment options and more. Stay tuned

This is Be Well with Skagit Regional Health. I'm Cheryl Martin. Dr. Arbreu, thanks for coming on.

Dr. Daniela Arbreu: Thank you very much for having me, Cheryl.

Cheryl Martin (Host): So, let's dive right in. What exactly is polycystic ovary syndrome, and why is it important for use—specially women—to understand?

Dr. Daniela Arbreu: So, polycystic ovarian syndrome is also known as PCOS, it's a very common disorder that is prevalent in women. We think about 7% of women, or seven out of a hundred of women, have experienced or have the disorder of PCOS. The reason that this is very important for us to know is because it can cause multiple issues, including cardiovascular disease, menstrual irregularities, difficulty with fertility, difficulty with weight loss, and many other issues that can happen with PCOS.

Host: You talked about how common it is. Who is most at risk of developing this condition?

Dr. Daniela Arbreu: We think that PCOS has a component of insulin resistance. And it's hard to say if women who have insulin resistance are at risk of developing PCOS or women who have PCOS are at risk of developing insulin resistance. But there is a very strong connection between the two. So, it's kind of the chicken or the egg—which one came first?

When it comes to polycystic ovarian syndrome or PCOS, we know that a big component of the insulin resistance can really contribute to how certain features and certain things can develop, such as the metabolic syndrome that's associated with it, or developing pre-diabetes or diabetes. And so, those are all things that are important to address when you're taking care of women who have polycystic ovarian syndrome.

Host: Talk in more detail about common symptoms that women should be aware of, and how might these symptoms of PCOS impact daily life?

Dr. Daniela Arbreu: So, the main symptoms that we see for PCOS are irregular menstrual cycles. So, that could look like if women who have that will have multiple gaps between their cycles that can last between several months to up to six months to a year, or very short cycles sometimes. Their cycles can be much heavier sometimes because of the irregularity of them.

And the other symptoms that we commonly see are symptoms of hyperandrogenism. And So, hyperandrogenism is really the increased amount of male hormones. So, most women do have some male hormones, but it is essentially an excess for women with PCOS. So, those symptoms primarily can present with acne or hair on unwanted places as well as hair loss. So, male pattern baldness can happen with PCOS. Hair on unwanted places can present with hair on the face, a mustache, or sometimes on the abdomen as well, or between the thighs. And lot of women find that some of those symptoms can be very stressful to experience.

And in addition to that, we know that PCOS, one of the markers that we see—and that is when women who maybe have some of those symptoms have undergone pelvic ultrasound—we see ovaries that appear to have multiple cysts on them or fluid-filled sacs on the ovaries themselves. And so, that is one of the things that we take into consideration when we are diagnosing PCOS.

Host: Doctor, what are some of the long-term consequences of PCOS?

Dr. Daniela Arbreu: Some of the long-term consequences of PCOS, there's multiple things, including something called endometrial hyperplasia, which is something that can predispose you to having a precancer or cancer of the lining of the uterus. This is something that we definitely want to try to prevent.

And so, making sure that your cycles are regular, including inducing ovulation at times or providing you a medication such as progesterone to shed the lining of the uterus, is very important if your cycles go through multiple spans of months without having a period.

In addition to that, we see mood disorders, depression, anxiety, metabolic syndrome, which can increase your risk of having high blood pressure or diabetes. We also see obstructive sleep apnea or OSA, that can be associated with obesity. And so, knowing if you have issues with waking up sleepy during the day or snoring throughout the night is very important for your healthcare provider to know about issues with fertility because of the lack of ovulation that happens with PCOS. These are all can be important long-term consequences that can affect your livelihood and your lifespan.

Host: So, I can only imagine when a woman, let's say, began to see more hair or acne, some of the things that you mentioned, this will cause her then to come into the office and that's when she may find out that PCOS is an option.

Dr. Daniela Arbreu: That is correct. So, the best way for women who are experiencing some of those symptoms is to come in and be evaluated by either their primary care provider or by a women's specialist. And so, the main things that we do when we are assessing for these is really hearing about the woman's experience, how long her symptoms have been present, and what are her goals in terms of treatment, which is why PCOS is an interesting disorder because there is such a variation in the way that it presents, that we really need to individualize the way that we treat women to make sure that they're getting the care that they would like.

Host: Talk about what treatment options are available and how do they help manage PCOS.

Dr. Daniela Arbreu: So, the main treatment options that are available have to really be tailored to each individual woman in terms of what her goals are at that moment of her life. The main things that we try to address is really the irregular menstrual cycles that can become very stressful. And so, we try to address the irregular cycles. And that could be done mainly with medication.

The main thing that comes with PCOS is that we see that there is an increased risk for obesity. And similar to insulin resistance, we know that, with obesity, we don't know if the PCOS has caused the obesity or the obesity is a part of a component of PCOS. And so, when we are addressing some of those concerns, if weight loss is a goal, this is something that we can also work on together.

So, treatment options, primarily, we start with discussing lifestyle modifications. So, working on a calorie deficit diet, if that's a goal of someone. We also speak about exercise, because that can decrease insulin resistance, which is a hallmark of PCOS. And it really just depends on kind of the goals at that moment. So if the goal is to regulate the cycles, we work on that with specific medications. If the goal is to become pregnant, we can work on that. And there are certain medications that have been shown to improve fertility in women who have PCOS.

Host: So, is there a way to prevent PCOS, or are certain preventive measures more about managing the risks and the symptoms?

Dr. Daniela Arbreu: So, PCOS is a disorder that doesn't have an actual cure. But the way that we think about it is that if we are successful in managing the symptoms, we can prevent long-term effects that are associated with PCOS, such as the cardiovascular disease or preventing type 2 diabetes. So, there are many things that we can do to mitigate some of the effects that PCOS can have.

Host: Are there any new technologies or advancements in the treatment of PCOS that we should be aware of?

Dr. Daniela Arbreu: That is a really good question. I think the main advancements have really become of how well-known this phenomenon is and how much better we have become at treating it. And so, the treatment really has to be tailored to each individual in order to help prevent progression of this disease.

The other thing that we have seen in the last couple years is the continuous glucose monitors. So, that is a new option for women who have some insulin resistance that is associated with PCOS, if it's to help prevent development of either type 2 diabetes or if it is already prevalent to treat it in a way that is beneficial. So, those continuous glucose monitors can really help, giving us a better outlook and really evaluate the insulin resistance that is occurring within PCOS.

Host: Now, it's my understanding that living with PCOS can be difficult mentally as well as physically. So, how do you address the emotional aspects of this condition with your patients?

Dr. Daniela Arbreu: Dealing with the mental aspects of PCOS can be very challenging. And so, part of the challenges that we see is related to body image. And so, addressing some of those components as well, either with lifestyle and kind of meeting together and addressing some of the stress that can be associated with that. Knowing that PCOS, we do see that it can be more difficult to lose weight than women who don't have the disorder of PCOS. And so, giving some reassurance that we understand that this can be very challenging, and there are different ways that we can assist with that.

In addition, I think it's very important to address symptoms of depression or anxiety that can be associated with PCOS or outside of the actual disease. Depression or anxiety is prevalent in the population in general. And the main thing I would recommend is therapy when it comes to that. So, finding a counselor that can work with you and be on the same page that you connect with can be very beneficial.

in addition to that, for women with depression, if they are finding counseling not to be sufficiently beneficial, we can discuss starting medication that has been shown to help with anxiety and depression.

Host: So if you sense that the PCOS is caused by obesity, is this a category where this person would be eligible for Ozempic or other drugs like that?

Dr. Daniela Arbreu: So, I will say, first of all, we don't know if PCOS is caused by obesity or if PCOS causes obesity. The other thing is that we know that there are about 20% of women who actually do not have obesity and still have the disorder of PCOS. When it comes to PCOS, certain insurance companies would qualify PCOS as a risk factor, which might help cover certain medications such as the GLP-1, semaglutide or Ozempic.

Host: So if a woman suspects that she might have PCOS, based on what we've discussed today, what are the first steps she should take towards getting a diagnosis?

Dr. Daniela Arbreu: So, the first step would be to speak to her primary care or women's specialist, speak about her concerns. And sometimes we undergo additional testing to make sure that there is no other causes that might explain why if a woman is coming in with irregular cycles, if there's other causes that might cause her to have those irregular cycles.

We usually also order the pelvic ultrasound to assess, to see if there's any findings on that, that would correlate with what we are anticipating. But for most women, if their cycles are irregular and they have symptoms of hyperandrogenism such as the acne or unwanted hair, the diagnosis can be made from those symptoms alone. And then, we just exclude additional etiologies that could cause it.

Host: Dr. Arbreu, thanks so much for educating us on PCOS, its symptoms, and treatment options. Very informative. Thank you.

Dr. Daniela Arbreu: Absolutely. It was my pleasure to be here. Thank you so much, Cheryl, for your time.

Host: To learn more, just visit skagitregionalhealth.org. If you found this podcast helpful, please share it on your social media and be sure to check out our podcast library for other topics of interest to you. Thanks for listening to Be Well with Skagit Regional Health.