Scott Webb (Host): Polycystic ovary syndrome or PCOS is a condition of which the ovaries produce a significantly abnormal level of male hormones, which are known as androgens. And joining me today to tell us about the symptoms and treatment options for PCOS is Dr. Nneka Iroka. She's a general endocrinologist with Elliot Endocrinology Associates.

Host: This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of Solution Health. I'm Scott Webb.

Doctor, thanks so much for your time today. We're going to talk about polycystic ovary syndrome and maybe along the way here, we'll abbreviate as PCOS. But as we get rolling here, what is polycystic ovary syndrome?

Dr. Nneka Iroka: Polycystic ovarian syndrome is a condition in which the ovaries produces a significantly abnormal level of male hormone, which in other words, we call them the androgens. So, these are hormones that usually are produced in women as well. But in persons with PCOS, they are produced in higher amounts than normally they should be produced. So because of that higher amount of level that these hormones are produced, they cause different manifestations in the body.

Host: Yeah. And let's talk about the manifestations, if you will, in other words, the symptoms. So, what are some of the symptoms that individuals might experience, and how might that inform then the diagnosis process?

Dr. Nneka Iroka: So, some of the symptoms that you see in persons with PCOS and one of the main symptoms here is the person may see irregular menses. They'll have irregular menstruation. Sometimes they may have it in this month; next month, they don't have it; the following months, they have it. Some people, it will present as not having menses at all. Some people, they will have menses, but then it occurs in a fashion that is very unpredictable. So, that's one of the symptoms you see in persons with PCOS.

The other symptom is they will also see things like hair in unwanted places. They can see hair around the chin area. They may find like dark coarse hair in the upper lip. Some people may see it around the nipple area. Some people, it may be around the chest or around the umbilical cord area. That's another symptom that you see in persons with PCOS.

Another symptom is acne. Some people will experience acne in the face or around the chest or in their upper back. And another symptom also of PCOS is they could have what we call male pattern baldness, which is losing hair, especially in the front aspect of the head. That's also another symptom of PCOS. And also, one other big symptoms of PCOS is that you may experience weight gain that could be difficult to lose. And then, the way this also contributes to the diagnosis is the irregular menses is part of what we call anovulatory aspect, which is what we use as part of the criteria of PCOS diagnosis. And then if they have things like hair in unwanted place or acne, those will contribute to what we consider the hyperandrogenic symptoms or hyperandrogenic aspect of PCOS, basically saying there are excess amounts of male hormones being produced.

Host: Yeah, I see what you mean, because I was going to ask you about diagnosis. So, I was assuming, you know, patient history, some of the symptoms you're discussing here. Are there any specific tests involved? Or is it really just you and your expertise and maybe the team, you know, listening to patients, getting the patient history and sort of putting the pieces together? Or are there actual tests?

Dr. Nneka Iroka: So, there is no one particular test that is used to say, "Oh, this test confirms that somebody has PCOS." So to diagnose PCOS, a person has to have two out of three criteria. Those three criteria are having irregular menses or having no menses, that's one criteria. The second criteria is if you have like hair in unwanted place or acne or loss of hair around the frontal area, that's another criteria. Or if you have elevated level of what we call androgens, like if you have high testosterone levels or high levels of other androgens, that's part of the second criteria as well. And then, the third criteria is having multiple cysts in the ovaries. It could be in one ovary or it could be in both ovaries. So if you have any two of these three criteria, then you do meet criteria of PCOS. However, there are some other things that can cause some of these symptoms. So if somebody presents with symptoms that could be PCOS, we tend to check other things that could cause it. And if those are fine, then we consider that you do have PCOS.

Host: Yeah. So, any two of the three, but as you say, there could be other risk factors or causes, and that's what I wanted to ask you about next, was sort of the misdiagnosis or delayed diagnosis when we think about PCOS, like what are some of the reasons why that happens? Why would we have misdiagnoses or delayed diagnoses?

Dr. Nneka Iroka: Yeah. So, that is a very good question because this has been something that is big in the PCOS world, where misdiagnosis tends to happen quite often or the diagnosis is delayed. And one of the main reasons here is because some of the symptoms of PCOS can also be due to other conditions besides PCOS, for example, when someone presents with irregular menses or not having menses. There are a host of things that can cause irregular menses too. For example, certain medications that one may be taking or if they have thyroid dysfunction, like hypothyroid or hyperthyroid, or if they have things like fibroids or even stress too can cause irregular menses. So because of some of this potential other causes of a particular symptom of PCOS, that could lead to a misdiagnosis or it could lead to delay in diagnosis.

Host: I see what you mean. Yeah. So if there are other conditions, it could also be the cause. So, you could see how, you know, fairly easily PCOS could be misdiagnosed or there could be a delayed diagnosis. So if individuals think or suspect that they have PCOS because they have some of the symptoms, maybe two of the three, hopefully not three of the three, but maybe at least two of the three, what are then the steps? Do they speak with their primary care provider, be referred? Take us through that.

Dr. Nneka Iroka: Yes. So if you have any of the symptoms of PCOS, you want to talk to your provider, your primary care provider. They can do some certain tests, which can check to see if it could be certain things causing it also. So, that's one thing. It is very important to talk to your primary care provider and also ask questions. You can ask. It's okay to ask your PCP, "Do I have PCOS? What are the tests that we can check to see if it's something else, or whether it's PCOS?" And also, it is also very important to discuss with your PCP and say, "Hey, do you think it's time that I see an endocrinologist who are specialists in this diagnosis and management of PCOS?" Or you can also ask to see if you can be referred to see a GYN, which is a gynecologist. So again, your PCP can look into the testing that needs to be done to see whether you have PCOS or they can refer you to see an endocrinologist or a gynecologist. So, one of the things here is advocate for yourself. Ask questions. Ask, "Can we do testing?" And with this, they will be able to come to a diagnosis.

Host: Yeah, for sure. Well, it was great to have your time today. Nice to meet you. Great to learn more about PCOS. And as you're saying here today, you know that folks just need to reach out, speak with their providers, be referred if necessary, be in the lookout for the symptoms, but understand the other things, other conditions may be the cause of those symptoms as well. That's why we have doctors and tests and all of that. So, thanks so much. You stay well.

Dr. Nneka Iroka: Thank you very much.

Host: And for more information, go to elliothospital.org and search polycystic ovary syndrome. And if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of Solution Health. I'm Scott Webb. Stay well, and we'll talk again next time.