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How to Prevent and Treat Polycystic Ovary Syndrome

Polycystic ovary syndrome can cause infertility and hair loss and increase your risk for heart disease, diabetes and uterine cancer.

Learn some of the simple steps you can take to reduce your risk from a UVA Children's Hospital pediatric endocrinologist.
How to Prevent and Treat Polycystic Ovary Syndrome
Featured Speaker:
Dr. Christine Burt-Solorzano
Dr. Christine Burt Solorzano is a pediatric endocrinologist at UVA Children's Hospital whose specialties include polycystic ovary syndrome.

Organization: UVA Children's Hospital
Transcription:
How to Prevent and Treat Polycystic Ovary Syndrome

Melanie Cole (Host): Polycystic ovary syndrome is a health problem that can affect a woman’s menstrual cycle, hormones, blood vessels and more. My guest is Dr. Christine Burt Solorzano. She’s a pediatric endocrinologist at UVA Children’s Hospital whose specialties include polycystic ovary syndrome. Welcome to the show, Dr. Burt Solorzano. Tell us a little bit about polycystic ovary syndrome.

Dr. Christine Burt Solorzano (Guest): Thank you. Polycystic ovary syndrome or PCOS is disorder where the ovaries of a woman make too much male hormone. It leads to acne, facial hair, and other male pattern hair growth, and also to irregular menstrual cycles. The irregular menstrual cycles mean that women can have trouble with infertility later when they want to start a family. And in fact, polycystic ovary syndrome is the leading cause of inovulatory infertility in women, affecting 46 percent of all reproductive-age women.

Melanie: What are some of the risk factors for PCOS?

Dr. Solorzano: One of the biggest risk factors for PCOS is excess weight, and this is likely related to insulin resistance. Insulin resistance is where your body has trouble using the insulin that it makes and therefore makes more insulin to help keep blood sugars normal. Girls and women with insulin resistance often have dark skin around their necks. That’s when you can tell if you might be at risk for it. And in research studies here at UVA, we found that about 60 percent of girls with obesity already have elevated male hormone levels. This group of girls are at very high risk to go on to develop full-blown PCOS during or shortly after puberty. Other groups of girls and women may have insulin resistance without obesity—those born small or prematurely, daughters of women with PCOS or girls who get early body odor or pubic hair.

Melanie: Are there some symptoms that would send up a red flag and send them to see you?

Dr. Solorzano: The main symptoms of PCOS are signs of male hormone excess, so bad acne or facial hair, especially if they’re having trouble with their periods, very irregular menstrual cycles or missing menstrual cycles.

Melanie: What happens if they are diagnosed with PCOS? What treatments are available?

Dr. Solorzano: The gold standard treatment, even with all our medications that are available, is still diet and exercise, and that’s even if a girl’s weight is normal. That’s because this helps with the insulin resistance that we were talking about. But medications containing progesterone like birth control pills can be helpful because they quiet the ovaries so they don’t make too much male hormone. And also, Metformin is commonly used, especially in girls, because it helps with insulin resistance. And it may be used for women or girls with early signs of PCOS when they’re early in the progression or later if they’re considering pregnancy.

Melanie: Because insulin resistance is such a big part of this, doctor, do we assume, or does this put them at a higher risk to diabetes?

Dr. Solorzano: Yes. Girls and women with PCOS are at higher risk of diabetes, both type 2 and gestational diabetes. And also, other metabolic syndrome kind of problems related to insulin resistance, like high blood pressure, cardiovascular, and problems including heart attack and stroke.

Melanie: And then what about fertility? You mentioned it was one of the leading causes of infertility. How does it affect fertility?

Dr. Solorzano: The reason it affects fertility is because you don’t ovulate during your cycle. So if you don’t ovulate, there’s no egg there to be fertilized. And it can be very hard to get the body to ovulate regularly with PCOS. So Metformin or diet and exercise can help the cycles be more ovulatory, have eggs produced each cycle. But if you’re having trouble and you want to become pregnant, then fertility stimulation treatments, which basically induce ovulation, can also be used.

Melanie: And what if a woman does get pregnant and she’s got PCOS? How does this affect her pregnancy?

Dr. Solorzano: PCOS can affect the pregnancy in that they’re at higher risk for gestational diabetes. They’re also at a higher risk for premature birth or for problems with preeclampsia. So it puts the woman at a slightly higher risk during the pregnancy. It also exposes the baby to higher male hormone levels, and we’re still learning what that means. But we do know that daughters of women with PCOS are at a higher risk of PCOS themselves.

Melanie: What about the emotional effects of PCOS, doctor? Because the appearance factor, you mentioned acne and male hormones and hair on the face. What are the emotional aspects of this?

Dr. Solorzano: Yes. These things can be very hard for girls and women to talk about, but especially teenage girls. You know, to have a teen, it’s hard enough to have normal puberty developing, but to be getting facial hair on top of it can really create a lot of problems with self-esteem, which eventually can lead to depression or anxiety or other problems like that.

Melanie: So what do you do? If it’s your child and they’re exhibiting these symptoms, do you also include a multidisciplinary approach and have them see someone for those emotional effects?

Dr. Solorzano: Yes. So the best treatment for the whole variety of problems that occur with PCOS is to see an endocrinologist or a gynecologist to help with the symptoms of PCOS. But that person should also partner with a primary care provider to help connect the girl into resources for counseling and other support. And also here at UVA, we have a program called Go Girls, which is where girls who have problems with insulin resistance or PCOS or diabetes get together and we exercise. We do Zumba together, and we talk about healthy topics and we also talk about self-empowerment ideas as a support for these girls.

Melanie: Really, what are the most important steps that a woman can take to prevent PCOS?

Dr. Solorzano: The important things to do to prevent PCOS are to keep a normal weight, eat a balanced diet, avoiding fast foods, get lots of fruits and veggies, plenty of water, no sugary beverages, make sure to get at least 30 minutes of exercise every day. Just a 20-minute walk after eating can really help your body use insulin better. Those are the most important things to prevent PCOS.

Melanie: What’s on the horizon? Are there some more advanced treatments, things that we can look for and advances in PCOS?

Dr. Solorzano: At UVA, we’re doing ongoing research to help understand exactly why PCOS starts. We believe that it starts during puberty. And so, by learning more about what causes PCOS, where it starts and how it affects the brain and how it communicates with the ovaries, we’re hopeful that we will be able to pinpoint exactly what and in which girls different treatments can be helpful.

Melanie: Is there an increased risk of cancer, Doctor, if you have PCOS with ovarian cyst, or is that something to be worried about?

Dr. Solorzano: Actually, ovarian cyst and irregular menstrual cycles put you at a slightly lower risk of ovarian cancer, but it puts you at a higher risk of uterine cancer, because the uterus needs an endometrial lining to shed at least a couple of times of year. And if you’re not having that menstrual bleeding, then it can put you theoretically at a higher risk of uterine cancer.

Melanie: Which makes your yearly exams and your visits with your physician even that much more important, correct?

Dr. Solorzano: That’s right.

Melanie: So why should women come to UVA for help with their PCOS and other endocrine conditions?

Dr. Solorzano: UVA has a team of endocrinologists and gynecologists who specialize in PCOS and other endocrine disorders for both children and adults. I think the other important thing is that we use the experiences with our patients to identify which areas of PCOS we don’t understand, and we use those questions to conduct ongoing research to help us understand how to treat girls with PCOS better. And then the other thing that I mentioned is the Go Girls Program. I think it has helped me connect with my patients in a way that I couldn’t in an exam room and has really provided valuable support to lots of girls in our local community.

Melanie: And your best advice, Dr. Christine Burt Solorzano, for women with PCOS, your best advice for dealing with this?

Dr. Solorzano: The best advice for dealing with it is to talk about it with your healthcare providers so that if you’re having bothersome symptoms, you can be referred for treatment. And then the other thing is to know that you’re not alone—it affects a lot of women—and that lifestyle changes, even the small ones can make a big difference in the long-term progression of this disease.

Melanie: Thank you so much. You’re listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks so much for listening, and have a great day.