Polycystic Ovary Syndrome affects 1 in 10 women and is a little bit of a misnomer – the ovaries are not required to even have cysts, and just because you have cysts, it does not mean you have PCOS. A commonly undiagnosed problem, PCOS is the most common hormone abnormality in a woman under age 50. If you have PCOS, you need to understand this hormone imbalance and how it affects how you age, because it is characterized by hormone imbalance: excess male hormones (androgens) and insulin resistance. Women with PCOS are art high risk for obesity, metabolic syndrome, diabetes, heart disease, and endometrial cancer.
Most commonly, the diagnosis is made in retrospect when a woman presents with infertility, so we need to get better at early diagnosis, education on the hormone abnormalities, assessment of future risk factors, and prevention of disease with aging. The increasing prevalence of diabetes and obesity affects women here too: by 2025, obesity and diabetes are projected to increase the rate of cancer in women by an astounding 30% increase in the diagnosis of cancer. Prevention of obesity and diabetes in an aging woman with PCOS needs to be a top priority.
The diagnosis of PCOS is also known as Stein-Leventhal Syndrome or Polycystic Ovary Disease (POD). It is commonly made after years or decades have gone by, and looking back, a woman usually had some of these symptoms:
Common symptoms of PCOS:
- Premenstrual Syndrome (PMS): Irritable and heavy, prolonged, irregular periods, cramping, headaches or migraines with periods, as well as abnormal uterine bleeding. For example, one may only have 4-9 periods per year, or skip a year.
- Acne: Teenage acne can be severe.
- Excess androgen: Increased male hormones leads to excessive facial and body hair (also known as hirsutism), severe acne, and even male-pattern baldness may occur.
- Polycystic ovaries: ovaries may be perfectly normal or have tiny cysts in a string-like pattern, or have larger cysts.
- Obesity: Weight gain may be due to accompanying hormone imbalance, insulin resistance, chronic metabolic syndrome, pre-diabetes or diabetes. Obesity further complicates the disease, and every attempt should be made to optimize diet. In those with obesity, diabetes or metabolic syndrome, a low carb or ketogenic diet usually increases HDL (good cholesterol).
- Insulin resistance: Insulin is released in response to an elevated blood sugar or blood glucose. Higher insulin levels lead to inefficient insulin activity, a more elevated blood glucose, and increased androgen production, furthering problems with the ovarian cycle. Exercise drives glucose into the cells, and the following forms of exercise have been shown to increase HDL (good cholesterol): aerobics, strength training, and high-intensity interval training (particularly beneficial for PCOS).
- Chronic inflammation: Women with PCOS have low-grade, chronic inflammation that causes the PCOS ovaries to increase androgen production. This leads to blood vessel and heart disease, increasing morbidity and mortality. The diet should be as anti-inflammatory as possible.
- Chronic metabolic syndrome: Leads to elevated: blood pressure, blood sugar, cholesterol and triglyceride levels that increase risk of blood vessel and heart disease. Leads to pre-diabetes and diabetes.
- Sleep apnea: Breath holding during sleep can occur with obesity, as the airways relax and obstruct breathing. Obstructive sleep apnea is thought to be more common than asthma or adult diabetes. Compared to women without sleep apnea, those with moderate to severe sleep apnea have a greater than 30% increased risk of heart disease. Post-menopause, sleep apnea worsens due to deficient hormones, leading to 35% higher risk for the most severe type of obstructive sleep apnea.
- Depression, anxiety, eating disorders: Commonly associated with PCOS, these conditions may resolve once the diagnosis is made and lifestyle changes are made such as adherence to an anti-inflammatory diet.
If you are a young or aging woman with PCOS, diet is your most important consideration for avoiding the known sequelae of this syndrome: diabetes, heart disease, obesity, chronic metabolic syndrome, and cancer. Do your best to keep a lifestyle that will allow you to chase your grandchildren!