Fertility Specialist Explains PCOS (Polycystic Ovarian Syndrome)
Nurse Practitioner Monica Moore, MSN, RN, Shares Her Own Story
I promised you another blog explaining PCOS (Polycystic Ovarian Syndrome) and who better than Nurse Practitioner Monica Moore, MSN, RN, to explain. As always, Monica goes a step further than a comprehensive description of the syndrome; she shares her own experience with us. And as always, she gives hope. Thanks, Monica, for a great blog!
PCOS, polycystic ovarian syndrome, is a common, but confusing endocrine condition. It is characterized by menstrual cycle irregularity, absent (anovulation) or infrequent ovulation, and an excess of androgens (male hormones) that cause acne, unwanted facial hair growth and hair thinning. It also predisposes the people who have it to diabetes, high cholesterol, and other risks. Although PCOS can’t be “cured”, it can be managed by making some simple lifestyle changes.
PCOS and Insulin Resistance
As stated above, PCOS is very common: about 5-10% of women who are reproductive age have it. What is now known is that PCOS is a condition caused by insulin resistance. Insulin resistance can lead to abnormally high levels of circulating blood glucose (sugar) which can lead to serious health problems such as type 2 diabetes, elevated cholesterol and high blood pressure.
I, like many other patients with PCOS, saw multiple practitioners to treat my symptoms. I saw a dermatologist for my skin, a GYN due to missed periods and had laser hair removal. When I wanted to attempt pregnancy, I saw a reproductive endocrinologist who did a vaginal ultrasound and showed me the multiple tiny cysts on my ovaries which are characteristic of PCOS. After I was given this diagnosis, I was initially disheartened. I didn’t want to be told that I would have to deal with this disease for the rest of my life. I then realized that it was actually a relief to have a reason for the symptoms that I was experiencing, and I set about reading as much as I could about PCOS.
Fast-forward 10 years, when I decided to become a fertility nurse. I now know, and try to explain to patients who have PCOS, that I would much rather have this diagnosis than many other infertility diagnoses. One reason is that it is well-known that anovulation is one of the easiest infertility factors to treat. Many patients with PCOS get pregnant with minimal fertility treatments. In addition, most of the infertility factors, such as blocked fallopian tubes, fibroids or endometriosis, cannot be improved by lifestyle changes. I have found that this can cause a sense of helplessness and frustration in the patients given these diagnoses. The negative consequences of PCOS, on the other hand, can be somewhat lessened by employing certain, reasonable strategies, enabling patients to be proactive in their own care.
PCOS and Weight: Opportunities and Challenges
Approximately 70% of people with PCOS are overweight and the condition itself makes losing weight even harder than it already is. One reason is that the hormones which regulate hunger and fullness are imbalanced. Someone with PCOS might still feel hungry after a regular-sized meal, for example. Also, people with PCOS crave carbohydrates, usually simple carbs such as bread and sweets, which signal the pancreas to release high levels of insulin and the cycle perpetuates itself.
On a positive note, studies show that even a modest weight loss can effectively lower the risks of the serious medical conditions and can alleviate some of the PCOS-related symptoms listed earlier. A weight loss of just 5% will go a long way towards restoring ovulation and menstrual cycle regularity. For those who are not attempting pregnancy, going on certain birth control pills can help to control excess androgens, which may help acne resolve and prevent new body hair from growing. They will not, though, get rid of existing body hair, but many people have success using lasers or electrolysis for this. Some patients require medication to increase their body’s sensitivity to insulin. One medication is called metformin (or glucophage) and is only prescribed if you have insulin or sugar problems--it is not a wonder drug that makes PCOS go away. There is now a natural insulin-sensitizing agent available, called Pregnitude®, that seems promising. Recent studies suggest that it can improve insulin resistance just as well as metformin, but without the side effects.
Improve Your Chances of Conception
Whether you need medication or not, here are some simple things that you can do to improve the quality of your health and improve the chances of conceiving:
1) Consult a Nutritionist. Meet with a nutritionist who specializes in PCOS or insulin-resistance, or attend a nutrition seminar. People with PCOS need to eat differently than others, since their hunger signals don’t work properly. There are easy ways to improve your diet, such as eating small meals frequently, and assuring that each meal contains a healthy mix of carbohydrates, proteins, and “good” fat component. A nutritionist will help you plan your meals and read labels to find healthy food choices.
2) Exercise. Don’t be daunted by the need to exercise for long periods of time every day. Even short, frequent sessions of exercise can be helpful. Try to incorporate activity in your daily life, such as walking to a colleague’s desk instead of sending an e-mail or walking outside with a pet instead of just letting it outside into your backyard. Some researchers suggest that the amount of inactivity daily is just as important as the amount of activity, so trying to move around often can help. Find an activity that you like and is fun, such as dance classes or a dance video that you can do at home. Try to make “appointments” to exercise, such as a class you pay for, or plan on meeting a friend at the gym.
3) Manage Stress. There are many ways to manage stress. Your body responds to stress by releasing a cascade of hormones. One of these is cortisol, which can lead to abdominal fat. The other is epinephrine, which triggers the liver to release glucose into the bloodstream to be used for emergencies. When there is no emergency, this glucose remains and prompts the pancreas to release insulin. Join a support group. Try to incorporate some form of a mind-body approach in your every day life. For some people, that can be yoga, acupuncture, acupressure, journaling, Reiki or just meditating on your own. Even adopting a sense of mindfulness can help, such as really noticing your food or reflecting on how beautiful a sunny day feels or a fall day smells.
4) Get more sleep! Lack of sleep can increase the signals for hunger and increase your appetite. The National Center for Health Statistics found that obesity was much more common in people who got less than 6 hours of sleep per night. There are some resources available, such as your local hospital’s Sleep Clinic, which can assist you in obtaining good-quality sleep.
5) Pursue comprehensive care. Comprehensive care for PCOS is paramount. This condition is multi-faceted and may require the participation of multiple health-care providers, such as your OB/GYN, dermatologist, reproductive endocrinologist and internist, but this can also lead to fragmented care in which one physician is not aware of what the other is doing. At RMACT, we have a PCOS clinic for this reason. Our team of clinicians, nurses and a nutritionist work closely with other providers to provide continuity of care and narrow any ‘gaps’.
Most importantly, realize that the diagnosis of PCOS is surmountable. Small, manageable steps can make a big difference!
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