Consistency Just Might Be the Key to Managing PCOS

Polycystic ovary syndrome (PCOS) is a multisystem metabolic disorder. It's characterized by meeting two of three criteria: irregular or infrequent periods, an increased level of androgens or male hormones, and polycystic ovaries. For women of reproductive age, PCOS is the most common hormonal disorder.

Symptoms can include irregular menstruation, enlarged ovaries or ovaries with many small follicles, excess body hair, hair loss, acne, weight gain or difficulty losing weight, and infertility. These symptoms can vary from person to person, and some are more severe than others.

PCOS can affect the reproductive system, metabolic system, skin and mental health. The syndrome has widespread effects on various systems.

"The treatment is divided based on the symptoms of the patient," said Ana Maria Kausel, M.D., an endocrinologist in New York City and the co-founder of Anzara Health.

PCOS is a chronic condition, and symptoms may change or develop over time. While it can't be cured, it can be managed and controlled, Kausel said. Specific symptoms warrant specific treatment. There is no one medicine for PCOS, but a variety of treatments can help.

PCOS treatment for the reproductive system

For the reproductive system, Kausel stressed that menstrual cycles are the best indicator of health for people who menstruate. Restoring the menstrual cycle back to regularity is essential in PCOS treatment.

"We can give cyclic progesterone or birth control with an appropriate anti-androgen progestin," Kausel said.

Kausel said it's important to understand that birth control does not cause PCOS.

"Women with amenorrhea [absence of menstruation] and PCOS are at very high risk of endometrial hyperplasia, which can lead to cancer, and birth control helps prevent that," she said. "Any measure to make the menstrual cycle regular is valid, including birth control."

But if a woman has not had a period for more than six months, an ultrasound is needed to rule out endometrial hyperplasia and see if an endometrial biopsy is needed, Kausel explained.

For people with infertility, meaning the inability to get pregnant after unprotected sex for a year, Kausel said a reproductive endocrinologist might prescribe medications, such as letrozole or clomiphene, that can help with ovulation. Some patients seeking to become pregnant may require in vitro fertilization (IVF) or intrauterine insemination (IUI). Pregnancy with PCOS is possible.

PCOS treatment for the metabolic system

PCOS affects the metabolic system in various ways, such as insulin resistance, diabetes, trouble losing weight or weight gain. People with PCOS also may be at higher risk for metabolic complications. Many people with PCOS have insulin resistance and cannot effectively use glucose.

"Metformin can help with insulin resistance and restores ovulation in up to 50 percent of women with PCOS. It's also given in patients who are seeking fertility," Kausel explained.

If patients have associated type 2 diabetes or obesity, the use of a class of drugs called glucagon-like peptide 1 (GLP-1) agonists might help, Kausel said. Several lifestyle recommendations are also recommended.

PCOS treatment for cosmetic symptoms

Acne and other cosmetic symptoms are common because of the hormonal imbalance in PCOS. A higher level of androgens can significantly impact acne, which is very common among PCOS patients. Diet may also play a role in acne. Some research suggests using combined oral contraceptives as the first-choice treatment for acne. It's critical to note that only combination birth control pills can effectively treat acne and PCOS. Sometimes, anti-androgen drugs are used. Traditional topical acne medication may also be utilized along with oral contraceptives.

For cosmetic symptoms, which include excessive hair growth (hirsutism), acne or oily skin and hair loss, Kausel said spironolactone could be used.

"Spironolactone is a water pill that blocks the androgen at the skin level. It's used for hair loss, hormonal acne and hirsutism. It has to be used long term and cannot be given in women seeking fertility since it can cause problems in the fetus," Kausel said.

Lifestyle recommendations for PCOS

Kausel said regardless of the symptoms, the main component of PCOS treatment is lifestyle changes, and diet plays a significant role.

"Physical activity and a diet low in sugar, not low in carbs and high in fiber are a must. Also, adding a healthy amount of healthy fats is recommended," Kausel said.

Exercise can help with metabolic function and alleviate anxiety and depression, which are common in PCOS. Kausel explained that a diet low in processed foods is vital.

Lifestyle changes can play a major role in insulin resistance.

"[Fructose is] metabolized only by the liver and converted into fat," Kausel said. "This liver fat creates a huge amount of inflammation, fatty liver, diabetes, obesity, high blood pressure, making everything worse."

Kausel also tells patients to be cautious about the drinks they consume.

"Ditch sodas, smoothies and juices, even green juices,” she said. “Once you blend fruit or juice vegetables, you destroy the fiber and only sugar is absorbed."

Increasing your fiber intake can also help.

"Fiber does the opposite of sugar. It feeds the good bacteria in the gut, regulates post-meal blood sugars and decreases insulin release," Kausel said.

Lastly, Kausel advised decreasing highly processed foods and increasing your intake of healthy anti-inflammatory fats, such as seeds, nuts, avocados and olives.

Other lifestyle recommendations include exercise, proper self-care and stress reduction. Some research supports that decreasing PCOS symptoms can help depression and anxiety.

A healthcare provider can also refer you to a specialist for the mental health impacts of PCOS, such as anxiety and depression.

Talk with your provider about each of your treatment options. Your doctor can also include specific lifestyle recommendations to help with your symptoms. Treatment should be individualized, depending on your symptoms and medical history. If you're seeking to become pregnant, it's important to tell your doctor, along with any other symptoms that are concerning to you.

Don't have a doctor you see regularly? You should. Telehealth makes it easy to connect with a doctor who can answer your questions and evaluate your situation. Many physicians offer video visits, which are a good way to see a doctor quickly since a lot of them have same-day appointments. Giddy telehealth provides access to hundreds of healthcare professionals whose expertise covers the full scope of medical care, including PCOS.

Receiving treatment for PCOS can help manage symptoms and decrease the risk of developing severe health problems. Your doctor might also recommend regular blood pressure tests. Keeping annual appointments with your doctor is essential because of the risk of developing other complications.