What is Polycystic Ovarian Syndrome (PCOS)?
PCOS is a health problem that can affect a womanís menstrual cycle, fertility, hormones, insulin production, heart, blood vessels, and appearance. Women with PCOS have these characteristics:
- high levels of male hormones, also called androgens
- an irregular or no menstrual cycle
- may or may not have many small cysts in their ovaries. Cysts are fluid-filled sacs.
PCOS is the most common hormonal reproductive problem in women of childbearing age.
How many women have Polycystic Ovarian Syndrome (PCOS)?
An estimated five to 10 percent of women of childbearing age have PCOS.
What causes Polycystic Ovarian Syndrome (PCOS)?
No one knows the exact cause of PCOS. Women with PCOS frequently have a mother or sister with PCOS. But there is not yet enough evidence to say there is a genetic link to this disorder. Many women with PCOS have a weight problem. So researchers are looking at the relationship between PCOS and the body’s ability to make insulin. Insulin is a hormone that regulates the change of sugar, starches, and other food into energy for the body’s use or for storage. Since some women with PCOS make too much insulin, it’s possible that the ovaries react by making too many male hormones, called androgens. This can lead to acne, excessive hair growth, weight gain, and ovulation problems.
Why do women with Polycystic Ovarian Syndrome (PCOS) have trouble with their menstrual cycle?
The ovaries are two small organs, one on each side of a woman’s uterus. A woman’s ovaries have follicles, which are tiny sacs filled with liquid that hold the eggs. These sacs are also called cysts. Each month about 20 eggs start to mature, but usually only one becomes dominant. As the one egg grows, the follicle accumulates fluid in it. When that egg matures, the follicle breaks open to release the egg so it can travel through the fallopian tube for fertilization. When the single egg leaves the follicle, ovulation takes place.
In women with PCOS, the ovary doesn’t make all of the hormones it needs for any of the eggs to fully mature. They may start to grow and accumulate fluid. But no one egg becomes large enough. Instead, some may remain as cysts. Since no egg matures or is released, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a womanís menstrual cycle is irregular or absent. Also, the cysts produce male hormones, which continue to prevent ovulation.
What are the symptoms of Polycystic Ovarian Syndrome (PCOS)?
These are some of the symptoms of PCOS:
- infrequent menstrual periods, no menstrual periods, and/or irregular bleeding
- infertility or inability to get pregnant because of not ovulating
- increased growth of hair on the face, chest, stomach, back, thumbs, or toes
- acne, oily skin, or dandruff
- pelvic pain
- weight gain or obesity, usually carrying extra weight around the waist
- type 2 diabetes
- high cholesterol
- high blood pressure
- male-pattern baldness or thinning hair
- patches of thickened and dark brown or black skin on the neck, arms, breasts, or thighs
- skin tags, or tiny excess flaps of skin in the armpits or neck area
- sleep apnea – excessive snoring and breathing stops at times while asleep
What tests are used to diagnose Polycystic Ovarian Syndrome (PCOS)?
There is no single test to diagnose PCOS. Your doctor will take a medical history, perform a physical examópossibly including an ultrasound, check your hormone levels, and measure glucose, or sugar levels, in the blood. If you are producing too many male hormones, the doctor will make sure itís from PCOS. At the physical exam the doctor will want to evaluate the areas of increased hair growth, so try to allow the natural hair growth for a few days before the visit. During a pelvic exam, the ovaries may be enlarged or swollen by the increased number of small cysts. This can be seen more easily by vaginal ultrasound, or screening, to examine the ovaries for cysts and the endometrium. The endometrium is the lining of the uterus. The uterine lining may become thicker if there has not been a regular period.
How is Polycystic Ovarian Syndrome (PCOS) treated?
Because there is no cure for PCOS, it needs to be managed to prevent problems. Treatments are based on the symptoms each patient is having and whether she wants to conceive or needs contraception. Below are descriptions of treatments used for PCOS.
Birth control pills. For women who donít want to become pregnant, birth control pills can regulate menstrual cycles, reduce male hormone levels, and help to clear acne. However, the birth control pill does not cure PCOS. The menstrual cycle will become abnormal again if the pill is stopped. Women may also think about taking a pill that only has progesterone, like Provera, to regulate the menstrual cycle and prevent endometrial problems. But progesterone alone does not help reduce acne and hair growth.
Diabetes Medications. The medicine, Metformin, also called Glucophage, which is used to treat type 2 diabetes, also helps with PCOS symptoms. Metformin affects the way insulin regulates glucose and decreases the testosterone production. Abnormal hair growth will slow down and ovulation may return after a few months of use. These medications will not cause a person to become diabetic.
Fertility Medications. The main fertility problem for women with PCOS is the lack of ovulation. Even so, her husbandís sperm count should be checked and her tubes checked to make sure they are open before fertility medications are used. Clomiphene (pills) and Gonadotropins (shots) can be used to stimulate the ovary to ovulate. PCOS patients are at increased risk for multiple births when using these medications. In vitro Fertilization (IVF) is sometimes recommended to control the chance of having triplets or more. Metformin can be taken with fertility medications and helps to make PCOS women ovulate on lower doses of medication.
Medicine for increased hair growth or extra male hormones. If a woman is not trying to get pregnant there are some other medicines that may reduce hair growth. Spironolactone is a blood pressure medicine that has been shown to decrease the male hormoneís effect on hair. Propecia, a medicine taken by men for hair loss, is another medication that blocks this effect. Both of these medicines can affect the development of a male fetus and should not be taken if pregnancy is possible. Other non-medical treatments such as electrolysis or laser hair removal are effective at getting rid of hair. A woman with PCOS can also take hormonal treatment to keep new hair from growing.
Surgery. Although it is not recommended as the first course of treatment, surgery called ovarian drilling is available to induce ovulation. The doctor makes a very small incision above or below the navel, and inserts a small instrument that acts like a telescope into the abdomen. This is called laparoscopy. The doctor then punctures the ovary with a small needle carrying an electric current to destroy a small portion of the ovary. This procedure carries a risk of developing scar tissue on the ovary. This surgery can lower male hormone levels and help with ovulation. But these effects may only last a few months. This treatment doesn’t help with increased hair growth and loss of scalp hair.
A healthy weight. Maintaining a healthy weight is another way women can help manage PCOS. Since obesity is common with PCOS, a healthy diet and physical activity help maintain a healthy weight, which will help the body lower glucose levels, use insulin more efficiently, and may help restore a normal period. Even loss of 10% of her body weight can help make a woman’s cycle more regular.
How does Polycystic Ovarian Syndrome (PCOS) affect a woman while pregnant?
There appears to be a higher rate of miscarriage, gestational diabetes, pregnancy-induced high blood pressure, and premature delivery in women with PCOS. Researchers are studying how the medicine, metformin, prevents or reduces the chances of having these problems while pregnant, in addition to looking at how the drug lowers male hormone levels and limits weight gain in women who are obese when they get pregnant.
No one yet knows if metformin is safe for pregnant women. Because the drug crosses the placenta, doctors are concerned that the baby could be affected by the drug. Research is ongoing.
Does Polycystic Ovarian Syndrome (PCOS) put women at risk for other conditions?
Women with PCOS can be at an increased risk for developing several other conditions. Irregular menstrual periods and the absence of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Without progesterone, which causes the endometrium to shed each month as a menstrual period, the endometrium becomes thick, which can cause heavy bleeding or irregular bleeding. Eventually, this can lead to endometrial hyperplasia or cancer. Women with PCOS are also at higher risk for diabetes, high cholesterol, high blood pressure, and heart disease. Getting the symptoms under control at an earlier age may help to reduce this risk.
Does Polycystic Ovarian Syndrome (PCOS) change at menopause?
Researchers are looking at how male hormone levels change as women with PCOS grow older. They think that as women reach menopause, ovarian function changes and the menstrual cycle may become more normal. But even with falling male hormone levels, excessive hair growth continues, and male pattern baldness or thinning hair gets worse after menopause.
MaryO’Note: Links are removed from this list
There’s been a list of the “34 signs of menopause” circulating for years. The list originated with Judy Bayliss’ wonderful newsgroup, The Menopaus Listserv (That’s Menopaus without the “e” at the end).
I’ve taken the liberty of adding my own Notes to the original list. You’ll find hundreds of articles pertaining to menopause symptoms, treatments and menopause / midlife-related health and emotional issues including articles on midlife relationships, weight and fitness issues, intimacy, psychological problems associated with menopause in Power Surge’s, “Educate Your Body” extensive library.
I suggest you begin with the comprehensive article explaining what menopause is: in “An Introduction To Menopause: Signs, Symptoms and Treatments”
You’ll find remedies for most of these symptoms on the Recommendations page.
Here is the list of: “The 34 Signs of Menopause:”
1. Hot flashes, flushes, night sweats and/or cold flashes, clammy feeling (related to increased activity in the autonomic / sympathetic nervous system). Without becoming too, technical, messages are sent to the hypothalmus because of declining estrogen production via neurons which result in vasodilation — widening of the lumen of blood vessels (lumen being the cavity of a tubular organ, i.e., the lumen of a blood vessel,) which, in turn, causes flushing or hot flashes. Tips for treating/minimizing (and even avoiding) hot flashes: Power Surge’s Menopause Survival Tips. Also, read the Power Surges (hot flashes) Forum
2. Bouts of rapid heartbeat (related to increased activity in the autonomic / sympathetic nervous system)
Note: Along with rapid heartbeat (palpitations), women can experience skipped heartbeats, irregular heartbeats. These are generally normal vasomotor responses experienced during menopause – usually due to fluctuating hormone levels. However, if these problems continue, it’s always a good idea to be checked by your health care practitioner. An echocardiogram is a common procedure to tell the doctor what he needs to know about your heart. If your health care practitioner doesn’t suggest it, ASK FOR IT! Read the Palpitations, Heart Issues, Hypertension Forum
3. Irritability. Note: Along with irritability, a host of “anger” problems can develop during menopause. Just as a perimenopausal woman can find herself suddenly crying for no apparent reason or provocation, so can she find herself reacting to given situations in an angrier manner than she normally does. This anger can sometimes feel like “rage.”
Again, this is hormone-induced, but for some women, the anger can become inappropriate and a woman can feel like she’s out of control. There’s nothing wrong with seeking counselling to discuss these issues with a mental health professional. This is a challenging time of life and some objective outside help can be tremendously useful in helping a woman cope with all the emotions she’s feeling. Remember, menopause isn’t simply physical changes, but emotional and spiritual changes as well. There’s an excellent forum on the Power Surge Message Board that deals with the issues of Anger / Mood Swings / Rage.
4. Mood swings, sudden tears. Note: Mood swings can include anything from mood shifts (happy one moment, depressed the next) to sudden bouts of crying when nothing overt has occurred to cause the crying. Mood swings can and have been misdiagnosed as bipolar disorder because one can feel such extremes of emotions due to hormone imbalance. Anxiety, depression, panic attacks and even feelings of agoraphobia aren’t uncommon during menopause. The panic attacks often can develop with the onset of hot flashes. For some women, hot flashes can be severe and quite frightening.
5. Trouble sleeping through the night (with or without night sweats). Note: This can develop into insomnia or just waking at 2 in the morning for an hour. Relaxation and breathing exercises can be useful at this time — many women may log onto the Power Surge message boards and are surprised to find so many other women there in the middle of the night. More help on the Insomnia, Sleep Disorders Forum
6. Irregular periods: shorter, lighter or heavier periods, flooding, and phantom periods. Note: A phantom period is when you experience all the symptoms you’re accustomed to having before you menstruate — but… no period comes. This is a common experience during perimenopause before a woman’s period actually stops.
7. Loss of libido (sex drive). Note: Not every woman loses her libido entirely during perimenopause, although some may temporarily. Many women simply have a decreased interest in sex – often it’s simply because they generally don’t feel well and sex is the last thing on their mind! Also, bear in mind that there are many medications that can affect one’s libido, including the anti-depressants some women take to cope with the depression and anxiety associated with menopause to anti-hypertensives.
8. Dry vagina (results in painful intercourse) Note: Click here for an excellent article about vaginal dryness, sexuality and midlife relationships. Recommended: Sexual Issues/Libido Forum
9. Crashing fatigue. Note: I’ve never been able to determine if the “fatigue” associated with perimenopause is a symptom in and of itself, or if it’s a side effect of the cumulative symptoms and general exhaustion (from them) many women experience. Take all the symptoms and “dump” them on one person — is it any wonder perimenopausal women are so fatigued? If you can, try to find time to grab a nap.
One of the things that helped my fatigue, and it’s all chronicled in my personal odyssey to find remedies, is the use of considerable amounts of soy isoflavones and protein, which I found in R Soy. I can’t say that it specifically targetted and relieved the crashing fatigue, but it helped so many other symptoms and gave me a burst of energy, that I feel comfortable in attributing the fatigue relief to R. There are various vitamins, such as those in the “B” family, that can help with fatigue as well. Also, increased amounts of vitamin C. The Recommendations page lists numerous vita-nutrients that can be useful in treating fatigue and other symptoms associated with perimenopause.
10. Anxiety, feeling ill at ease. Note: One of the biggest complaints during menopause. Read the Anxiety/Stress Forum
11. Feelings of dread, apprehension, and doom (includes thoughts of death, picturing one’s own death). Note: It’s possible that this can be a manifestation of depression associated with menopause, or possibly feelings that come from going through daily discomfort through a difficult menopause transition that can last anywhere from 3-12 years.
A woman living under these circumstances can feel totally overwhelmed and frightened by the physical, psychological and spiritual changes. When there seems to be no reprieve from the suffering, for some it can leave them feeling drained wondering when and IF they’ll ever feel well again. It isn’t unusual for women at this time of life to have thoughts about dying. One phase of their life is coming to a close (not soon enough for many). There may be apprehension and fear about moving on to the next phase of life and wondering whether things will get better or worse. Helpful: The Panic Attacks / Disorder / Fear / Apprehension Forum
12. Difficulty concentrating, disorientation, & mental confusion. Note: Forgetfulness during perimenopause is often referred to lightly and humorously as “brain fog” but it’s not always funny. Note: An excellent article, Menopause And The Mind. Also, visit the Memory Loss, Foggy Thinking, Forgetfulness, Verbal Slips Forum
13. Disturbing memory lapses. Note: See #12
14. Incontinence — especially upon sneezing, laughing: urge incontinence (reflects a general loss of smooth muscle tone).
15. Itchy, crawly skin (feeling of ants crawling under the skin, not just dry, itchy skin Note: the feeling of ants crawling on your skin is called “formication”) Visit the Your Skin: Dryness, Itching, Vaginal Dryness, Disorders, Discomfort Forum
16. Aching, sore joints, muscles and tendons. (may include such problems as carpal tunnel syndrome). Note: Osteoarthritis can develop during perimenopause – and those with existing arthritic and/or rheumatic pain may find it’s exacerbated during the menopausal transition. See the Joints Aches and Pains/Arthritis Forum
17. Increased tension in muscles.
18. Breast tenderness. Note: Breast swelling, soreness, pain.
19. Headache change: increase or decrease. Note Many women develop migraine headaches during perimenopause. However, if one doesn’t have a history of migraine headeaches, they’re generally a short-lived experience of perimenopause. Also see the Headaches, Migraine Forum
20. Gastrointestinal distress, indigestion, flatulence, gas pain, nausea. Note: For nausea, try some ginger or, as I use, boiling hot water with a few teaspoons of lemon or lemon juice concentrate in it. Many women also develop acid reflux (Gerd). For some, it can be an uncomfortable feeling of severe burning sensations in the throat. If it persists, see your health care practitioner.
21. Sudden bouts of bloat. Note: Bloating, water retention are common complaints during perimenopause. Also, Acid reflux and heartburn are very common during perimenopause. Treat them as you would if you weren’t going through menopause.
22. Depression (has a quality from other depression, the inability to cope is overwhelming, there is a feeling of a loss of self. Natural hormone therapy, ameliorates the depression dramatically). Note: There are various natural methods of treating depression. Read Power Surge’s Menopause Survival Tips.
Also, many women using progestins or progesterone supplementation experience “depression” as a side effect. Power Surge recommends only naturally compounded, bio-identical hormones. Naturally compounded estrogen and progesterone supplementation doses can be individually adjusted to suit each woman’s needs. So, if a woman is experiencing depression from progesterone, the level of progesterone supplementation can be reduced until the compounding pharmacist comes up with the right blend. The combination of estrogen and progesterone is important in achieving the desired results. Other remedies, such as St. John’s Wort can be very effective in alleviating the depression associated with menopause.
My personal experience was that my perimenopause-related depression was eliminated when I started using R Soy Protein. R is excellent for mood swings, but I was astonished by the impact it had on the hormone-related “lows” I experienced before using it. Also recommended, The Depression Forum
23. Exacerbation of any existing conditions. Note: Often, conditions women had prior to entering perimenopause become
exaggerated (worse) during the menopause transition.
24. Increase in allergies. Note: Many women who suffer from allergies develop worse allergies during the menopausal years. Many women who’ve never had allergy or respiratory problems may develop them for the first time. Many people don’t realize that histamine levels are affected by hormone levels. Women can develop wheezing, coughing and a host of respiratory problems. This generally disappears as the hormones level out once a woman becomes menopausal.
25. Weight gain. (is often around the waist and thighs, resulting in “the disappearing waistline” and changes in body shape.) A good read, Weight Gain and Fitness Issues
26. Hair loss or thinning, head or whole body, increase in facial hair. Note: There is often a loss of pubic hair during menopause. Many women are more comfortable simply shaving their pubic area instead of having patches of hair.
27. Dizziness, light-headedness, episodes of loss of balance. Note: Although common complaints during menopause, I always recommend anyone suffering from dizziness, dysequilibrium have her blood pressure checked just to be on the safe side. However, women can experience these symptoms during perimenopause without having hypertension.
28. Changes in body odor. Note: I wouldn’t be too concerned about this one. It can happen, but in 13 years of running Power Surge, I’ve heard of relatively few cases of developing body odor during menopause.
29. Electric shock sensation under the skin & in the head (“take the feeling of a rubber band snapping against the skin, multiply it (exponentially, sometimes) radiate it & put it in the layer of tissues between skin & muscle & sometimes a precursor to a hot flash.”) Note: Those buzzing sensations, as though you’ve put your finger into a live electrical socket, can be frightening. They’re all part of the hormones, nerve endings and electrical waves running through our bodies when our hormones are constantly fluctuating. Many women experience this during perimenopause, but it eventually passes.
30. Tingling in the extremities (can also be a symptom of B-12 deficiency, diabetes, or from an alteration in the flexibility of blood vessels n the extremities.)
31. Gum problems, increased bleeding.
32. Burning tongue
33. Osteoporosis (after several years)
34. Brittle fingernails, which peel & break easily.
Some additional signs from Dearest:
- Internal shaking / tremor-like feelings. Read the Internal Shaking Forum
- Acne and other skin eruptions
- Itching wildly and erratic rashes
- Shoulder pain / joints / arthritis development or flare up in
preexisting conditions
- “Heart pain” – a feeling of pain in the area of the
heart (if persistent, get checked by your health care practitioner)
- Acid reflux / heartburn / difficulty digesting certain foods
Some of the 34 signs may also be symptoms of one of the following:
- Hypothyroidism
- Diabetes
- Depression with another etiology
- Other medical conditions (see The Educate Your Body Library)
If you have reason to believe you may have one of these conditions, see your healthcare practitioner for treatment.
Dearest
Note: Remember that although these may be common complaints during menopause, they might also indicate some other health problem. Be sure to consult with your personal health care practitioner before attributing these symptoms to menopause.
Power Surge 