Episode Transcript
Interviewer: Birth control pills are not adequate treatment for polycystic ovarian syndrome. So what should you do to treat it? That's next on The Scope.
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Interviewer: There's sometimes a misunderstanding that birth control pills are an adequate treatment for polycystic ovarian syndrome, but they actually can make it worse. So what should you do? Dr. Joseph Stanford is with University of Utah Healthcare. What do you know about treating this syndrome? What can we learn?
Dr. Stanford: So we know a lot more about the underlying causes of the syndrome now. There's underlying insulin resistance so we want to treat that to get at the underlying condition, underlying disease and not just mask it with a birth control pill, which actually worsens insulin resistance.
Interviewer: Does it really? Okay. So what are some of the things that a woman can do to help manage that?
Dr. Stanford: So we start with diet and exercise. Don't we always start with that? But it is really critical, in this condition especially. Women with polycystic ovarian syndrome sometimes have a lot of trouble losing weight. They may be overweight. And so there may be medications as well as the diet and exercise to help with that to some degree. But still, the cornerstone is diet or healthy weight.
Also, a diet that is what we call a "low-glycemic index diet." And that's a diet that does not raise blood sugar suddenly. So obviously minimize the added sugar, we want to minimize simple sugars, and also minimize simple starches. We want a diet that will give you a low, steady blood sugar. So that's complex carbohydrates and proteins and fats. Good amounts of good fats. So that's a diet called a low-glycemic index diet used for diabetics. Also, it works very well with polycystic ovarian syndrome.
Interviewer: And if a woman does this diet well, first of all, are there medications that go along with it?
Dr. Stanford: There are medications that can be used along with it and some women need them and some may not.
Interviewer: Okay. So some diet is enough.
Dr. Stanford: For some, yes.
Interviewer: And then you do the diet. The cysts go away. The symptoms go away. Do you have to stay with that diet then for the rest of your life?
Dr. Stanford: Yes.
Interviewer: You do? Okay. Isn't that the way it always is as well?
Dr. Stanford: If you meet with a dietician and get your diet adjusted to something you enjoy but is also healthy, that's the goal really for long-term maintenance.
Interviewer: Are physicians still using birth control pills pretty commonly to treat this condition?
Dr. Stanford: Yes, I would say they are, especially when it's just dealing with the irregular periods that are part of the condition. And they do make the periods regular. The problem is they don't treat the other underlying issues.
Interviewer: And if you don't treat those underlying issues, those other ones, what other issues could arise as a result?
Dr. Stanford: Some women could still have problems with infertility later on. She could also be at higher risk for diabetes, gestational diabetes or regular diabetes later in her life.
Interviewer: Do those cysts go to scar the ovaries at any point? Or once you kind of get back on that diet, they just kind of go away?
Dr. Stanford: These are small cysts and they don't cause scarring. With management of the disease with diet, exercise, and maybe medications, those cysts can get smaller or fewer of them. They won't go away entirely. In fact, a certain small level cyst is normal to have. It's the excessive small cysts that cause the polycystic ovarian syndrome.
Interviewer: So it sounds like the first thing you should do is just pretend like you have diabetes and eat accordingly.
Dr. Stanford: That could work. If you have questions about that, it doesn't hurt to meet once or twice with a dietician and really get it figured out.
Interviewer: All right. Are there other diet considerations?
Dr. Stanford: Yes. There's a good study recently that showed that women who eat more of their calories at breakfast and a lot fewer at dinner sort of the opposite of what most Americans do right? No breakfast and a big dinner. But if you turn that around and eat a bigger breakfast and a very small dinner, that actually reduces your insulin secretion and your testosterone for women with PCOS. So that sort of switch around on the diet can be really helpful.
Interviewer: It's amazing. So some of these small, little changes really can make that much of a difference.
Dr. Stanford: It makes a big difference.
Interviewer: Wow, that just is incredible to me. What about exercise?
Dr. Stanford: Exercise is critical. Isn't it critical for anything? But it's definitely critical for this condition. And that doesn't have to be running marathons. Just regular aerobic exercise. Walking every day, 20 minutes, can do wonders. So just a consistent level of exercise.
Interviewer: So it sounds like this condition arises out of poor diet and not exercising enough.
Dr. Stanford: Women that have this condition have some underlying genetic issues that make them more susceptible to that. So some women could get away with a poor diet and not exercising, and women with PCOS basically can't get away with it because they have an underlying condition that's exacerbated by the way they're living. It's not something to blame the women. Our society kind of pushes us in one direction and we have to push back and push into a more healthy direction.
Interviewer: Gotcha. What about supplements?
Dr. Stanford: So there actually is one supplement that's been shown to really help in this condition. It's called inositol. I-N-O-S-I-T-O-L. That is related to the B vitamins and you can look that up. It's been shown in randomized trials to actually improve the PCOS biochemical anomalies.
Interviewer: What's the takeaway from this conversation?
Dr. Stanford: The takeaway is that women with PCOS can get to be normally healthy. They just have to pay more attention to it than someone who doesn't have it. And maybe in the long run that's a good thing. It'll help you live your whole life healthy.
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