Jul 22, 2021

TRANSCRIPT

PCO, OCP that is a palindrome, something that's the same when you read it forwards and backwards, but it also refers to a common hormonal problem in women, and something used for management. This is not a quiz game, but this is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health, and this is the "7 Domains of Women's Health" on The Scope.

PCO, polycystic ovaries and polycystic ovary syndrome is a hormonal condition in women of reproductive age. It's not a disease, but a syndrome, meaning a constellation of symptoms and findings without a single common cause. The symptoms and the findings that define PCOS include irregular periods and evidence of increased androgens or male hormones. Some definitions include having multiple small cysts on the ovaries that can be seen on ultrasound. However, not all women all over the world have access to an ultrasound to look at their ovaries, so many experts just use irregular periods and evidence of androgen excess. Also, young women who have lots of eggs, have lots of follicles. So, on ultrasound, they look like they've PCOS, but they don't. So the ultrasound part is kind of controversial.

Irregular periods mean that menstruation comes more than 35 days apart, and not on a schedule. Now, some women feel that their cycles are irregular, if some months they have periods on the 15th of the month and some months on the 17th, but PCOS means that the cycles are much more irregular and often without ovulation. If women who have PCOS usually don't ovulate, they don't make the hormone progesterone, which is made by the ovulation cyst, and is important for keeping the uterus healthy each month. So having regular periods makes the uterus healthy, and having irregular periods can lead to unpleasant or dangerous bleeding and a not very healthy uterus.

The excess androgens part of PCOS means that women have more than normal levels of hormones made by the ovary that are like testosterone. Now, all women make male hormones. In fact, the female hormone estrogen is made out of male hormones. However, women with PCOS have many small egg follicles that are stuck in development that makes male hormones. That's the polycystic part of polycystic ovaries. These little follicles usually do not ovulate. They don't make the estrogen at the level of an ovulating follicle, and they don't make progesterone to keep the uterus lining healthy and that causes irregular periods.

So what are the main symptoms of PCOS? Well, irregular periods and excess hair growth on the face and other parts of the body. If a woman with PCO is trying to get pregnant and doesn't ovulate, she may be infertile. Many women with PCOS have gained weight, and this complicates the problem of irregular periods and extra male hormones. Some women have insulin resistance and may be prediabetic, partly related to the PCO part and partly related to obesity.

Now, PCOS is very common, as many as 1 in 20 to 1 in 10 women have this syndrome. It was probably less common in years past when women were much less likely to be obese, and not all women experienced PCO to the same degree. Some women have slightly irregular periods with only minimal signs of excess male hormones, and some women have extremely irregular periods and very significant hirsutism or excess body hair.

Okay, that's the PCO part. What about the OCP part? Oral contraceptive pills have estrogen and progestin in them. The way OCPs work for contraception is to block the development of follicles, so ovulation doesn't happen and they control the uterus lining, so periods are regular and light. The way OCPs work by suppressing the development of little follicles, those little cysts that can make male hormones, make them useful in controlling symptoms of PCO. Also, women with PCO have estrogen but lower amounts and the higher estrogens in the OCPs can help counteract the effects of male hormones. The progestin in the OCPs help control the lining of the uterus, so women can have regular periods. There you go.

Now, clearly OCPs do not cure PCO, but they are very useful in the control of symptoms. There's even some evidence that women who are taking OCPs for the PCOS and then choose to try to get pregnant, may actually be more likely to ovulate the first several months after stopping OCPs. Not all women who have PCO are good candidates for OCPs. Some women with PCO who are obese and have high blood pressure, which may be a contraindication to OCPs. Some women don't like the way they feel on OCPs, although many women with PCO say they feel better on OCPs.

Are you guys getting tired of the PCO or OCP palindrome? Well, hang in there. We're almost done. Some women may have other contraindications to OCPs, including a history of blood clots or migraine headache. And of course, some women want to get pregnant. For women who are overweight with PCO, their first effort might be diet and exercise with the focus on weight loss. Women with PCO who lose as little as 10% of their body weight are more likely to ovulate and to have regular periods. Then, of course, they may choose OCPs for birth control. For some young women, a diet low in refined carbohydrates, high in vitamins and minerals and good nutrition, and regular exercise may make them feel the best. However, for some women, and many women, diet and exercise do not work to control their symptoms and OCPs may be the best option.

There are many kinds of OCPs, but they all work mostly the same way. The combination pills with estrogen and progestin work the way we just talked about. The lowest dose pill that does the job would be the first choice. The OCPs are different in the kind of progestin in the pill, and some women feel better on one pill than another. They all work to control periods and lower male hormone effects. So, because PCO is so common, most primary care providers, which include internists, family physicians, pediatricians who see teenagers, and OB/GYNS are familiar with the signs and symptoms and routine treatments. However, there are other options in treatments for symptoms other than OCPs and weight loss and exercise and diet. If a woman with PCOS is struggling to understand her condition, is not getting help with symptoms, or is struggling to get pregnant, she may want to see a specialist in PCOS such as a reproductive endocrinologist.

PCOS is complicated in all of the 7 domains of women's health -- physical, emotional, social, environmental, intellectual, financial, and spiritual. Having irregular periods, being infertile, having the body that you don't think is really you, all those things are affected. If you or someone you know is struggling, we can help. And thanks for joining us on The Scope.

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