PCOS, polycystic ovary syndrome.
Another news story today that is both good and not so good. I started writing this as a Facebook post after reading this article, but it got a bit long so brought it over here as a blog post.
First, the good. The women interviewed have good outcomes and good information, and Assoc Prof John Eden provides a nice short and clear video on PCOS which I recommend watching.
Now the not quite as good.
The article starts with Lucy, who was diagnosed with PCOS at 14 years of age. It doesn’t say how long she’d had her periods by 14 yrs, but possibly not very long, and it can be difficult to diagnose a young woman with PCOS before at least 2 years has passed since her first period. The reason is that it takes a while for some teens to get into a groove and establish a regular cycle. Jean Hailes for Women’s Health recommends not testing unless the young woman is troubled by symptoms, and to otherwise wait until she has had at least 2 years of irregular periods.
Second, and this one makes me grind my teeth: she was 172cm tall, weighed 52 kg and was 14 years old and told to lose weight. Even though the BMI is flawed, it is worth noting that the normal range is 18.5-24.5kg/m2 and hers was 17.6kg/m2 so already below the healthy level. Lose 5kg (the reason provided was that it was “in anticipation of weight gain” – heck, maybe I’ll have a hip replacement in anticipation of arthritis) and her weight would be 47kg and her BMI would be 15.9km/m2. So, obviously, even more underweight. Eating disorders and crappy body image are a MAJOR issue in teens and here we are inviting it, no, prescribing it.
Second point, part B. In addition to the eating disorder/body image concerns, once you drop your body fat that low, you don’t ovulate, so you have rubbishy irregular, absent, heavy, crapiola periods, so who knows if it is PCOS or hypothalamic amennorhoea (too little body fat to ovulate)!!! If you are overweight then losing weight is absolutely indicated in the management of PCOS but for crying out loud this really irks me – from the eating disorder and the lack of understanding about hormone function.
Third, I learnt over 20 years ago (when working at the Royal Hosp for Women, and later at Family Planning) that PCOS may impact on fertility but it is not an all-or-nothing scenario and for most women they can absolutely have children – so why are young women, girls, still being given incorrect information?
Fourth, if you have seen me for repro conditions, especially PCOS, you will have had to sit through my blurb about “they’re not cysts….all women still having periods have follicles that are visible of the ultrasound (size and position, in the ‘rosary’ at Prof Eden mentions is the key thing) … and you CANNOT diagnose PCOS with an ultrasound alone.” You can diagnose the presence of follicles but given that all menstruating women have them, that alone is not enough – you need the symptoms (period abnormalities, excess dark hair, acne, and others) and blood tests to show abnormal hormone levels.
Lastly, I would add that there is MUCH that you can do with diet and lifestyle to normalise your periods and ovulation if you do have PCOS and that going on the pill is not the only answer. As a brief insight to some of the options:
- A low GI diet as mentioned is really important, especially as for many women they also have insulin resistance (or even Type 2 diabetes) and this is a core strategy.
- Loads of fruit and veges and whole grains for nutrients as well as fibre – this helps clear ‘used’ hormones that you have metabolised from your bowel so that you don’t re-absorb them, worsening the hormone situation (called enterohepatic recycling)
- Some nutrient supplements might help, like zinc which helps with the follicle maturing and developing to a normal size and helps with acne.
- Herbal medicine can help in a number of ways, for example Licorice and Peony combined normalise ovulation so you ovulate and menstruate regularly, spearmint reduces androgens, and Tribulus can help the follicles develop to a normal size.
- Exercise helps with insulin sensitivity and reducing androgens (male hormones)
So as always, correct diagnosis, evidence-based advice and treatment is the way to go!
