Most conversations with your doctor about polycystic ovary syndrome (PCOS), probably tend to focus on irregular menstrual periods, including missed and/or heavy periods. But women with PCOS face other problems, too — and a big one is weight gain.
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It’s not clear whether PCOS is a direct cause of the extra pounds many women with PCOS carry, but according to fertility specialist Julie Tantibhedhyangkul, MD, a link does exist.
“Experts think a combination of genetic predisposition and environmental factors, including diet, exercise and lifestyle, contribute to the PCOS symptoms,” she says.
PCOS affects as many 5% to 10% of women, with symptoms appearing as early as age 11.
Knowing how it can impact your weight can help motivate you to take control of it and other health issues, including diabetes, she says.
Signs and diagnosis
PCOS occurs when your hormones are out of balance. Women with PCOS make slightly more male hormone (androgen) than is normal. Even a tiny increase in androgen production can have an impact on how your ovaries function.
Doctors look for two out of three symptoms when making a diagnosis:
- Chronic irregular or missed periods (due to high androgen levels).
- Signs of high male hormones, such as acne and hirsutism (abnormal facial and body hair growth).
- Multiple small cysts on the ovaries (not everyone with PCOS has these, despite the name).
PCOS can also cause:
- High cholesterol.
- Insulin resistance, which raises a woman’s risk for diabetes.
The symptom that’s most likely connected to weight gain is insulin resistance, Dr. Tantibhedhyangkul says.
Insulin resistance and weight gain
Many women who have PCOS also have insulin resistance, which happens when the body has difficulty pulling glucose from the bloodstream and converting it to energy. Therefore, the body needs to produce more insulin in attempt to maintain a normal blood sugar level. Over time, the body begins to overproduce insulin to keep blood sugar level normal.
Insulin resistance is often cited as a large contributing factor to obesity, Dr. Tantibhedhyangkul says. When blood glucose levels continue to rise despite increased insulin levels, type 2 diabetes develops.
“PCOS itself might make women gain weight more easily than others,” she says. “And, the more weight they gain, the more additional symptoms they’ll have.” In fact, she says, more than half of women with PCOS are overweight.
A genetic connection?
Although researchers haven’t confirmed a clear genetic link, PCOS does tend to occur in families, and it’s possible that a particular mutation contributes to whether a woman develops the condition.
If you have a mother or sister with PCOS or a first-degree relative with diabetes or glucose intolerance, this may mean you’re more likely to develop the condition. An estimated one-quarter of women with PCOS have mothers with the condition, and one-third have sisters with the condition.
Interestingly, PCOS can be passed down from your father’s side as well.
4 tips to reduce the impact
Unfortunately, there’s no cure for PCOS. But there are things you and your doctor may do to minimize its impact:
- Keep weight in check. If you’re overweight, combining diet and exercise to lose at least 5% to 10% of your body weight can help with high cholesterol, pre-diabetes symptoms and, potentially, infertility.
- Control insulin. In some cases, your doctor might prescribe metformin. This drug is usually reserved for controlling diabetes, but because it attacks insulin sensitivity, it may be helpful in treating PCOS as well. It can be difficult to determine who would be benefit from this medication, so Dr. Tantibhedhyangkul uses it only to treat women with PCOS who have prediabetes or diabetes.
- Treat infertility. Infertility difficulties are best addressed with drugs that induce ovulation, such as Clomiphene citrate (Clomid®) or Letrozole (Femara®), she says. In some women who do not respond to medical therapy, a laparoscopic procedure called ovarian drilling might help improve ovarian function.
- Balance hormones. For women who are not trying to conceive, oral contraceptives can help balance hormones and regulate the menstrual cycle. They also can decrease cancer risk, help control excess hair and improve acne.
Whether PCOS is a direct cause of weight gain or not, it’s clear that losing weight is helpful, Dr. Tantibhedhyangkul says: “When it comes to PCOS, a main focus is always on weight loss, diet modification and lifestyle changes.”