Health Essentials from Cleveland Clinic

Most conversations with your doctor about polycystic ovary syndrome (PCOS), tend to focus on menstrual irregularity, including missed periods and/or heavy periods. But, women with PCOS face other problems, too — and a big one is weight gain.

It’s not clear whether PCOS is a direct cause of the extra pounds many women with PCOS carry. According to fertility specialist Julie Tantibhedhyangkul, MD, a link does exist, however.

“Experts think a combination of genetic predisposition and environmental factors, including diet, exercise and lifestyle, contribute to the PCOS symptoms,” she says.

PCOS affects about 5 million American women (between 5 and 10 percent 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 normal.

Even a tiny increase in androgen production can have an impact on ovarian function, causing irregular periods, anovulation (not ovulating regularly), and signs of high male hormone, such as acne and excessive hair growth.

Doctors look for two out of three symptoms when making a diagnosis:

1. Chronic irregular or missed periods (due to high androgen levels)
2. Signs of high male hormones, such as  acne and hirsutism (abnormal facial and body hair growth)
3. Multiple small cysts on the ovaries (not everyone with PCOS has these, despite the name).

Also, the physician generally needs to rule out other conditions that can mimic PCOS. These include thyroid disorders, a high prolactin level, non-classic congenital adrenal hyperplasia, androgen-secreting tumors.”

PCOS also causes:

• Infertility
• High cholesterol
• An increased risk of diabetes (insulin resistance)
• Depression

The symptom that’s most likely connected to weight gain is high insulin levels, Dr. Tantibhedhyangkul says.

Also, women who are overweight, and who have diabetes and high cholesterol are also at risk of developing heart disease.

Insulin resistance and weight gain

Insulin resistance — when the body has difficulty pulling glucose from the blood stream and converting it to energy — is often cited as a large contributing factor to obesity, Dr. Tantibhedhyangkul says.

Women with PCOS don’t produce normal insulin levels. Instead, their bodies over-produce insulin in an attempt to maintain a normal blood sugar level, and this frequently leads to more androgen productions and weight gain.

It can lead to a vicious cycle of increasing insulin resistance, more severe symptoms and even more weight gain.

“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.

Genetic connection?

Although researchers haven’t confirmed a clear genetic link, there’s evidence of a genetic role. 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. Among women with PCOS, 30 percent have mothers and 50 percent have sisters with the condition. Interestingly, PCOS can be passed down from your father’s side as well.

Tips to 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 5 to 10 percent 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 surgery 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,” she says.