HYANNIS – Over the past year, Mary suffered with intense menstrual cramps, dark hair growth on her chin, abdomen and back, facial acne, migraine headaches and weight gain.
“The hair growth and weight gain made me feel self-conscious,” said Mary, 14, (not her real name). “I wanted it all to go away.”
Based on clinical information and symptoms, she was eventually diagnosed with polycystic ovary syndrome, (PCOS) a condition that causes a hormonal imbalance and problems with metabolism.
“There is an excess of estrogen, which is not balanced by the production of progesterone,” said Lucia Cagnes, MD, a Cape Cod Hospital gynecologist. “The imbalance of these hormones and increased levels of testosterone (androgens), all produced by the ovaries, cause symptoms typical of the syndrome.”
PCOS effects about one out of every 10 women in childbearing years (between 15 and 44), according to the U.S. Department of Health and Human Services, Office on Women’s Health.
“It can cause infertility, increase the risk of miscarriage and be a precursor for diabetes and hypertension,” Dr. Cagnes said. “Also, there is an increased risk of endometrial cancer, which is one of the major reasons why women need to be checked and monitored very carefully, starting when they are a teen.”
The syndrome is becoming more common, mainly because more studies are focusing on it and women are better informed about recognizing the symptoms, Dr. Cagnes said. She has diagnosed all ages, beginning with teens to a patient in her practice who was diagnosed when she had symptoms after menopause.
“That was so unusual, but it can happen,” she said.
Symptoms and Testing
Dr. Cagnes lists the following symptoms that can be indicative of PCOS:
Irregular periods
Long intervals between periods such as six to eight weeks or longer
Excessive hair growth on the face, chest and abdomen (hirsutism)
Weight gain that you aren’t able to lose
Acne on the face, chest and upper back
Abnormal (dysfunctional) vaginal bleeding, very heavy during periods or between periods
There isn’t any one blood test that will actually prove the presence of PCOS, according to Dr. Cagnes.
Sometimes she checks the woman’s ratio of follicle stimulating hormone (FSH) and luteinizing hormone levels for an imbalance. While these hormones regulate the menstrual cycle, women with PCOS can have an elevated LH, causing problems with the ovaries. The imbalance can lead to an overproduction of testosterone, which can prevent ovulation and cause excessive hair growth and acne.
A pelvic ultrasound is another option for diagnosis.
A polycystic ovary can be indicative but not a definite diagnosis of PCOS, according to Dr. Cagnes.
“Most of the time we base our diagnosis on clinical findings; the irregular periods, hair growth, and weight gain,” she said. “PCOS runs in families and, even if the patient says there is no history, often times her mother may have it and not know it.”
Treatment Options
The first line of treatment, especially for teenagers, is birth control pills to regulate their periods, said Dr. Cagnes.
“It is very dangerous when you don’t bleed regularly because your hormonal balance is off. Later in life they are at risk of osteoporosis, bone loss and endometrial cancer. We want to avoid these.”
In Mary’s case, her birth control pill prescription has eliminated the excessive hair growth and the acne has completely cleared.
“I’ve noticed that I am feeling much better,” she said.
Dr. Cagnes recommends women see a gynecologist regularly for checkups and monitoring. They will refer to an endocrinologist if there are metabolic concerns, such as diabetes or changes in thyroid or adrenal gland levels.
There is also a hormonal treatment for women who have difficulty getting pregnant, said Dr. Cagnes.
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