The Pitfalls of PCOS

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I see a lot of young girls and teens who have PCOS (Polycystic Ovary Syndrome) — and most don’t even know they have it when they first meet me. Not only are these girls overweight and unhappy, but almost always by the time they get to me they’ve really been through the ringer. What do I mean by that?  I’ll get to it in a minute.

First, in the simplest terms, PCOS is a health condition linked with both hormone imbalance and insulin resistance. Women with PCOS have greater chances of developing several serious health conditions, but note: It is the #1 cause of infertility issues affecting women of child-bearing age.

The hormones involved in controlling girls’ periods, and ultimately reproduction, are produced in the pituitary gland located in the brain. In PCOS two of these hormones, luteinising hormone (LH) and follicle stimulating hormone (FSH) are produced in proportions that are off kilter. The imbalance of these two hormones prevent the follicles (the egg-containing structure in the ovary, one of which should grow monthly to release an egg) in the ovary from developing properly. They tend to remain small and don’t mature enough to release an egg. As a result, a string of small follicles forms on the ovary, giving rise to the characteristic polycystic ovary.

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All human beings have both female and male hormones. The dominant female hormone is estrogen. The dominant male hormone is testosterone. These hormones need to be balanced in our bodies. Polycystic ovaries contribute to the hormonal imbalance because if the ovaries aren’t working correctly, they aren’t releasing enough estrogen into a girl’s blood stream, but they are increasing production of male hormones (collectively called “androgens”), namely testosterone. This in turn is responsible for not only irregular periods, but also the “male patterns” of acne, increased hairiness on the face, chin, neck and other regions (called hirsutism), head hair loss or thinning, weight gain and a host of other symptoms.

In my opinion, based on all my years of experience, PCOS is too often not diagnosed early enough because parents (moms most often) aren’t aware of it or never heard of it. They therefore go through a long hunt-and-peck throw-stuff-up-against-the-wall-to-see-what-sticks process in a desperate attempt to deal with the symptoms of PCOS, one at a time as they present themselves. In so doing, the diagnosis of PCOS is put off for way too long . . . and I want to show you specifically why this is the case.

1.  Irregular Periods = Gynecologist

For young girls with irregular periods, the pediatrician will send them to a gynecologist, who will put them on a birth control pill, first of a low-dosage, and then when that doesn’t work, the pill prescription will change from one to the next in an attempt to adjust the hormone levels.  As hundreds of moms/daughters have told me, this process can take well over a year or more as the doctor and patient tries to find the pill that’s “just right.”

. . . and all the while the girl’s PCOS has not been diagnosed.

2.  Weight Gain = Gym, Dance Classes, Sports

 . . . and while the birth control pill game is going on, the girl starts to gain weight.  Weight gain in girls with PCOS is usually rapid, and most often without change in food intake. Most of my clients say their weight gain came out of nowhere. They are puzzled and frightened; they go on one quick-fix diet after another; they exercise, but nothing halts the gain.  And, because (as I mention above) their male hormones are more dominant, their weight gain is in a “male pattern”—meaning, fat deposits around the waist (the tire), the upper body (the broadness of the upper chest, shoulders and arms. The combination of elevated male hormones and elevated insulin causes rapid weight gain, and the fatter a girl gets, the more insulin resistant she becomes, the more abnormal her hormone ratios become, and the more fat she gains. A terrible vicious cycle.

So, in addition to being on birth control pills in an attempt to regulate the girl’s menstrual cycle, a mom now attempts to put her daughter on a diet and, most often, simultaneously sign her up for the gym or exercise or dance classes . . . anything to keep her daughter physically active

. . . and all the while the girl’s PCOS has still not been diagnosed.

3.  Facial Hair = Electrologist

Then the male pattern of excess facial and body hair starts to present itself. Again, in a male pattern, hair is often dark and coarse and grows on the chin, cheeks, upper lip, chest, on the stomach, inner thighs, back and buttocks. This excess hair is called hirsutism. So, what does a mom do for her daughter?

Well, first comes the attempt to self-treat facial hair removal with many of the over-the-counter hair removal products (and sometimes girls do this on their own for a time before telling their mom about the problem). This goes on for a year or more with many of my clients.

. . . and all the while the girl’s PCOS has still not been diagnosed.

Then at some point the girl and her mom see the effort is in futility, so the mom brings the daughter to an electrologist for attention to the facial hair issue. Electrologists are wonderful but it’s a long process, on the one hand; and on the other, it cannot correct the underlying problem.  So, the girl begins the electrolysis regimen.

. . . and all the while her PCOS is still not being diagnosed.

4.  Body Hair = Waxing

So the girl is now on prescribed birth control pills in an attempt to manage her hormones to regulate her menstrual cycles; she is attempting to do one diet after another in an attempt to lose weight; she is signed up for personal training or exercise classes or sports activities in an attempt to either lose weight or prevent more weight gain; she is going to an electrologist for the long process of facial hair removal; but the body hair (specifically, in this case, the chest, stomach, inner thighs and back, although the buttocks are also affected) is growing and the girl is very self-conscious and unhappy, so what does a mom do for her daughter?

She makes appointments for regular waxing treatments to remove the body hair.

. . . and all the while the PCOS still has not been diagnosed.

5.  Acne = Dermatologist

Somewhere along the way during all the attempts to treat the other symptoms, the acne presents itself. Now, I don’t mean the usual “period pimple” or two that all girls get every month.  Girls and boys get acne differently. PCOS is almost always accompanied by acne in a “male pattern”–not only on the face, but on the forehead, chest and back. Acne in PCOS is typically far worse than simple adolescent “period pimples” the week before a girl’s menstruation. The acne is often large, painful, inflamed cysts that look and feel like boils.

So what does a mom do for her daughter who is suffering with acne that they can’t seem to control with any over-the-counter products? She brings her to a dermatologist.

Barring an unusual or highly extraordinary circumstance, the dermatologist will start with topical treatments first because, of course, it’s not invasive, it’s less painful and less expensive. Additionally, before moving from one mode of treatment to the next, time has to be given to gauge effect and progress.

. . . and all the while the PCOS is still not diagnosed.

When the topical protocol doesn’t work or is not too effective, the move to other treatments, most commonly laser procedures, begin. This too is a process, a series of treatments that can last for some time.

. . . and all the while the PCOS is still not diagnosed.

6.  Depression = Psychiatrist

At this point, try to imagine how a girl feels, especially when she’s in her teens or a young lady in her 20’s.  (Try also to imagine how her parents feel.  They are desperate to help their daughter and are pained to see her so unhappy.)

• Her gynecologist put her on birth control pills to try to regulate her cycles, and it too often doesn’t.
• She’s been on one diet after another, gone to nutritionists, signed up at the gym, is taking exercise classes, doing sports, etc., becoming obsessive about trying to stop the weight gain.  She’s tried eating minimally, and some even try the binge-purge route, and nothing works.
• She’s going to an electrologist for facial hair removal.
• She’s going for regular body waxing.
• She’s being treated by a dermatologist for acne.
• She has all these things affecting her physically, and she can’t seem to get it under control. She’s extremely unhappy and self-conscious.  It starts to affect her mentally, and she becomes depressed.

So, what does her mom do? She brings her to a psychiatrist.

The psychiatrist doesn’t know much (if anything) about the brain effects of ovarian hormones and rarely checks any hormone levels. The brain symptoms resulting from PCOS hormone imbalances are missed. Even worse, some of the antidepressant or “mood stabilizing” meds commonly prescribed for depression in girls with PCOS aggravate the hormone imbalances.

So now, in addition to:

✅ Being on birth control pills to try to regulate her cycles.

✅ Going on one diet after another to try to lose weight.

✅ Working out, doing sports, taking exercise classes, etc., to try to prevent more weight gain.

✅ Going to an electrologist for facial hair removal.

✅ Going for regular body waxing.

✅ Being treated by a dermatologist for acne.

. . . the girl is now seeing a psychiatrist for anti-depression meds.

. . . and STILL she is walking around with PCOS and doesn’t know it!

Somewhere along the way the girl and her mom find their way to me. And their world changes. I only have to ask the following questions:

1. Have you ever had regular periods?
2. Do you have lip, chin, side burn hair? Excess body hair?
3. Do you have blackish patches of skin either under your arm pits or back of the neck?
4. Do you have acne or acne-like breakouts on your forehead, chest and back?
5. Did your weight gain some on slowly, a little at a time, or rapidly?

As soon as they answer these questions, and before they can say anything else, I start reciting to them every single thing that I just wrote above:

“Let me guess, Mrs. Smith.

First, your daughter’s pediatrician referred you to a gynecologist; he/she put your daughter on birth control pills.

Then, as I see here from the long list of diets your daughter has been on, she went on one after another after another over the last several years.

Then, along the way, I’ll bet you took her to an electrologist, then for body waxing, then to a dermatologist or other skin care specialist for the acne; and, since I see the antidepressant meds listed here on the questionnaire, I assume your daughter is also under the care of a psychiatrist. Is that right?”

. . . and I hit the bulls-eye every time:  The mother and the daughter look at me as if I’ve been a fly on the wall in their lives throughout the entire time they’ve been trying to deal with an issue that has still never been mentioned.

• The girl’s hormones are imbalanced because of the PCOS, with male hormones playing a more dominant role, so she gained weight.
• The fat itself produces more hormones, which provides greater imbalance, more male dominant hormones, so she gained more weight.
• She tried to diet, under-ate, her metabolism slowed, and she gained more weight.
• She become depressed, ate more than she should to comfort herself, and she gained more weight, not only because of excess calories but also because her insulin isn’t working efficiently.

In other words, the girl has been through the ringer.

“Mrs. Smith.  I’d bet good money on the fact that your daughter has PCOS [and I explain in detail and in easy-to-understand manner what that is].  She’s insulin resistant, which is the early stages of diabetes. You MUST take her to an endocrinologist to either confirm what I believe is the issue or to rule it out.”

So help me God, I cannot tell you how many girls, who never heard of PCOS until that moment, took my advice and saw an endocrinologist, who diagnosed PCOS. They were relieved to at least know that they were now in the right and good hands of the medical specialist who could help them, complemented by how I could help them as well.

It is my opinion that pediatricians are too quick to refer to a gynecologist. The ovaries are the turf of gynecologists, yes — but more specifically with a focus on pregnancy and birth, on surgical approaches to correct gynecological problems like fibroids, endometriosis and cancers. It is the endocrinologist, however, who focuses on the endocrine disorders like the thyroid and diabetes management (including insulin resistance). As I tell my clients, the endocrinologist is the medical professional who specializes in “all things hormonal” and who can best work with a PCOS patient to get hormones balanced.

For more specific information on this subject, including the relationship between carbohydrates and insulin resistance and their connection to PCOS, I refer you to my article, Polycystic Ovary Syndrome.  As I say in that article, there’s no cure for PCOS; it’s for life.  It is, however, absolutely manageable, and it is absolutely possible to lose weight.  I know this because I’ve helped countless number of teens and young women with PCOS to not only lose weight but to keep it off as well.  

Maintaining a slim, healthy weight is crucial to being in control of PCOS . . . or it will be in control of you.