Polycystic ovary syndrome, commonly referred to as PCOS, is a hormonal disorder that can lead to infertility, miscarriage or premature birth, sleep apnea, anxiety, depression, eating disorders, and even some cancers. And those are just some of the problems connected with PCOS.
As with type 2 diabetes, PCOS is also associated with insulin resistance, obesity, and metabolic syndrome, the latter involving a web of interwoven conditions such as high blood sugar, raised blood pressure, and undesirable cholesterol and triglyceride levels—all factors for increased cardiovascular disease risk.
More than half of women with PCOS actually develop type 2 diabetes by age 40, especially those carrying extra weight, says the Centers for Disease Control and Prevention.
Who is Typically Affected by PCOS?
This article says that men who are related to women who have PCOS may get their own version of the condition, but in today’s blog we’re going to focus on the women.
PCOS is especially common among women of child-bearing age, but it can occur as early as when puberty begins. Even after women go through menopause, they may continue to experience symptoms of PCOS and it’s questionable as to whether removing your ovaries will also eliminate your PCOS. In addition, this condition does not discriminate when it comes to ethnicity or race—as far as PCOS is concerned, after puberty, all women are fair game.
What are the Causes and Symptoms?
The causes are complicated. And not even the experts know for sure how PCOS comes about. What we do know is this:
- Hormones may be one of the keys to unlocking the mystery. For example, insulin resistance causes your pancreas to overproduce insulin which, in turn, impacts your ovaries, creating higher levels of male hormones (androgens) like testosterone. This hormone imbalance is a calling card of PCOS. (Read more here.)
- Your family history matters. If PCOS—or type 2 diabetes—is part of your female family’s story, you’re more likely to share that chapter with your mom or sister. For instance, a study from the University of Alabama at Birmingham found that 24% of women with PCOS had a mother with the condition while 32% had a sister with PCOS.
- That excess weight! It plays a role in so many of the problems associated with PCOS, but does the extra weight cause PCOS or does PCOS lead to weight gain? While being overweight is linked with PCOS, not all women who are overweight develop this condition and not all women with this condition are overweight.
Can PCOS Cause Infertility?
Even the symptoms aren’t all that clear because they are also symptoms of other possible conditions. But—and now we’re getting somewhere—the possible causes and symptoms are puzzle pieces that your doctor can put together to help make a diagnosis—and in turn help you manage your PCOS.
In addition to being aware of hormone imbalances, family history and excess weight, here are some symptoms to look out for:
- Your menstrual cycle is messed up. Irregular, infrequent or prolonged periods may occur or your periods may just stop.
- Infertility. PCOS is one of the most common causes.
- Excessive body or facial hair—in other words, more hair than you’d like to see in places where you’d prefer not to see it.
- Hair thinning or loss in areas where you really don’t want to lose it, like on your head.
- Acne on your face, chest and back which may be difficult to treat.
- Dark skin patches often in the folds of the neck, groin, armpits or under your breasts.
- Skin growths (e.g., skin tags) under your arms or on your neck.
- Small fluid filled ovarian cysts. Although not all women with PCOS actually have ovarian cysts, some have as many as 25 or more of these cysts on one or both of their ovaries. Along with those cysts, some women, but not all, report pelvic pain.
- Chronic low-grade inflammation. According to this article, people with PCOS tend to have it. Interestingly, some research has shown that low vitamin B12 levels are associated with inflammation.
Are People with PCOS Low in Certain Nutrients?
Yes, there is an interesting, but not surprising, connection between nutrients and PCOS. Not surprising because if you’re not getting enough of the right vitamins (either through diet or dietary supplements), you’re likely to have health issues. So, first and foremost, think well-balanced, nutrient-rich diet.
When it comes to vitamin B12, there are even more connections. This study reminds us that PCOS is associated with abdominal obesity and insulin resistance and that vitamin B12 and folate have previously been shown to improve insulin resistance in patients with metabolic syndrome. So, the researchers sought to determine the levels of vitamin B12 (and folate and homocysteine concentrations) in PCOS patients in comparison to those without the condition.
With regard to B12, they found that concentrations of B12 were lower in PCOS patients with insulin resistance compared to those without. Further, those B12 concentrations were significantly lower in PCOS women with obesity versus the obese-control women.
And there were two more interesting conclusions from the study: Fasting insulin, insulin resistance and homocysteine were independent determinants of serum vitamin B12 concentrations in PCOS patients; and insulin resistance, obesity and elevated homocysteine were associated with lower serum vitamin B12 concentrations in PCOS patients.
Further research is needed to confirm their findings, said the researchers. But the connection is certainly worth considering. And worth considering especially now because of a new warning about a popular drug often recommended for those with diabetes (and PCOS) and its effect on vitamin B12.
When Treatment Both Helps and Hurts
Metformin is the generic version (also available under brand names) of that recommended drug which is known to help patients manage the body’s response to insulin and help lower blood sugar levels. However, several studies have pointed to an association between long-term use of metformin and vitamin B12 deficiencies. One of those published studies advised a 13% increased risk of vitamin B12 deficiency for each year of total use of the drug in 1,000 subjects taking metformin for around 12 years. Read more here.
For PCOS patients, it makes sense to regularly test your vitamin B12 status as the first step in avoiding deficiencies of that essential nutrient. And, for PCOS patients, it also makes sense to work with your doctor to test your HbA1c (blood sugar levels) regularly to make sure they are at desirable levels. At OmegaQuant, we offer at-home tests for both. Read about them here and here.
How is PCOS Typically Diagnosed and Managed?
Because so many of the symptoms of PCOS are also associated with other health problems and because some women don’t have any symptoms, sometimes your first clue to PCOS is if you’re having trouble getting pregnant.
However, if you have any of the potential causes or symptoms discussed earlier, tell your doctor about your concerns.
There’s no one test to diagnose PCOS, but here’s how PCOS is detected: your doctor will use your family history, a physical exam, and blood work, possibly followed up with a pelvic exam and maybe even a transvaginal ultrasound, to make a diagnosis.
As this article explains, once diagnosed, your treatment plan will depend on your symptoms, your other health conditions and your pregnancy plans and may include medications, nutrition, lifestyle changes or a combination of those therapies.
As metformin is one of the recommended drugs to treat the blood sugar issues related to PCOS, you will likely be recommended a B12 supplement, in line with regular testing of B12 levels, because of concerns mentioned earlier about the drug causing B12 deficiencies. Other medications may be recommended to help you ovulate or stunt excess hair growth, as examples, and some women benefit from herbal medicines.
Will PCOS Go Away?
From a nutrition standpoint, what you eat or supplement with matters. This study advises, among other things, that PCOS diet therapy should include higher intake of folic acid, vitamins B12, C and D, dietary fiber and calcium. Other recommendations include cutting down (or out) foods with added sugars and trans- or saturated fats and adding inflammation fighters (like fish oil found in salmon and other fatty fish) and fiber foods (e.g., beans, lentils). The Academy of Nutrition and Dietetics suggests focusing on whole grains, fruits, vegetables, lean protein, and low-fat or fat-free milk, cheese or yogurt. And, says the Academy, don’t skip meals.
Don’t be surprised if your doctor recommends lifestyle changes for managing PCOS such as regular exercise to manage your weight or stress-reducers to help with anxiety.
PCOS might be a life-long struggle, but there are steps you can take to make a difference.