PCOS Symptoms, Causes, and Treatments: A Q&A with Dr. Martha Noel

The information provided is not intended as medical advice; always consult a healthcare professional for medical concerns. This interview has been edited for clarity and accuracy.

Polycystic Ovary Syndrome (PCOS) is a common reproductive disorder that affects millions of women worldwide. In this comprehensive guide, we'll dive deep into the world of PCOS with expertise from Dr. Martha Noel, a reproductive endocrinologist and infertility specialist. She specializes in diagnosing and treating hormonal and reproductive disorders, with a focus on conditions like PCOS.

Let's explore the most pressing questions about PCOS and uncover the facts you need to know.

What is PCOS and what does it mean for women's health?

Dr. Noel: "PCOS is a really common reproductive disorder. It affects, depending on how you define it, between like 5% to 8% of reproductive-age women. And it's a very broad spectrum of symptoms."

PCOS, or Polycystic Ovary Syndrome, as defined by the Mayo Clinic is a complex hormonal condition that can impact various aspects of a woman's health. It's characterized by a combination of symptoms that can affect menstrual cycles, fertility, and overall well-being.

"I see a lot of people with PCOS who have been told at some point that they won't be able to get pregnant, and that's not true."

What are the main symptoms of PCOS?

According to Dr. Noel, there are three primary symptoms associated with PCOS:

1. Irregular menstrual cycles: "So what that means is somebody who doesn't get a period every month, who's not on any kind of hormonal contraception that's keeping them from getting a period. Typically this is defined as less than eight cycles per year naturally."

2. High androgen levels (hyperandrogenism): "The second part of that criteria is what's called hyperandrogenism, which is a technical way of having high levels of testosterone circulating in your blood."

3. Polycystic ovaries: "The third part of our third criteria for diagnosing PCOS is how the ovaries look on ultrasound... It means you have a higher than average underlying egg count for your age."

Dr. Noel emphasizes that a PCOS diagnosis requires meeting two out of these three criteria.

Additionally, PCOS can cause hair loss or growth and have effects on the skin. She says, "It can either manifest in a blood test for testosterone, the number is high or a little less commonly it manifests as normal levels of testosterone in the bloodstream. It's an exaggerated physical response to testosterone, which is typically, really severe acne, excess hair growth, kind of in a male pattern distribution."

What is the connection between PCOS and acne?

Acne is a common symptom of PCOS due to elevated androgen levels. Dr. Noel mentions that birth control pills can help manage this symptom: "The birth control pill binds up testosterone in your bloodstream so that it's less available to act on the skin. It's effective as a treatment for the skin symptoms of PCOS."

How is PCOS diagnosed?

Dr. Noel breaks down the diagnostic process: "There is a consensus called the Rotterdam criteria, which define those three symptoms. To be diagnosed with PCOS, you need to meet two of these three criteria. And you also need to exclude a lot of the diseases that can kind of mimic PCOS."

A proper PCOS diagnosis involves:

- Assessing menstrual cycle regularity

- Blood tests to check hormone levels, particularly testosterone

- Ultrasound examination of the ovaries

It's important to note that a comprehensive evaluation by a healthcare professional is necessary for an accurate diagnosis.

What causes PCOS?

Dr. Noel highlights the significant genetics behind PCOS: "There's a big genetic influence to PCOS. There is a big heritable component to it. So what that means is that if you have PCOS, there's a 50% chance that your mother had PCOS, that your sister would have PCOS, that your daughter would have PCOS."

However, environmental factors can also play a role: "We live in a world in which most of us are not eating a very healthy diet all the time, or it takes a lot of work to eat a healthy diet and not eat processed foods and things like that."

Additionally, the National Institute of Health lists that PCOS symptoms are primarily caused by hormonal imbalances, particularly elevated levels of androgens and insulin resistance. High androgen levels can disrupt ovulation, leading to irregular or absent menstrual cycles, and contribute to symptoms like excess hair growth and acne. Insulin resistance, common in those with PCOS, raises blood sugar levels, prompting the body to produce more insulin and, in turn, more androgens, creating a challenging cycle of symptoms that makes PCOS difficult to manage.

How does PCOS affect fertility and pregnancy?

Dr. Noel reassures that PCOS doesn't necessarily mean infertility: "I see a lot of people with PCOS who have been told at some point that they won't be able to get pregnant, and that's not true."

"The main fertility issues that underlie PCOS are just lack of ovulation."

She explains: "Once you are ovulating regularly, somebody with PCOS has exactly the same chance of getting pregnant as somebody without PCOS. The main fertility issues that underlie PCOS are just lack of ovulation."

For women with PCOS trying to conceive, Dr. Noel mentions effective treatments: "There are oral medications that have been studied for a long time that can be used to help somebody with PCOS ovulate. Eighty percent of people with PCOS when they go on these medications will ovulate in response to them."

What is the connection between PCOS and insulin resistance?

Dr. Noel explains the link: "Part of what underlies PCOS is something called insulin resistance, which means that your body doesn't process sugar or glucose as efficiently as somebody without PCOS. And when that happens, glucose levels in the bloodstream build-up, this often leads to fat deposition.."

This insulin resistance can contribute to weight gain and make it more challenging for women with PCOS to lose weight.

"Don't blame yourself"

How can women manage weight issues associated with PCOS?

Dr. Noel offers practical advice:

1. Diet modifications: "From a dietary standpoint, for example, avoiding things with high levels of like simple sugars in them. Avoiding simple carbohydrates like white bread, flour tortillas, and white rice. Your body is going to be more sensitive to those than somebody who doesn't have PCOS."

2. Movement: "Exercise that builds muscle mass is really important because your muscle processes a lot of the glucose that circulates in your body. The more muscle you have, even if your insulin receptors aren't working as well, the more muscle you have, the more glucose you'll be able to process."

3. Medications: "There are medications that people use to try and help with insulin resistance. The most commonly used and the one that's been used for the longest is something called metformin, which is an insulin sensitizer."

Why is birth control often the first treatment prescribed with those with PCOS symptoms?

"It's not because you were on the birth control pill. You've had it all along."

Dr. Noel explains: "Birth control pills are like one of the primary ways that we treat PCOS... They treat a lot of the different aspects of it." Specifically:

1. They regulate menstrual cycles

2. They reduce testosterone levels, which can help with skin symptoms

3. They mask some PCOS symptoms, which can be beneficial for symptom management

However, she cautions: "The birth control pill masks things. It masks PCOS. So if you were put on the birth control pill at 16 for whatever reason, and you come off it when you're 30 and you find that you do not have regular cycles and then you're told you have PCOS, it's not because you were on the birth control pill. You've had it all along."

Can PCOS be diagnosed in teenagers?

Dr. Noel highlights the challenges of diagnosing PCOS in teenagers: "There are some people who think you actually can't diagnose PCOS in a teenager in a classic way. Many, many women without PCOS have irregular cycles for the first 5 to 8 years after they first get their periods. So to use that as a diagnostic criterion in a teenager is challenging."

She advises caution and suggests reassessment in adulthood: "If you carry a diagnosis of PCOS that someone gave you when you were 16 and they told you to go on a birth control pill, that's all you need to do in your 20s, reassess that."

How can women with PCOS practice self-care and manage their symptoms?

Dr. Noel offers several pieces of advice:

1. Seek accurate diagnosis: "Talk to your gynecologist so that you can make sure you're getting an accurate diagnosis."

2. Consider a multidisciplinary approach: "If you are in an area where there are centers that do a multidisciplinary approach to treating PCOS, look for them because they exist."

3. Focus on metabolic health: "Weight loss is a really important part of this, and it can be a really frustrating part of it for people with PCOS. But the earlier you can start to adjust your dietary habits, the better."

4. Address mental health: "People don't think so much about the mental health consequences of PCOS. And I think that's a really important thing to acknowledge and get on top of early on while you're working at some of the other health consequences." She adds, "Don't blame yourself" for your PCOS.

PCOS is a complex condition that affects many aspects of a woman's health. While it can be challenging to manage, with proper diagnosis, treatment, and self-care, women with PCOS can lead healthy, fulfilling lives. Remember, as Dr. Noel emphasizes, PCOS is not your fault, and there are many effective ways to manage its symptoms and improve your overall health.