Empowered patients, better outcomes —
This is the theme of September 2023’s Polycystic Ovary Syndrome (PCOS) Awareness Month. Along with this month's focus on awareness, PCOS has made the news:
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GLP-1s for PCOS: Metformin has long been a default for women diagnosed with PCOS, but with all of the recent focus on GLP-1s as weight loss drugs, the potential value in PCOS and fertility has become another topic of discussion.
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Bringing public awareness: Over the past month, several popular celebrities have opened up about their PCOS struggles - with symptoms ranging from heavy bleeding and pain to acne, fertility issues, and more.
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Future diagnostic potential: Last week, the NIH published a study concluding that AI and machine learning tools can successfully diagnose PCOS.
We thought this would be a good opportunity to take a quick dive into what PCOS is and the current treatment landscape.
PCOS is a chronic, hormonal condition that affects 8-13% of women of reproductive age, and the WHO estimates 70% of cases go undiagnosed worldwide. PCOS Awareness Month aims to improve the quality of life of those with PCOS, improve diagnosis and treatment, and promote the need for research.
PCOS symptoms affect everyone differently and may fluctuate over time. The most common symptoms include:
There are several comorbidities commonly seen alongside PCOS. For example, type 2 diabetes, heart disease, high blood pressure, gestational diabetes, and sleep apnea are often diagnosed in patients with PCOS. Infertility is another major concern associate with PCOS, as 70-80% of women with PCOS experience infertility. 90-95% of women seeking care for infertility due to the absence of ovulation have PCOS. Long-term complications of PCOS may also include psychological conditions such as depression and anxiety, as patients may feel shame due to the social stigma surrounding fertility issues. Elevated cortisol levels, a biomarker of stress, likely play a role in the mental and physical symptoms of PCOS.
The exact cause of PCOS is unknown, though many experts believe genetics play a significant role in its development. It is common for women with PCOS to have insulin resistance and elevated levels of androgens, as the incidence of hyperandrogenism in patients with PCOS is 60-80%. Insulin resistance, obesity, hyperandrogenism, and dyslipidemia are clinical characteristics of PCOS known as metabolic syndrome. An estimated 43% of adult women with PCOS also have metabolic syndrome.
The diagnosis of PCOS is often delayed, though the future is promising with AI and machine learning potential. Many patients do not receive a diagnosis until their 20s or 30s. Unfortunately, there isn’t a specific diagnostic test. Instead, a process of elimination is the typical method used by physicians. Blood tests, physical exams, pelvic exams, and sonograms may be used during this process. Based on current recommendations, a PCOS diagnosis can be made if an individual presents with two of the following - elevated androgen levels, irregular periods, or polycystic ovaries.
PCOS treatment looks different for everyone. Depending on the patient’s main concern, treatment options may involve medication, lifestyle changes, or surgery. Most of the medications prescribed for PCOS are intended to correct irregular periods, reduce hair growth and acne, or stimulate ovulation. Lifestyle changes usually include increases in exercise and dietary changes such as reducing processed foods.
Continuing to research the causes, enhance the diagnosis, and improve/expand treatment options of PCOS is valuable and essential to improve the overall metabolic health of our society (not to mention improving the quality of life of women suffering in silence). Focusing on patient advocacy, provider-patient communication, and community building can pave the road toward empowered patients and improved outcomes.
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