WomensHealthDoc INFO
BACK

Help for Women with Polycyctic Ovarian Syndrome

What is PCOS

PCOS is is estimated to affect at least 10% of American women to some degree.  It is also one of the most perplexing and fast-growing disorders challenging women and their doctors today. Many patients encounter conflicting diagnoses and 2nd opinions, leading to discouragement, and in worst cases: treatment dead ends. If this sounds like your story, we urge you to keep trying - even if you must find a new physician - because PCOS can usually be helped, with time, effort and understanding.

While the exact causes of PCOS are unknown, like PMS, we know a great deal about it’s symptoms and patterns of development. A genetic predisposition also appears to exist. We know that PCOS results in hormonal imbalances that wreak havoc with female wellness: particularly her reproductive system and psychological well-being. Due in part to this, PCOS has the potential to produce a great variety of symptom type and intensity in patients - varying by individual. In fact, no two cases of PCOS are identical. (Other than perhaps in identical twins)

PCOS-Related Conditions:

Diagnosing PCOS

Unfortunately, since no definitive test for PCOS has existed; as many
as half the women having PCOS either ignore it, or mistake it for
obesity, PMS, or other “female troubles.” Since symptoms often mimic those
of many other conditions, PCOS is often mis-diagnosed, sub-optimally
treated, or simply ignored by patients and physicians alike. Worst of all,
physicians frequently label these patients as overweight or obese,
then direct them to “lose weight and exercise.” Others may consult a
gynecologist, who typically treats the most obvious symptoms
(irregular cycles) while leaving other metabolic changes such as the
metabolic syndrome, hypertension, abnormal lipids (cholesterol), insulin resistance, pre-diabetes and diabetes inadequately treated.

Ironically, androgens can also stimulate the hair follicles of the face and neck, which can result in unwanted facial hair (hirsutism) in some women. Note:  hirsutism, acne, and significant weight gain are not symptoms of alopecia, but may indicate PCOS, with differing treatment options.

Endocrinologists are often consulted but their efforts are often focused on diabetic and insulin resistance issues, leaving much of the management of the PCO to the Gynecologist. Dermatologists may also be involved in the treatment of cosmetic skin abnormalities such as acne and increased body hair. However, the the central need for a comprehensive weight control and nutrition plan is often left unmet. Thus the woman with PCOS may “fall through the cracks” as the treatment of her condition is split among different specialists. The diagnosis of PCOS can be tricky and it is frequently missed because physicians have not kept abreast of the recent international consensus convention on diagnostic criteria for PCOS.

For example: a woman can have a normal sonogram without ovarian cysts and still meet the diagnostic criteria for PCOS. A woman can also have regular cycles and still have PCOS - and also be capable of having a baby. Many women are told that they could not have PCOS because they have had a baby, have regular cycles, or have normal ovarian sonograms. These statements are false, and commonly lead to an incorrect diagnosis. While most women with PCOS tend toward obesity - it can also be absent - again raising the possibility of mis-diagnosis.

The Symptoms of PCOS

Many PCOS patients will have experienced menstrual disruptions soon after the onset of puberty, often due to the lack of menses - or, cycles will begin normally, then lengthen and/or skip months. Complicating matters, the introduction of oral contraceptives during this time usually stabilizes the cycle, leading many to a false sense of well being. Nevertheless, during this time other symptoms of the disorder also begin to appear.

These may include a variety of hair and skin problems arising from elevated or imbalanced androgens (male hormones) inherent to the disorder. Acne, seborrhea, dandruff are common, and may wax and wane with menstrual cycles. Hirsutism - excessive hair growing in male patterns - frequently occurs, and less frequently, but equally distressing: male pattern baldness.

Finally, overweight and obesity frequently appear, and/or a tendency to gain weight easily, and shed it only with great difficulty. Fat distributes generally in the body’s midsection: an “apple” shape - versus the “pear” that is typically associated with hypertension, diabetes and lipid metabolic abnormalities. PCOS increasingly has been linked to abnormalities of insulin and glucose metabolism. While losing weight may improve some of the metabolic aberrations, it will not “cure” PCOS.

Overview of symptoms:

As patients grow into adulthood, several metabolic conditions may emerge as a result of PCOS’s hormonal fluctuations, including: hyperinsulinemia (excess insulin production), insulin resistance (poor response to insulin), impaired glucose tolerance (pre-diabetic), and type 2 diabetes mellitus (non-insulin-dependent, characterized by elevated blood sugar).

Infertility is another concern that emerges in adulthood. Difficulty conceiving often provides the motivation to (finally) visit a physician.

The First Step: Diagnosis

The first step is to obtain a definitive diagnosis, beginning with a
comprehensive physical evaluation and detailed patient history. The positive diagnosis can be made through analysis of symptoms and physical findings, hormonal testing, and ultrasound. Most patients will have positive results in two or more of the above-mentioned categories, for example: abnormal menstrual
cycles and/or increased sexual hair growth and/or obesity. Also telling are the presence of ovarian cysts in strings of pearls patterns revealed by ultrasound. These cysts gave rise to the disorder’s name, however they are not diagnostically critical.

Revised diagnostic criteria for PCOS have been proposed based on a 2003 consensus meeting held in Rotterdam. (European Society of Human Reproduction and Embryology/American Society of Reproductive Medicine consensus workshop group) These criteria comprise a broader spectrum of variations of PCOS considered to
represent forms of the condition of PCOS.

Two out of the following three are required:

What Can be Done About PCOS

Diagnosing PCOS is not enough - the physician must also
diagnose your PCOS.

It is essential to approach PCOS from the functional perspective to evaluate your unique response to the disorder, including possible hormonal imbalances and other metabolic disturbances. Since there is no final “cure” for PCOS; our treatment goals are to relieve your distress and manage your symptoms over the long term. Later in maturity, your PCOS will most likely fade away, as is the outcome with most cases.

The Individualized Assessment

Your PCOS treatment begins with your Individualized Assessment (PCOS-IA). This detailed investigation of your health includes a review of your health history, lifestyle, genetic heritage, behavioral and other factors. Of special importance are extensive one-on-one interviews, questionnaires, some special tests and lab analyses.

The IA’s primary function is describe your unique “flavor” of PCOS, including
its developmental history and symptomology, biological and physiological factors such as weight status androgen (male hormone) levels or effect, ovarian function, pituitary function and hypothalamic function, degree of insulin resistance, and other aspects.

Using the IA’s data, we are able to design a treatment program that is specific and effective for your PCOS, based on a mix of appropriate methods and therapies. Fortunately, the selection of useful therapies continues to grow.

Effective PCOS Treatments

Weight Loss: Weight loss often brings improvement of endocrine hormonal balance, including possible return of ovulation and fertility. We are medical weight loss experts; experienced in the resolution of complex, and challenging weight management cases. (see Nu-Living Weight Management Program)

Oral Contraceptives: Oral contraceptives can be a mainstay of PCOS treatment for women that do not wish to become pregnant. They begin the process of re-balancing hormone levels, preserving ovarian function and reducing excess androgens (male hormones). However, the correct OC must be used: one that is tolerable and does not aggravate other present metabolic abnormalities, such as insulin resistance and/or diabetes.

Anti-androgens: These may improve the skin problems and hirsutism that occur with PCOS and are commonly used, however they are not officially FDA approved. Examples include spironolactone, flutamide, cyproterone acetate, and Finasteride

Gnrh Analogs: gonadotropin releasing hormone: released from the hypothalamus, GnRH promotes production and release of the gonadotropins (LH and FSH) from the pituitary gland. Useful therapy for suppression of the ovary and its abnormal hormonal production of PCOS, however high cost and undesirable side-effects limit use.

Fertility Drugs: “Fertility drugs” are commonly used in an attempt to temporarily override PCOS disruptions (of follicle growth and ovulation) and thereby facilitate ovulation. In addition to Clomiphene (an oral fertility agent), there are several injectable gonadotropin preparations that can be used.

Surgical therapy: Surgery is available for the treatment of infertility in women with PCOS, yielding a 75-85% probability of becoming pregnant after laparoscopic surgery. However pelvic adhesive formation, often severe, occurs in a number of cases, rendering surgery as a “last resort” measure in most practices today.

Anti-diabetic agents: By treating the insulin resistance, PCOS may be also treated, possibly reversed. Overall effectiveness remains an open question that can only be answered context of the individual patient. With some PCOS patients these medications have successfully restored normal menstruation and fertility, even the absence of the insulin resistance, making them (at least) a useful alternative when other therapies have failed.

Metformin (Glucophage): This drug has received much media attention, and for some women with PCOS, it can be a reasonable alternative. It received a strong endorsement from the American Diabetes Association, has been prescribed to over one million U.S. patients, and used in over 80 other countries. In studies Metformin helped restore normal menstrual cycles in approximately 50 percent of women with PCOS. Blood androgen levels sometimes decrease, but there may not be much improvement in hirsutism or acne. In addition, metformin does not provide contraception. In fact, it might stimulate ovulation, so women must be careful in their use of this drug if they do not want to become pregnant.

Metformin may also help with weight loss. Although not considered a” weight-loss drug”, studies have shown that women with PCOS who are on a low-calorie diet lose more weight with metformin added along with diet and exercise in the recommended regimen. Weight lost in the early phase of metformin treatment is often regained in time. These studies also suggested that metformin might reduce risk of early pregnancy loss and development of diabetes during pregnancy in women with PCOS.

Metformin is not presently FDA approved for the treatment of PCOS despite widespread use and numerous reports of its effectiveness. Metformin appears to have an excellent safety profile and is generally well tolerated, with the most frequently reported side effects including gastrointestinal upset and a tendency toward looser stools, and/or more frequent bowel movements. These are common in the first month and can be reduced by starting at lower dose; also more commonly experienced after a fatty meal, or dessert. Note: The long-term safety of metformin and other experimental drugs is currently unknown.

Actos and Avandia: the so called “insulin sensitizers” are approved for the treatment of type 2 diabetes. Like Metformin, these drugs have been used in the treatment of PCOS. While there have been encouraging reports and there are now on going studies; like Meformin, these drugs are not FDA approved for the treatment of PCOS. 

PCOS Comprehensive Treatment

The first step in our functional program will be a visit Dr. terlinsky’s office, for a complete History and Physical, including a referral to the WHD/PCOS Program. This initial visit may last up to 3 hours, and includes the comprehensive PCOS-IA, and lab tests. It includes time for a relaxed, detailed discussion about your history, symptoms, concerns, family, and other topics which may play a role in your disorder. These discussions, along with questionnaire, lab and other data will determine your unique PCOS profile; and provide the detailed information Dr. Terlinsky will consider in your treatment program and protocols.

Treatment usually includes some combination of
the following elements:

Proposed treatment options will be fully discussed with the doctor,
including any potential risks, alternative treatments and answers to any questions you may have.

PCOS Program Costs

The cost is $1000 for the basic PCOS-IA Assessment, Profile and Treatment Program, plus an additional $200 per month to cover the ongoing Weight Loss Program, Hormonal Balancing program, PCOS monitoring, feedback and adjustment sessions.

Note: our PCOS program actually requires extensive doctor’s time and involvement compared to most of our other programs, because it incorporates major elements of several programs. Specifically, Hormone Testing and Balancing, Nutritional Support, Metabolic Testing and Support and our Nu-Living Weight Management program. (hint: it’s a bargain!)

A note on Health Insurance

Unfortunately, Insurance companies do not reimburse the amounts necessary to treat this complex and severe condition. Patients choose to pay out-of-pocket for their visits when they understand their health to be the very best investment they can make. After all, without your health, how can you fully enjoy life’s other good things: spiritual purpose, family, friends, possessions, hopes and dreams? It helps to ask the question: what is my health worth to me?

Putting Cost in Perspective

Proper treatment of PCOS can achieve the above and more, when you and your doctor do the work required. Insurance companies avoid issues such as PCOS because there exists no simple, rote cure - no inoculation, surgery, or drug.

All of these syndromes can be treated, but success depends less on drugs
or surgeries, and more on your physician’s expertise and
commitment and your willingness to participate with you to change habits
and lifestyle.

These kinds of variables are difficult for insurance providers to
assess, and probably will continue to be excluded until the industry
is reformed. In the meantime, we recommend entrusting your health and wellness issues to dedicated medical professionals - not teams of CPAs.

Our comprehensive programs include many hours of physicians time - at reduced rates - in order to return your health to an optimal level. The completed programs average $2,000 total cost, and may vary somewhat, depending on individual needs. 

Divided over a lifetime of enjoyable health, the cost is very small
indeed: just 18 cents per day. Many people spend thousands each year dining out; on vacations, auto payments and home improvements! Wouldn’t it make sense to invest 18 cents a day in yourself - and begin enjoying those other things - and living life - to the fullest?