We recently spoke with the highly-experienced consultant physician, Professor Franklin Joseph, to find out how this condition impacts young women and how it should be treated.
Polycystic ovary syndrome (PCOS) – Sarah’s story
I still remember the sadness in Sarah’s eyes and the hopelessness in her voice when she first told me her story. It all began when Sarah was 13. Her teenage years should had been some of the happiest years of her life but life seemed to have other things planned.
Her periods began as they should have but soon became irregular and infrequent. She started to develop facial hair and people would often comment on her “beard”. She was investigated, given a diagnosis of Polycystic Ovary Syndrome (PCOS) and treated with a hormone pill to regulate her periods and counterbalance the facial hair.
It seemed to help and so she carried on. Over the next few years the weight kept piling on and no matter what she did she just couldn’t stop it going up, let alone lose any. Her skin was getting greasier and her acne was getting worse.
I remember her mother telling me how Sarah had gone from being bubbly and outgoing to reclusive and withdrawn. She had almost resigned herself to living with things the way things were. She was 28 when she came to see me and was concerned she was losing hair from her scalp. She had recently met someone and started to worry about whether she could ever start a family and just didn’t know where to go.
I hear this story repeated to me so often. It still astounds me that that someone like Sarah still has to endure the effects of PCOS without exploring all the options available.
How common is PCOS?
PCOS is one of the most common metabolic, hormonal and reproductive conditions, affecting millions of women around the world. It’s devastating impact on a woman’s life and health goes beyond the physical consequences.
How does it impact women’s health?
The mental and psychosocial effect is often overlooked and women find themselves in a vicious cycle. There are often missed opportunities to intervene early and prevent things from getting to the point that women are affected by insulin resistance, weight gain, depression, anxiety, eating disorders, body image issues, pregnancy-related complications, non-alcoholic fatty liver disease, endometrial cancer, infertility, and many more.
Some studies suggest that around 50 per cent of women with PCOS will become diabetic or pre-diabetic before the age of 40.
As with Sarah, most women with PCOS begin experiencing symptoms at puberty. What is important, however, is to recognise and understand their priorities at any given stage of their life:
• What matters to them at that time?
• Is it the frustration of not being able to lose weight?
• Is it the embarrassment and stigma of facial hair and acne?
• Is it the anxiety around fertility?
For some women one or the other is an issue, and some are vexed by all of these.
How should PCOS be treated?
One could treat individual symptoms with individual therapies. Acne, unwanted hair growth and irregular periods could be treated with a combined oral contraceptive pill (containing oestrogen, the female hormone) to counter the effects of the androgen (male hormone) imbalance that is seen in PCOS. The periods are “regulated” to give a predictable pattern on a monthly basis.
If the only issue was unwanted hair growth in the wrong places combined with balding (again due to the male hormone imbalance) then there are specific medications that are used to target this.
If infertility is the predominant issue, fertility treatments including medications, hormones and procedures are possibilities.
What none of these strategies do however is address the underlying metabolic abnormality of insulin resistance that goes hand in hand with weight gain and together contributes to the male: female hormone imbalance.
The first line strategy to address the issue is to encourage weight loss in a constructive multidisciplinary supportive environment that offers diet, exercise and psychological support in a journey that can be an uphill task for a lot of women with PCOS.
Combined with this, Metformin, a treatment for Type 2 diabetes often has beneficial effects in addressing the insulin resistance. The treatment options for weight loss now also extend to other pharmacological options that can be of benefit including GLP-1 agonists such as Saxenda.
Whilst there is hope and there are options, the starting point is awareness that these options exist. It is important that women do not suffer in silence and accept the status quo.
It is important that they are well informed, question and challenge and get the help that they need as early as possible.
If you have been diagnosed with PCOS and would like to explore the treatment options for weight loss, we recommend getting in touch with Professor Franklin Joseph who will be able to assist you. Click here to visit his Top Doctors profile today for information on appointment availability.