A New Year's Resolution for Physicians: Empathize with the Obese (Adobe Stock)

PCOS, or polycystic ovary syndrome, affects between 5-10% of reproductive-age women. Although the name suggests this is primarily a gynecological problem, we now know that PCOS is one more on the growing list of conditions that have insulin resistance and compensatory hyperinsulinemia as an underlying problem.

What do I mean by that? Populations of people have variable sensitivity to the hormone insulin. Insulin has important effects on muscle and fat cells that help to regulate blood sugar, blood fats, and other aspects of metabolism. People who are resistant to insulin’s effects on blood sugar will try to compensate by producing and secreting more insulin from the pancreas. Obesity, particularly abdominal obesity, increases insulin resistance.

High insulin levels wreak havoc on many of the body’s tissues leading to the development of high blood pressure, abnormal lipids, glucose intolerance, and a pro-inflammatory state. When people display clusters of these abnormalities, we say they have insulin resistance syndrome (IRS) or metabolic syndrome. IRS puts people at risk for developing atherosclerosis (coronary artery disease, stroke, peripheral vascular disease) and type 2 diabetes. IRS is common and is becoming even more prevalent in tandem with the global obesity epidemic.

PCOS occurs in women and girls who often have a family history of the condition. About 50% of PCOS females are obese. Most have irregular, infrequent, or absent periods. Many will develop excess body hair in male pattern (for example, coarse hair on the chin, chest, or upper abdomen). This is known as hirsutism. Some will develop male pattern baldness. Acne is common. Acanthosis nigricans, a skin condition that strongly suggests insulin resistance, also occurs in conjunction with PCOS. If a pelvic ultrasound is obtained, it usually shows multiple cysts on the ovaries.

PCOS accounts for 75% of anovulatory infertility (infertility that occurs because the woman doesn’t ovulate). Even if the PCOS woman is able to get pregnant, she suffers from a very high first trimester miscarriage rate. Fortunately, there are treatments that help some women with PCOS have successful pregnancy outcomes.

As concerning as the effects of PCOS on fertility and successful pregnancy are, there are other reasons why PCOS should be diagnosed early and treated with lifestyle modifications and/or medications. PCOS increases the risk of high blood pressure, lipid disorders, and coronary artery disease. It also increases the risk of type 2 diabetes. Fifty percent (50%) of women with PCOS have diabetes by age 40!

Individuals diagnosed with PCOS should exercise and diet with the goal of achieving and maintaining a healthy weight. Metformin, a drug that is used to treat diabetics, has been used in combination with fertility drugs to achieve pregnancy. Specific insulin sensitizers, such as the thiazolidinediones (e.g., rosiglitazone and pioglitazone) may be helpful in some cases.

The Polycystic Ovarian Syndrome Association is an organization of women with the disorder. There are lots of good information on their website (www.pcosupport.org), including a brief quiz that you can take to see if you are at risk for having the condition.

Remember, PCOS is not just a problem with periods or trouble getting pregnant. It is a medical condition that has implications for your health over your lifetime. If you think you have PCOS, see your doctor and ask to be evaluated for PCOS and insulin resistance. Be sure to ask about her/his experience taking care of PCOS patients. If you need help finding someone in your area, the American Association of Clinical Endocrinologists has a web-based Physician Finder that is easy to use (be sure to click on PCOS when asked to enter the specialty you are seeking).

Patricia Salber MD, MBA (@docweighsin)
Patricia Salber, MD, MBA is the Founder and Editor-in-Chief of The Doctor Weighs In. She is also a physician executive who has worked in all aspects of healthcare including practicing emergency physician, health plan executive, consultant to employers, CMS, and other organizations. She is a Board Certified Internist and Emergency Physician who loves to write about just about anything that has to do with healthcare.