Ovarian cysts aren't usually a big deal. Most women
get a few through the course of their lives and never
even know it. On the other hand, if you ever had
one burst, you'd never forget it.
The rupture of an ovarian cyst can be excruciatingly
painful. While it's generally harmless, medically
speaking, the pain often sends women terrified to the
emergency room, convinced their appendix has given
out, or worse. It's not an experience you'd ever
want to repeat.
But women with polycystic ovary syndrome often
have to. As the name implies, these gals often have
many ovarian cysts. It doesn't mean they'll rupture,
or rupture any more often, but there are actually
other characteristics of polycystic ovary syndrome,
or PCOS, that could be more important than even
that awful pain. That's because women with PCOS
are far more likely to have insulin resistance, which
makes them subject to higher rates of diabetes and
heart disease. And not surprisingly, most women
with PCOS are overweight.
What's the trouble?
PCOS is both a hormonal and a metabolic disorder.
Women with PCOS produce too much androgen, a
male hormone. An excess of androgen can cause
menstrual irregularities, weight gain, acne, excess
hair growth, and the production of those ovarian
cysts. They're also overwhelmingly likely to have
insulin resistance, a condition that develops over
time and makes it harder and harder for your body to
metabolize energy, so it kicks up its insulin
production to compensate. People with insulin
resistance gain weight more easily and have a harder
time losing it.
And for women with PCOS, the more they gain, the
worse their PCOS symptoms become.
But there's something of a chicken-and-the-egg
situation here. Researchers aren't sure whether
PCOS makes a woman more likely to gain weight, or if
it's the weight gain that increases the likelihood of
developing PCOS. One study last year showed that
32 percent of women with PCOS were obese, and
another 24 percent were overweight, but not yet
But whether PCOS is the instigating culprit or not,
the chances are that they'll keep gaining, and if they
do, that's going to make their PCOS condition worse.
Unfortunately, women with PCOS often don't know it,
and there are quite a few around. The condition is
estimated to affect about 6 percent of American
women. They go on dealing with the spectrum of
problems it brings without necessarily connecting
them. Physicians, too, often don't connect the dots,
partly because the symptoms are likely to be dealt
with by different specialists. Rough, dark skin or
acne problems may take a young woman with PCOS
to a dermatologist. If she's having painful periods or
intercourse, which are both common, she may see
her gynecologist. A woman having trouble conceiving
may go to a fertility specialist. And the abnormal
hair growth and weight gain' Most women will
probably try dealing with those in a non-medical
But often women just endure their discomforts
without seeking help at all. That's not good,
because again, the painful monthly cycles and the
daily discomforts caused by skin and hair problems
are only the tip of the iceberg. It's the more serious
health problems like diabetes and cancer that are the
To complicate matters, there's no one simple blood
test or scan that enables a PCOS diagnosis. Even if
a woman has an ultrasound that reveals numerous
ovarian cysts, that's no telltale indicator. Women
can have multiple ovarian cysts that never become
problematic and are totally unrelated to the disorder.
Ultimately, a diagnosis is accomplished by identifying
the usual symptoms and ruling out other possible
Fortunately, once it's diagnosed, PCOS is not
complicated to treat. That doesn't mean it's easy.
While most of the symptoms can be addressed
directly, by prescribing anti-hair growth medications
for the hirsutism, for instance, and dermatology
treatments for the skin problems, probably the most
universally helpful treatment for overall relief is
weight loss. And that'especially with the
complications of PCOS'is never a simple task.
It helps that patients with PCOS are motivated.
Some initially find it hard to believe that weight loss
can offer so much relief, or even a total remission of
their symptoms. But remember that there is that
chicken-and-egg mystery still out there with PCOS.
Often, patients who have struggled with an
increasing weight problem, even when they're certain
they're not eating any differently. But that's an
outcome of the insulin resistance that is a factor in
two-thirds of PCOS cases. It's hard to deal with the
underlying issue if you're not aware of it, and the
failures at weight can be tremendously demoralizing.
But when patients learn how much improvement
really is possible for all their symptoms, many
earnestly apply themselves to the task of taking off
the excess weight. Some doctors use medications to
help manage their PCOS patients' blood sugar and
insulin production, but I've often found that insulin
resistance can be countered through dietary
measures alone. That may not always be the case,
however, and PCOS patients have to be evaluated
with consideration for their other body chemistry
But for PCOS patients who do make dietary and
activity level adjustments and begin losing weight,
there are usually many very immediate
improvements. When symptoms start to resolve as
their extra pounds gradually fall away, these are
people with more to celebrate than most.
Through Thick & Thin:
As with many illnesses, there is a clear connection
between excess weight and the risk of more
pronounced symptoms or even progression to more
serious conditions. But with PCOS, doctors aren't
sure if the condition is causing the weight problem or
the other way around. But they do know that
dropping excess weight inevitably leads to