If you suffer from polycystic ovarian syndrome, or PCOS, there are ways to manage and prevent worsening symptoms with different PCOS treatment options. In this post, we discuss those as well as the general pain symptoms this condition can cause. As always, talk to your doctor first before attempting any treatments.
What is PCOS?
PCOS is a hormonal disorder that affects 5% to 10% of women between the ages of 15 and 45. The exact cause of PCOS is still unknown, making PCOS treatment and diagnosis difficult. Some experts believe that genetics, obesity, and insulin resistance are leading causes of the disease.
PCOS causes a wide variety of symptoms, including varying degrees of pain in the pelvic region. While some women experience symptoms starting at puberty, others do not develop symptoms until later in life.
It also increases your risk of other diseases, including:
- Type 2 diabetes
- High-blood pressure
- Uterine cancer
- Severe liver inflammation called nonalcoholic steatohepatitis
What does PCOS do, exactly?
Despite the name, PCOS doesn’t guarantee that you’ll have cysts in your ovaries, though some women do. Instead, PCOS changes the way your body uses insulin, making it inefficient. Insulin is what the body uses to convert food (particularly sugar) into energy. Because the body isn’t using insulin properly it produces more insulin, leading to insulin resistance.
This increase in insulin production causes the body to produce more androgens than normal. Androgens are male hormones, like testosterone, that are already naturally produced in small amounts in the ovaries. The increase in these androgens causes several visual and physical symptoms associated with PCOS as we’ll discuss shortly.
In addition to the hormonal imbalance, PCOS may cause follicles to form in the ovaries around your eggs. This can prevent them from being released, which can stop ovulation and lead to infertility and pain.
How do I know if I have PCOS?
It’s possible to have PCOS without having any symptoms. Most women develop symptoms around the time of puberty, though some women don’t experience symptoms until later in life, usually due to trauma or sudden weight gain.
The most common PCOS symptoms are:
- Irregular periods
- Heavy menstrual flow
- Uterine or ovarian pain
- Ovarian cysts
- Weight gain
- Inability to lose weight with diet and exercise
- Male pattern hair growth (especially on the chin, breasts, and stomach)
- Male pattern baldness
How to diagnose PCOS
The only way to diagnose polycystic ovarian syndrome is to visit your doctor, most commonly your gynecologist. Your doctor will start out by asking about your family history and symptoms. Be honest and complete when answering. For example, you may have a higher risk of developing diabetes if you have a family history of the disease.
Explain all your symptoms to your doctor, as well. It’s helpful to keep a journal of your symptoms prior to visiting your doctor, noting when your symptoms become worse. Your doctor will also want to know about your diet and how often you exercise. If you follow a diet and exercise routine and are unable to lose weight, it could be an indicator of PCOS.
Your doctor will likely perform a pelvic ultrasound (also called a transvaginal ultrasound or endovaginal ultrasound) to look at your reproductive organs. Your gynecologist will insert an ultrasound device into the vagina and apply light pressure on your pelvis to generate images of your ovaries, fallopian tubes, and uterus. This helps determine if there are other possible causes for your symptoms, like cysts.
Finally, to provide a diagnosis your doctor will order bloodwork. This bloodwork could be fasting or non-fasting and collects information on your insulin levels and blood sugar. It’s done on the third day of your menstrual cycle to test the levels of three important fertility hormones:
- FSH (follicle stimulating hormone), which aids in menstruation, sexual development, and fertility
- LH (luteinizing hormone) as higher levels can indicate PCOS
- E2 (estradiol), which is responsible for the growth of the breasts, uterus, fallopian tubes, and vagina
Your doctor may also test for other hormones including prolactin, TSH (thyroid-stimulating hormone), testosterone, and DHEAS (dehydroepiandrosterone).
What are my PCOS treatment options?
Because PCOS symptoms vary, treatment will vary by patient. While there is no cure for PCOS, there are many treatment options that can help reduce or eliminate the symptoms. The majority of these are non-invasive, lifestyle changes you can start under the guidance of a doctor. Others deal directly with symptoms, like hair growth.
The most common PCOS treatment options are:
- Weight loss
- Diet changes
- Other lifestyle changes
- Alternative supplements
- Hair removal and management
There are no FDA approved medications as a PCOS treatment, however the two most common medications prescribed to treat PCOS symptoms are hormonal birth control and metformin.
Hormonal birth control helps regulate your period (including length and flow) and can improve menstrual pelvic pain and reduce excess hair growth.
Metformin also treats diabetes, and helps to improve the efficiency of insulin, lowering blood sugar levels and androgen levels. In some cases, it also helps to re-start ovulation after a period of several months.
You may also receive topical medication to treat acne.
If you’re experiencing severe or chronic pain from your PCOS, also talk to your doctor. Through a combination of lifestyle changes, complementary therapies, or medication, they can help manage your pain.
Weight loss is one of the most common PCOS treatment options recommended by doctors. Losing weight improves the way that the body uses insulin and regulates hormones. Even modest weight loss – approximately 5 to 10% of total body weight – can reduce your symptoms.
Obesity also increases the risk of developing diabetes and high blood pressure, making it even important to lose weight.
However, because of the way PCOS affects insulin it does make it more difficult to lose weight. Always work closely with your doctor for guidance on the best to manage your weight.
In some cases, medical assistance such as medication or surgery may also be necessary to lose weight.
PCOS diet changes
While diet changes are necessary to lose weight, they may also be necessary to treat PCOS symptoms and manage blood sugar levels even if you are already at an ideal body weight. The most common diet change necessary for those diagnosed with PCOS is to manage carbohydrates.
Carbohydrates release glucose (or sugars) during digestion, which triggers the release of insulin to convert the glucose into energy. Some carbs release all their sugars right away, while others release their sugars into the bloodstream more slowly. Carbohydrates that digest more slowly do not cause a sudden spike in insulin levels and this, in turn, can help manage PCOS symptoms.
The glycemic index is a method that ranks carbohydrates based on how they affect the blood glucose (insulin) levels. Foods with a lower glycemic index (or GI) do not cause spikes in insulin, according to the following levels:
- Low GI = 55 or less
- Moderate GI = 56 to 69
- High GI = 70 or above
Examples of low GI foods include green vegetables like asparagus and broccoli, apples, bananas, red grapes, and corn.
There are several PCOS diet books available that can provide diet change guidance with a focus on lower GI foods. Additional information on the glycemic index, including a food search, can be found at glycemicindex.com
Diet changes that support weight loss will be more drastic and should be discussed with your doctor to ensure they are safe and healthy.
Frequent exercise can also help treat and manage PCOS symptoms. It does this by managing glucose and hormone levels in the body. Even if you are already at an ideal body weight and do not need to lose weight, changing your exercise habits can improve symptoms.
Studies have shown that there is no connection between a specific type of exercise or intensity level that reduces PCOS symptoms. The focus is not on intensity, but rather on quantity. Ensure that you are exercising at least 30 minutes a day, five times a week, and including a variety of strength training and cardiovascular methods. Many doctors also recommend at least 90 minutes of intense aerobic exercise per week.
Be sure to discuss your exercise program with your doctor, and discuss any risks before beginning a new program, especially if you are overweight or obese and need to lose weight.
Other lifestyle changes
In some cases, it may be necessary to make additional lifestyle changes, such as eliminating alcohol, processed foods, dairy, and breads to help treat and manage your PCOS symptoms.
These other changes may not be evident at first, but open communication with your doctor can help determine additional measures to be taken. Likewise, keeping a symptom tracker can help you find certain triggers that increase your pain or symptoms.
Some women find success managing their symptoms with alternative supplements, including:
- Inositol and chromium, which can help regulate insulin and blood sugar levels
- Omega-3, vitex, and zinc, which can help reduce testosterone levels and restore hormone levels
- NAC (N-Acetyl-Cysteine), which can help regulate menstrual cycles and improve endocrine health
- Vitamin D that can regulate weight, insulin levels, and improve fertility
Always consult your doctor before beginning a supplement regime, as these could interfere with other medications or conditions.
PCOS hair removal and management
If you have male pattern hair growth, laser hair removal may be an option to help reduce this symptom. Your doctor may also be able to prescribe medication to manage hair growth or loss.
Can I get pregnant with PCOS?
Finally, PCOS often causes infertility issues in women. These can lead to miscarriages or inability to conceive. Many women may not even find out they have PCOS until they fail to conceive and seek medical help.
Fortunately, there are several options available to help women with PCOS conceive. Because PCOS affects all women differently, a variety of treatment options may be needed to conceive. Like all other PCOS treatment options, these focus first on lifestyle changes to manage symptoms with more interventional treatments and medications following.
They may include:
- Weight loss, exercise, and diet changes, especially for women with mild PCOS symptoms, as they can help improve fertility, hormonal balance, and insulin levels
- Medication, for you or your partner, to increase fertility or stimulate ovulation
- IFV (in vitro fertilization) for women who do not see results with weight loss, exercise, diet changes and medication
- In some severe cases, surgery is needed to stimulate temporary ovulation (this surgery, called ovarian drilling, is performed using a laser or needles and typically restores ovulation for six to eight months)
None of these methods are guaranteed to lead to pregnancy. Surrogacy may be an option for some couples, or you may consider adoption.
For those who do conceive, pregnancy with PCOS can have additional risks like high blood pressure or new symptoms. Be sure to discuss the possible risks with your doctor.
Can PCOS go away on its own?
Polycystic ovarian syndrome is a life-long disease and while symptoms may change, the disease won’t ever go away. Even menopause does not cure PCOS. The best way to manage PCOS is through treatment and management of your symptoms.
If you think you may have PCOS or are experiencing pain despite a diagnosis and PCOS treatment, a pain specialist may be able to help. Click the button below to find a pain doctor in your area who can help you with more advanced pain management options or look for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.