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Diet / Weight Control Infocenter

The light on PCOS, Weight Gain and Diabetes

by Caroline J. Cederquist, M.D.

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 obese.

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.

Undetected trouble

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 settings altogether.

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 real worries.

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 causes.

Treatment options

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 issues.

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 improvements.

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