Dolly Doctor

Giving a voice to the silent disorder Polycystic Ovary Syndrome

The often undiagnosed disorder that can severely impacts the lives of women
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When Doctor Jill Forer has a patient come to her and say they have Polycystic Ovary Syndrome (PCOS), she replies earnestly and with support, “so what?”

Watch: Keke Palmer on her stuggles with Acne and PCOS.

Her response is not out of malice or disinterest but to subside the fears associated with the syndrome.

PCOS is a hormonal disorder found in women who have reached their reproductive years and is not well understood.

A report by The Royal Australian College of General Practitioners released in 2012 reported that the syndrome is “present in 12-21 per cent of women of reproductive age.”

However, it also highlights that “70 per cent of women with PCOS in the community remain diagnosed,” a study originally about diabetes found that “urban Indigenous women in Darwin (Northern Territory) of whom 15 per cent had PCOS by the United States National Institutes of Health criteria, none were previously diagnosed with PCOS.”

To better understand PCOS, Dr Jill has shared important knowledge to help make sense of this confusing subject that has caused a lot of stress for young women, who have either been miseducated, wrongly diagnosed or left confused.

NOTE: In this article, we will be referring to what is typically known as cysts as follicles because they are not actually cysts.

“They are not cysts. They are tiny little follicles. You can get big cysts for other reasons, and if you have severe PCOS, you may have bigger follicles.

“They are not cysts, and they have a connotation of being a fluid-filled sack, but they are not.

“They are small fluid follicles, and that fluid is just like a serum,” said Dr Jill.

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PCOS is commonly misdiagnosed. (Credit: Getty)

What are the signs you have PCOS? 

There are three elements that doctors look for when diagnosing PCOS, and to qualify for a diagnosis, you must show two out of three symptoms.

1. Irregular or no periods.

2. An increase in male hormone production in either the blood or through physical signs like acne, facial hair or hair on other parts of the body and possibly thinning hair.

3. Multiple small follicles on the ovaries. A doctor will be looking for more than 12 follicles on the ovaries.

“In order to be diagnosed with PCOS, you need two out of there of those things to occur.

“So there are people who have PCOS that have multiple follicles but don’t have irregular periods, and they don’t have any acne on their face, those people do not have PCOS; they just have polycystic ovaries,” said Dr Jill.

Is having polycystic ovaries a sign of PCOS?

No, it’s not.

It is only a sign of PCOS when someone exhibits two out of three symptoms (listed above).

The sole presence of follicles on the ovaries is not PCOS.

“Polycystic ovaries on their own are not the syndrome, and many people have polycystic ovaries who have regular periods every month, they have an egg every month, and they are not overweight.

“If somebody just has polycystic ovaries, but they don’t have decreased amounts of periods or an increase in androgen, then they do not have the syndrome; they just have polycystic ovaries,” explained Dr Jill.

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The teal ribbon supports patients with ovarian cancer, PCOS and Ptsd illness. (Credit: Getty)

The relationship between PCOS and insulin resistance

Insulin resistance is believed and considered to be the leading cause of PCOS.

Insulin resistance refers to when insulin doesn’t work in the cell membrane (for example, in the muscle).

So to compensate, the body produces more and more insulin as if it were a physiological insurance policy.

The existence of insulin resistance causes an increase in androgen production which will stop the ovulation process, a key symptom found in PCOS.

Does everyone experience the symptoms in the same way? 

Dr Jill explains the severity of PCOS as a sliding scale from one to ten.

In her example, the symptoms present in PCOS exist on different extremes of the spectrum.

One example shows only one sign of polycystic ovaries, and the other exhibits all the symptoms of extreme PCOS.

“We can have a lean girl who has no pimples, no signs of facial hair, no signs of extra hormones, they get their period every month, but on an ultrasound, they have polycystic ovaries, so on the spectrum that is number one then you go to ten.

“Ten is when you have a girl who is overweight, who has acne, facial hair, insulin resistance and very few, less than one or no period in a year, and that is PCOS in its most overwhelming presentation.

“Anything between one and ten can be considered polycystic ovaries or PCOS,” said Dr Jill.

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This image depicts an ultrasound that depicts cysts aka folicles. (Credit: Getty)

How is PCOS diagnosed? 

As explained above, having two out of three of the main symptoms is a way to identify PCOS with the help of a doctor.

However, to receive a proper diagnosis, it’s recommended that you seek a GP experienced in woman’s health because an inexperienced doctor may completely miss the signs.

It is important to know that if you’re taking oral contraception, it can be harder to reach a proper diagnosis because you do not experience a real period on the pill.

Instead, you are having a withdrawal period.

A withdrawal period does not occur through your hormones working, but instead by you giving and taking away your hormones through the pill – this process disguises the PCOS, and as a result, a diagnosis cannot be made.

To find out if you have PCOS you may need to have a pelvic ultrasound, a blood test or a physical exam. 

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PCOS is treatable. (Credit: Getty)

How can PCOS be treated?

One of the most important things you can do for your body is to eat good food and exercise, which is even more essential if you manage PCOS.

“If you understand PCOS is linked to insulin resistance, then you understand that insulin resistance is also linked to diet,” said Dr Jill.

Dr Jill sights foods like bread, cakes, chips and similar products as triggers for insulin resistance because they are usually combined with oil and sugar, which “aides and abets insulin resistance.”

“If you eat a wholefood diet and consume minimal food from packets unless it is a wholefood, then your body won’t have to make as much insulin.

“So if your body doesn’t have to make as much (insulin), then you don’t have the effects of all this extra insulin floating around your body, which is what stops your menstrual cycle from being normal and stops your egg from cycling every month,” said Dr Jill.

Basically, you need to eat the rainbow, have nourishing foods full of good produce, and reduce processed meals.

Exercise is also super important if you want to manage your PCOS

All you need to be doing is moving your body through walks, dance, sport, cycling or whatever activity you prefer.

Sometimes doctors recommend exercise snacks (this is an activity prescribed to people with diabetes too) which is a technique that eases insulin resistance. 

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PCOS depicted through paper cut. (Credit: Getty)

“What we recommend is for a few minutes before consuming a meal to use all your muscle groups, by either running up the stairs once or twice, doing star jumps, or even dancing  for two or three mins before eating.

“This tends to undo the insulin resistance by sending messages to the insulin that you don’t need it for the food that you have eaten.

“When you will have lower insulin, it is more likely your body will have a cycle; your egg will pop out and makes you get your period,” said Dr Jill.

It may feel annoying that to treat PCOS properly, you must eat well and maintain an active lifestyle, but it’s a great way to have control over the process.

For people who have a severe case of PCOS, a doctor may prescribe them metformin to treat insulin resistance.

“If you have the syndrome there are many things that can be done.

“Lifestyle changes and we can use metformin which is actually a treatment for diabetes, which removes the insulin resistance.

“When the insulin resistance disappears women start to ovulate and get back regular periods,” said Dr Jill. 

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Eating well and exercising are great ways you can action treatment yourself. (Credit: Getty)

Does PCOS cause infertility? 

“Having the syndrome doesn’t mean infertility and treatment is easy,” Dr Jill said. 

Of course, it’s unlikely you are concerned about fertility yet, but this common misconception has caused many women unnecessary stress.

Plenty of women who have received a PCOS diagnosis have given birth to many babies.

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