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Hair growth on areas of the body where women are less likely than men to have hair like the face, chin and chest Male-pattern baldness Menstrual-cycle irregularities, including periods that occur more or less frequently than usual and have a lighter or heavier flow Multiple cysts on one or both ovaries Of the women who develop the condition, up to 80 percent are also overweight or obese, and many are insulin resistant. PCOS can also have a genetic component. While talking with her mother about her diagnosis, Kerry learned that her mom and aunt also had PCOS. Women with insulin resistance have higher levels of insulin and glucose circulating in their blood. Elevated insulin levels may trigger the ovaries to produce higher- than-normal amounts of androgens and can also interfere with the way the female body regulates androgens. THE PCOS DIAGNOSIS PCOS can develop any time during young adulthood. Many women don't find out they have PCOS until they inquire about symptoms like acne and heavy menstrual cycles or experience fertility issues. Abnormally high levels of androgens coupled with the presence of multiple ovarian cysts can interfere with ovulation, making PCOS the leading cause of female infertility. To determine whether a woman has PCOS, her doctor may first order tests to rule out other conditions. For example, Kerry's doctor checked the levels of thyroid and thyroid-stimulating hormones in her blood to rule out hypothyroidism, an autoimmune disease that can also cause weight gain, irregular or heavy periods, and infertility. The doctor also performed a physical exam, a blood test to examine the androgen levels in Kerry's blood, and a pelvic exam and ultrasound to check for cysts on her ovaries. "The exact criteria for a PCOS diagnosis varies," Dr. Lewis says. "In general, however, doctors can make the diagnosis if women have high levels of androgens in their blood, menstrual irregularities and multiple ovarian cysts that are visible on an ultrasound image." A PERSONAL APPROACH There is no cure for PCOS, so treatments focus on symptom management. Strategies that doctors may recommend depend largely on the woman's immediate family planning goals and may include taking oral contraceptives to ma nage menstr ual symptoms or fertility drugs like clomiphene to stimulate ovulation. Other med ications may be prescribed to ma nage acne, facial hair growth, scalp hair loss and insulin resistance. To help reg ulate blood sugar and insulin levels, doctors may prescribe a medication called metformin, which is commonly used to treat ty pe 2 diabetes. In women with PCOS, metformin also works to improve the likelihood of ovulation, according to Dr. Lewis. B E Y O N D R E P R O D U C T I V E H E A L T H Polycystic ovary syndrome (PCOS) can have health consequences beyond infertility and menstrual-cycle irregularities. It also increases women's risk for: • Endometrial cancer • Heart disease • Pregnancy complications, including preeclampsia and gestational diabetes • Behavioral health conditions like anxiety and depression • Sleep apnea • Type 2 diabetes "If women have PCOS, they should talk with their doctors about ways to help manage their risk of developing these serious conditions," says Dr. Lewis. In most cases, weight loss is also recommended. "Even in the 20 percent of women affected by PCOS who are not obese, eating a healthy diet and getting regular exercise is important in managing the condition,"Dr. Lewis says. Kerr y took her doctor's advice and made some lifestyle changes, starting with attending an indoor cycling class three times a week. In addition, she gets up 20 minutes earlier ever y morning to prepare oatmeal and fr uit or a smoothie for breakfast. She also tries to incor porate more fr uits and vegetables into each meal. Because she's not ready to start a family, her doctor prescribed birth control pills to help regulate her periods and control her acne. "The best thing women can do is ask questions when they see their doctor," Dr. Lewis says. "PCOS is more common than most people think, and we can help women manage their symptoms and build their families." P H Y S I C I A N RE F E R R A L / / 718 . 49 9. C A RE 11