"Get The Skinny."   by Caroline J. Cederquist, M.D.

The light on PCOS, Weight Gain and Diabetes

   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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Caroline J. Cederquist, M.D. is a board certified Family Physician and a board certified Bariatric Physicians (the medical specialty of weight management). She specializes in lifetime weight management at the Cederquist Medical Wellness Center, her Naples, FL private practice, you can also get more information about Dr Cederquist and her 
weight management plan by visiting www.DietToYourDoor.com