Polycystic ovary syndrome, commonly referred to as PCOS, is one of the most common hormonal disorders that affects patients of reproductive age. Worldwide, 13% of women of reproductive age are affected by PCOS — and experts estimate that as many as 70% of women who have PCOS may go undiagnosed.
Sarah Hutto with the University of Minnesota Medical School and M Health Fairview talks about what this common condition is and the important work of educating the next generation of providers on PCOS.
Q: What is PCOS?
Dr. Hutto: Polycystic ovarian syndrome is a hormonal condition associated with irregular menstrual cycles, excess production of androgens — which causes symptoms such as acne and hair growth/thinning — and possible evidence of multiple “cysts” (more appropriately follicles) on the ovaries. Not all of these findings need to be present to be diagnosed with PCOS. PCOS is multifactorial in nature and is influenced by genetic and environmental factors. It is highly associated with metabolic syndrome — a group of health conditions that increases your risk of Type 2 diabetes, heart disease and stroke — which is critical to understand and manage for patients with this diagnosis.
Q: Is PCOS considered underdiagnosed?
Dr. Hutto: PCOS is underdiagnosed for a multitude of reasons. The symptoms patients present with are variable, and if providers are not aware of this, diagnosis may be delayed. There is also discourse between different medical societies about the criteria that should be used to formally give a patient the diagnosis of PCOS, which impacts the development of management and treatment plans. Symptoms of PCOS can also overlap with other medical conditions, and as such it is essential to look at all symptoms patients have to ensure accurate and timely recognition of PCOS.
Q: Is PCOS associated with other health conditions?
Dr. Hutto: Yes, PCOS can be associated with elevated risks for other health conditions that have short- and long-term health implications, and are important to monitor and screen for after a diagnosis of PCOS. This includes:
- Metabolic conditions, such as insulin resistance, diabetes, elevated lipids, obesity and fatty liver
- Cardiovascular conditions, such as high blood pressure and heart disease
- Reproductive conditions, such as fertility issues and pregnancy complications
- Mental health conditions, such as depression, anxiety, body image concerns and altered eating behaviors
- Precancerous or cancerous changes to the endometrial lining of the uterus
- Sleep disturbance and sleep apnea
Q: How can PCOS be managed?
Dr. Hutto: Management of PCOS should be individualized to each patient and their presenting symptoms and concerns. Shared decision-making should be used in order to ensure patient desires are understood while making care plans. Options for medication management, preventive screening and lifestyle modifications should all be discussed in the context of the patient’s overall health and goals. Treatment will also differ if patients are planning to become pregnant — those who plan to become pregnant may focus on fertility treatments, while those who don’t may be more interested in options like birth control, endometrial protection and medications to address insulin resistance, acne and hair growth.
Q: What type of work are you doing at the University of Minnesota to improve and advance knowledge of PCOS?
Dr. Hutto: In my work, I focus on informing and teaching the next generation of providers the proper evaluation, diagnosis and treatment plans for PCOS. The more informed providers we have in our community who can complete an accurate assessment for PCOS, the better health outcomes and treatment plans our patients will have to navigate this challenging diagnosis and optimize their quality of life.
Sarah Hutto is an associate professor in the University of Minnesota Medical School and an obstetrician and gynecologist with M Health Fairview and University of Minnesota Physicians. Her clinical interests include high-risk obstetrics, benign gynecologic conditions and surgery, women's reproductive rights, contraceptive counseling, preventive health care and general women's health. She practices at the M Health Fairview Women’s Health Specialists Clinic.
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