Uterine cancer – if you don’t have regular periods, the lining of the uterus may not shed as often as it should, and instead build up and grow thicker, increasing the risk of cancer of the uterus. If PCOS goes untreated, this may increase the risk of cancer of the uterus.
There are some other conditions that women and/or PCOS experts suspect may be linked to PCOS, though research has yet to confirm this:
Breast cancer – some studies have suggested that women with PCOS have an increased risk due to the obesity link and the hormonal fluctuations that can lead to an excess of oestrogen in the body and irregular periods. Other studies,6 however, haven’t found this link.
Eating disorders – a recent study suggested that PCOS doesn’t cause eating disorders, but as weight-management problems are a common symptom of PCOS it’s hardly surprising that research7 suggests that as many as 60 per cent of women with PCOS may have eating disorders, such as bulimia.
Osteoporosis (brittle bones) – women with PCOS and unhealthy eating patterns such as bulimia just aren’t giving their bones the nutrients they need to stay healthy and strong.
Thyroid imbalance – since the hormonal systems in your body are all interconnected, it’s logical to assume that the hormonal havoc PCOS causes could trigger an imbalance in thyroid hormone production.
Chronic Pelvic Pain – some women with PCOS suffer from chronic pelvic pain. Although no research has been done it’s not difficult to see why women with PCOS think there may be a link with their PCOS.
Digestive complaints – many women with PCOS complain of digestive problems, in particular constipation and Irritable Bowel Syndrome. So far research has not discovered why this is the case, but it may have something to do with the slightly lowered metabolic rate associated with PCOS, which would make your digestive system a bit slower.
Lowered immunity – many women with PCOS say they get ill more than women without PCOS. There could be an explanation for this. Research8 has suggested a link between lowered immunity and menstrual irregularity. It seems the high levels of testosterone associated with PCOS cause a fault in the way the body processes the stress hormone cortisol, so the body’s ability to deal with stress is weakened. And people under stress are more likely to get ill.
Fatigue – although fatigue and lack of energy aren’t officially recognized as symptoms of PCOS, the hormonal fluctuations and blood sugar issues suggest energy levels could be an issue.
Endometriosis – it’s not uncommon to see both PCOS and endometriosis in the same woman. Some experts believe the two conditions are not only similar but may be linked in some way.
Ovarian cancer – a 1996 study reported an increased risk of ovarian cancer among women with PCOS, but more recent research suggests that the link is by no means established.
Depression – some experts believe that depression, in particular bipolar disorder, is more common in women with PCOS, but is there a direct biological cause or is it because dealing with PCOS can just really get you down?
Asthma – could the excess oestrogen associated with PCOS worsen asthma? Research9 indicates that women with irregular periods have higher rates of asthma and allergy than women with regular periods. Metabolic problems, such as insulin resistance, have been suggested as an underlying cause for both.
Fibroids – there is no doubt that fibroids are related to oestrogen levels. Could they also be related to PCOS?
CHAPTER 5 HOW CAN MY DOCTOR HELP?
Your doctor is most likely to suggest a combination of medication and lifestyle modifications to help you control the signs and symptoms of PCOS. Medical and surgical treatment can also help you if you’re having trouble conceiving.
Do bear in mind that your treatment will be unique to you and will depend upon your individual symptoms. If you do decide to take medication we would strongly urge you to take an active role in your medical care by learning as much as you can about the condition and by working with your doctor to develop the best treatment plan for you.
TREATING IRREGULAR PERIODS
If you have irregular periods, your doctor is most likely to prescribe you oral contraceptives. In addition to protecting the uterine lining by inducing a monthly bleed, some brands of contraceptive pill can control excess face and body hair. And, of course, you get the contraceptive benefit.
Before prescribing oral contraceptives, your doctor will perform an examination or a blood test to be certain that you aren’t pregnant. If you haven’t had a period for six weeks or longer, your doctor may also first prescribe medroxyprogesterone acetate or a progestin (Provera) to induce a menstrual period. A progestin is a medication that mimics the action of progesterone. This will cause a period in almost all women with PCOS, but it doesn’t help with the cosmetic concerns (excess hair or acne) and doesn’t provide contraception.
A modest amount of weight loss can also restore normal periods in some women. For example, many overweight women with PCOS who lose 5 to 10 per cent of their body weight notice that their periods become more regular.
The final treatment for irregular menstrual periods is the use of insulin-lowering agents (see page 55).
POSSIBLE SIDE-EFFECTS
Some women who take oral contraceptives (not just those with PCOS) may notice amenorrhoea (lack of menstrual periods) or breakthrough bleeding (bleeding that occurs at the wrong time of the month). Often this breakthrough bleeding settles down after a few menstrual cycles, but if it happens your doctor may order an ultrasound scan of the uterus to check your endometrium (uterine lining).
If ultrasound shows that the endometrium is very thin, and if you don’t mind having no periods, your doctor may simply recommend continuing with oral contraceptives. If you prefer having menstrual periods, the type and dosage of contraceptives can be changed.
If the ultrasound shows that the endometrium is thick, your doctor will often prescribe a different type and dosage of oral contraceptives to trigger a period.
Many women worry that they will gain weight on the Pill. In the early days of the Pill this was a real problem; however, with the low-oestrogen pills now used, weight gain is very unusual. Nausea and bloating are potential side-effects, but these symptoms almost always go away after two or three months of taking the Pill.
Some women also say that the Pill increases their appetite. The British Medical Association’s Official Guide to Medicines and Drugs,1 does list weight gain as a possible side-effect. It goes on to say that ‘Oestrogen may also trigger the onset of diabetes mellitus in susceptible people, or aggravate blood sugar control in diabetic women.‘This isn’t usually a concern, but if you have PCOS you are at an increased risk of obesity and insulin resistance already, so you need to discuss this carefully with your doctor.
In addition, blood clots can occur, although this is a rare complication in healthy women. The risk of a healthy woman developing blood clots with the contraceptive pill is estimated at just 1 in 30,000.
While the Pill is thought to be very safe and effective, it’s important that we point out that it might lower your libido and can occasionally raise blood pressure, as well as cholesterol, blood sugar, and insulin levels.2 A preliminary study reported in the January 2006 Journal of Sexual Medicine claims that taking the contraceptive pill may lead to long-term loss of libido. A US–Canadian study3 has also found that even low-dose oral contraceptives appear to increase women’s risk of a heart attack or stroke. Dr John Nestler and Dr Paulina Essah of Virginia Commonwealth