In a conversation with world expert Dr. Shirisha Avadhanula, Aara Health talked about PCOS. Dr. Avadhanula is an Endocrinologist at the Cleveland Clinic and Clinical Assistant Professor of Medicine at the Cleveland Clinic Lerner College of Medicine. Her special expertise includes Thyroid, Transgender care, Obesity medicine, and women’s health.

What is PCOS?

• PCOS or Polycystic ovary syndrome is a constellation of symptoms rather than a disease. It occurs due to an overproduction of the ‘male’ hormones called Androgens. 

What causes PCOS?

• During a normal hormonal cycle of a female, the pea-sized pituitary gland secretes hormones that travel to the ovaries from the bloodstream. In turn, the ovaries release an egg to be fertilized. During an abnormal cycle or PCOS, ovulation (release of an egg) does not take place leading to the formation of cysts and the production of androgenic hormones like Testosterone.

Who can typically get diagnosed with PCOS?

• PCOS is the most common hormonal disorder worldwide; Anybody that is biologically female and in their reproductive age can get diagnosed with PCOS.

What are the symptoms of PCOS?

• There are no particular screening criteria, but most patients have increased, coarse, and/or dark facial hair; new acne on the face and back; new body hair; changes in voice, and male-patterned baldness. But the most common criteria is when females stop getting their periods and are not able to get pregnant. 

How are ethnicities related to PCOS?

• There remain some specific ethnicities that may manifest a more severe form of PCOS. For example, people of the Hispanic community are prone to severe symptoms like excess facial hair. 

How can PCOS impact fertility?

• It is not impossible to get pregnant while suffering from PCOS. But it does lead to infertility in some patients. The right medication and weight loss increase the chances of getting pregnant but the women have to be monitored very closely because of complications during the pregnancy. 

How is testing for PCOS carried out?

• Checking for Androgen levels, Prolactin Levels, and Bio-chemical tests. The most common criteria of diagnosis include Clinical evidence of Hyperandrogenism, irregularities in the Menstrual Cycle, and/or cysts on the ovaries.

Who can you visit for the correct diagnosis?

• Patients can visit Primary health doctors, Obstetrician-Gynecologists, and Dermatologists to deal with excess growth of facial hair. Patients can also visit mental health specialists to deal with the anxiety and stress that comes with the diagnosis. 

How is the Treatment for PCOS carried out?/What kind of medication is prescribed during PCOS treatment? 

• Treatment for PCOS starts by maintaining a healthy BMI. Medication for the disorder includes Hormonal Contraceptives pills as the first line of treatment, followed by Anti-Androgen medication for cosmetic benefit. Also, medicines like Metformin help in decreasing Insulin resistance and offer mild weight benefits. Side-effects of medication like Metformin include gastrointestinal distress; Which can be decreased by taking the medication at the right time. There is a skew of side effects with hormonal medication, hence it is really important to have an open conversation with your primary healthcare provider.

What are the processes for follow-up care for PCOS?

• The follow-up care for PCOS is permanent. Checking in with your Endocrinologist is essential to make sure the medication is working. A yearly visit to your doctor and checking of your Haemoglobin A1C, blood pressure, cholesterol, and BMI is also very important.

What are some methods of precaution for PCOS? 

• As PCOS tends to run in families, it cannot be prevented. Maintaining your BMI, keeping your Androgen levels down, and seeking attention on time is very important. Patients suffering from PCOS also need regular motivation, exercise, and well-rounded diets. Awareness will be very helpful in the long run.

Debunking some myths about PCOS:

• PCOS is not a disease that can be cured rather a spectrum of symptoms that can be mitigated. 
• Pregnancy does not cure PCOS.
• It is possible to get pregnant while suffering from PCOS. But the presence of this disorder does affect the process. 

Being healthy is a collaborative approach between patients and doctors, hence Dr. Shirisha Avadhanula discussed having transparent conversations and the importance of seeking the attention of a primary health worker at the right time. Educating patients, and increasing public awareness about this very common hormonal disorder were also highlighted by the expert before parting with Aara Health.