PCOS and Weight Gain -Is This Really The Case?
Polycystic Ovarian Syndrome (PCOS) is the most common hormonal disorder in women and I am one of those women who has probably had PCOS since an early age however, it went undiagnosed. As with many women, we usually take a more vested interest in our hormones when we are interested in becoming pregnant. So that is what happened with me, and as an end result, I found out I had PCOS. But does PCOS cause weight gain? Because I have never had a weight issue and therefore I was confused, which lead me to do lots of research. I wanted to understand what exactly were the PCOS symptoms and treatment options
First of all, the name of the disorder leads us to believe that you have cysts on your ovaries but that is not the case (well not always). PCOS signs and symptoms are usually very clear, however the symptoms can overlap with other hormonal-related disorders and very similar to puberty as well. In my case, the reason that I never thought I had PCOS and/or my doctor never suggested being tested for it, is most likely due to that fact that I am a “lean PCOS”. I never even knew that existed because the top PCOS symptoms are obesity and diabetes and therefore treatment starts with changes in diet.
If there is one learning point that I want to come out if this article is that you do not need to have ALL the PCOS symptoms, you do not have to be overweight and you should not hesitate going to see a doctor. The long-term risks are way too serious to undermine your symptoms. PCOS symptoms may not necessarily both you or interfere with your daily life, but going undiagnosed with PCOS, especially if you have no periods at all like me, can be very dangerous in the long-term. Not having a regular period for many years increases the chances of endometrial cancer six fold.(1)
PCOS – What Is It?
Simply put, it is a hormonal disorder where there are issues with your reproductive hormones and as a result,affects your fertility.
The 3 main hormones that are unbalanced when you have PCOS are:
Androgen: This is the “male” hormone and in women with PCOS, this hormone is elevated;
Insulin: Is the hormone that controls blood sugar level and women with PCOS may have insulin resistance which means that the insulin does not respond well to blood sugar;
Progesterone: The level of this hormone is too low, and this is what may lead to infrequent, unpredictable or lack of period.
PCOS – The Cause
The cause is really not known until today. In fact, it was believed that being insulin resistant or obese may lead to PCOS, but now there are more and more women being diagnosed as having “lean PCOS” which leaves the cause less understood.
What is interesting though is that obese women and lean women with PCOS are both insulin resistant compared to the normal population. This means what was once believed to be the biggest contributor to becoming insulin resistant, which is obesity, is not the case with PCOS and there is another factor contributing to the insulin resistant symptom.
Studies show that girls with severe acne or resistant to oral and topical agents for acne treatment, including Accutane may have a 40% likelihood of developing PCOS
- There is no ONE gene for PCOS but there seems to be a huge genetic factor that plays a role. Between 25% to 35% of women will develop PCOS if their mother and/or sister have the disorder, and this is a much higher probability than the normal population. (2)
PCOS – Symptoms
1.Irregular, unpredictable or absent periods;
2.Weight Gain (not always)
A female who has “lean PCOS” may not look fat from the outside but may still have a significant amount of visceral fat.
Visceral fat is stored around the abdomen area and may not even be noticeable because it is stored inside the abdominal cavity and surrounds important internal organs like the liver, pancreas and intestines.
Visceral fat is more dangerous than subcutaneous fat, because can lead to many serious health risks. It requires expensive scans to be able to measure the percentage of visceral fat in the body making it even harder to diagnose.
3.Type 2 diabetes
4.Hirsutism– which is having excess hair on parts of the body which is typically not the case such as face and buttocks;
5.Acne – this is not only at puberty but adult acne as well, if PCOS goes untreated.
6. Scalp Hair Thinning is a common symptom in women with PCOS. (3)
7. Skin conditions such as: (4)
a. Alopecia – hair loss on areas of the body which is not common, such as eyelashes and eyebrows.
b. Acanthosis Nigrcans – Changes in your skin, which is the result of high insulin levels. These skin abnormalities present itself as patches of thick and darker skin around the creases of your neck, groin and breasts. You may also develop “skin tags” or skin growths.
PCOS – Diagnosis
There is no one test for PCOS so a full assessment must be done to diagnosis PCOS effectively.
There is a general agreement that to be diagnosed with PCOS, 2 of the 3 symptoms must be present: (5)
1. Chronic anovulation – cycle is longer than 32 days or even absent, due to hyperandrogenism.
2. Hyperandrogenism – this is because your body produces a substantial amount of insulin because the insulin is not effectively carrying glucose to the body’s cells. This elevated level of insulin may cause a shut down in your ovaries and lead to a high level of androgen and testosterone, all of which affect ovulation.
3. Polycystic ovarian morphology (PCOM) – having cysts on the ovaries is not always the case. Some women may have over 25 cysts on their ovaries and despite this, it goes unnoticed unless an ultrasound is conducted because there is no pain usually associated with cysts.
Prevention of Long-Term Consequences
It is VERY important ladies to seek diagnosis if you have any of the symptoms discussed.
It is better safe than sorry.
Even if you feel that your symptoms do not interfere with your daily life it is best to determine what the underlying cause is.
Mothers, it is particularly important to have your daughter’s symptoms assessed even though they resemble typical hormonal changes often seen through puberty. In fact, even enlarged ovaries (PCOM) is common in adolescent girls so typically an ultrasound is not the best way to diagnose. (6)
Regardless of the steps needed to diagnosis, it is worth the time and effort, eliminate PCOS or confirm that is the culprit.
It is known today that PCOS can to:
a. Infertility – 80% of women with PCOS have fertility issues and PCOS is the leading cause of infertility in women(7)
b. Psychological Health Problems; anxiety, anger poor quality of life and a general increase in negative mood states. The cause of this is still not know. Some say women are also more depressed, but this could be the cause of sadness due to be infertile, rather than depression because caused directly by PCOS. (8)
c. Cardiovascular risks – this is the result of poorly managed diabetes and weight. Women with PCOS have a 70% higher change of high cholesterol, blocked arteries, high blood pressure, stroke and heart attack.
d. Metabolic issues: Type II diabetes and visceral obesity (explains why you can have a “lean” PCOS female.
e. Cancer (9)
It is really important to point out that the elevated risk in cancers is for PREMENOPAUSAL women. Their risk of cancer, compared to the normal population is:
-6x higher for endometrial cancer
-3x higher for endocrine gland cancer
-2x higher for pancreatic cancer
Once a PCOS patient reaches menopause, their risks of cancer is not any higher than non-PCOS menopausal women.
Why is endometrial cancer so much more common?
Because lack of periods or having absent periods (amenorrhea) causes an accumulation of the lining of the uterus, which normally sheds very 28 days. This accumulation of cells cause the cells to start binding and growing abnormally leading to cancer.
Treatment for adolescents can be as simple as anti-androgen medications and the dose will be dependent on age and weight. This can prevent so many complications for the adolescent later on in life.
As for childbearing women, the good news is that today, it is still possible to get pregnant. The treatment will include:
a. Lifestyle changes – to lose weight and help with insulin imbalances
b. Medications that induce ovulation;
c. Other fertility treatments (IVF)
d. Surgery called Laparoscopic ovarian drilling. This is a last resort and is a small surgery that damages part of the ovary which in 50% of cases, re-initiates ovulation in women.(10)
Treatment for women with “lean PCOS”(11) is a little different. Management of their symptoms can still include medications to induce ovulation, however diet is not as simple to help treating being insulin resistant.
In fact, there are no benefits for weight loss and in most cases, lean PCOS women do not have any subcutaneous fat to lose. Lean PCOS women would still benefit from medications to control insulin levels to help with decreasing visceral fat.
The most common pharmaceutical treatment, for both obese and lean PSOC women is Metformin, as it is shown to decrease androgen levels and re-start ovulation. There are mixed results of this drug being as effective for lean PCOS women. Of course, treatments need to be discussed intensively with doctor is a case-by-case situtaion, given the complexity of PCOS.
Do Not Find Excuses
Do not do what I did ladies.
I had very irregular periods, ranging anywhere from 40 to 55 days. This started from when I went through puberty and these long cycles caused me enormous abdominal pain. This, coupled with major acne, I had two major signs of PCOS. Instead, the main focus was pain reduction and acne treatment.
I went through two treatments of accutane, after several other oral treatments failed, and tried different types of birth control to regulate my periods and pain.
Once I had successfully treated my acne, I stayed on birth control for almost 10 years.
I finally decided to stop birth control because I wanted to give my body a break. My irregular periods returned, but not for long because started to work a job that involved rotating shift work and my periods completely stopped for 7 years. Although this was mentioned to my doctor, it was just ignored because ultimately, it was clear that my hormon levels were being effected by working night shifts.
I worked shift work from 2008 to 2017 and today, 3 years later, I am still without a period even after several sessions of progesterone and estrogen treatment to trigger ovulation. My husband and I have no other option than to undergo IVF to have a baby.
I am still very grateful and blessed that I do not have diabetes, that I am not over weight, no not have any signs of visceral fat nor signs of endometrial cancer.
No matter what, continue to exercise, eat well and get good sleep – these 3 will always serve you to maintain health and prevent illness.
Please share your experiences with PCOS if you have it or know someone who has it.
Lets share our stories below:)