womenshealthADM: Good evening Dr. Fish, thank you for coming. What do you want to tell us about PCOS?
DrLisaFish: We are both on the board of the Hormone Foundation, which is the patient's arm of the Endocrine Society. Thank you for having us. We're highlighting polycystic ovary syndrome (PCOS) which is the most common hormone related disorder in women.
womenshealthADM: We are glad to have you. Are you ready for questions?
DrLisaFish: Sure!
womenshealthADM: OK, who has a question for Dr. Fish?
womenshealthADM: from Angel: Will all cases have enlarged ovaries with small cysts?
DrLisaFish: Well certainly from the name it sounds like that; however the diagnosis of PCOS is based on having irregular menstrual cycles and symptoms of excess androgens and that can result in excess hair growth on the face and body, acne, or hair thinning and many women who have small cysts on their ovaries do not have PCOS so it is no longer a main part of the diagnosis.
DrLisaFish: Thank you for the question!
DrLisaFish: Next?
womenshealthADM: Pauline...
Pauline: Is it safe to take metformin while breastfeeding?
DrLisaFish: Metformin is a medication that improves insulin sensitivity, and is being used to treat women with PCOS. It has been shown to help women ovulate and does seem to be safe when women are trying to get pregnant. We don't have enough data now to say whether or not it is safe to use during pregnancy or during breastfeeding. Most practitioners would stop treatment as soon as a woman knows she is pregnant, and would not start it again until she is done breastfeeding.
DrLisaFish: Next?
womenshealthADM: from angel: It is mentioned that the patient will have an abnormal glucose test. Is that regularly or on occasion? Can that include during pregnancy?
DrLisaFish: We know that insulin resistance is part of PCOS and many women with the syndrome will have impairment of glucose tolerance which is in between normal and diabetes. There is also a higher chance of developing diabetes, but not everyone with PCOS has abnormal glucose tolerance.
When a woman becomes pregnant, she needs to increase her insulin production to overcome the effects of placental hormones, and for women who already have insulin resistance there is a higher chance of gestational diabetes.
DrLisaFish: next?
womenshealthADM: Heather you have questions?
Heather: Yes. My insulin tests come back normal, so how do I get a doctor to prescribe drugs that might help the pcos?
DrLisaFish: PCOS is a clinical diagnosis and an insulin test is not necessary to make that diagnosis. If you have 9 or fewer periods a year and evidence of excess androgen effects then you would meet criteria for the diagnosis. Your doctor might want to rule out some other problems, but having a normal insulin level should not prevent you from being able to be treated.
DrLisaFish: next?
womenshealthADM: from angel: What can I tell my doctor to do? Can it be treated by a regular physician if someone lives in a rural area? Exactly what does treatment involve?
DrLisaFish: Well, it depends on your symptoms. For some women, their main goal is just to become pregnant; for some it is excess facial hair; and for other women it is high blood pressure, abnormal cholesterol levels, and abnormal glucose levels. So treatment depends on a woman's concerns and needs at that time.
DrLisaFish: next?
womenshealthADM: from angel: What can I tell my doctor to do? Can it be treated by a regular physician if someone lives in a rural area? Exactly what does treatment involve?
DrLisaFish: Well, it depends on your symptoms. For some women, their main goal is just to become pregnant; for some it is excess facial hair; and for other women it is high blood pressure, abnormal cholesterol levels, and abnormal glucose levels. So treatment depends on a woman's concerns and needs at that time.
