Polycystic Ovary Syndrome

What is polycystic ovary syndrome (PCOS)?

Polycystic ovary syndrome (PCOS) is the name for set of symptoms that are related to an imbalance of hormones. PCOS affects the ovaries, as well as many other parts of the body.

People with PCOS usually have at least two of these problems:

• Not ovulating. Normally, your ovaries make the egg that is released each month as part of a healthy menstrual cycle. This is called ovulation. But with PCOS, the egg may not develop as it should, or it may not be released during ovulation. Your periods may be irregular, or you may not have them at all.
• High levels of androgens. Androgens are hormones that are important for normal male sexual development. Women normally make smaller amounts of androgens. Having higher levels of androgens can cause you to have extra body or facial hair (called hirsutism).
• Cysts in one or both ovaries. Cysts are growths that are small, fluid-filled sacs.

What causes polycystic ovary syndrome (PCOS)?

The exact cause of PCOS in unknown. Research has shown that different factors may play a role, including:

• Genetics. PCOS tends to run in families.
• Imbalances in androgen levels.
• Insulin resistance. This is a condition in which your body can't use insulin properly. Insulin is a hormone that helps move blood glucose (sugar) into your cells to give them energy. Insulin resistance can lead to high blood glucose levels.

What are the symptoms of polycystic ovary syndrome (PCOS)?

PCOS often develops as young as age 11 or 12, around the time of your first period. But you can develop it later.

The symptoms can vary from person to person. Some people have few or even no symptoms. They may not realize they have PCOS until they have trouble getting pregnant. Other people may have more severe symptoms.

The symptoms of PCOS may include:

• Irregular or missed menstrual periods.
• Too much hair on the face, chest, stomach, or thighs.
• Obesity, weight gain, or trouble losing weight.
• Severe acne which may be hard to treat.
• Oily skin.
• Patches of thickened dark skin (called acanthosis nigricans).
• Infertility. PCOS is one of the most common causes of infertility. But many women with PCOS can still get pregnant.

What other health problems are linked to polycystic ovary syndrome (PCOS)?

PCOS is linked to many other health problems, including:

• Insulin resistance, which can lead to prediabetes and type 2 diabetes.
• Heart disease. Having PCOS increases your risk, and this risk goes up as you age.
• High blood pressure.
• High LDL ("bad") cholesterol and low HDL ("good") cholesterol. This increases your risk of heart disease.
• Sleep apnea, a disorder that causes you to repeatedly stop breathing during sleep.
• Depression and anxiety.

Although there are links between PCOS and these conditions, researchers do not know whether:

• PCOS causes some of these problems
• Some of these problems cause PCOS, or
• There are other conditions that cause both PCOS and these other health problems

Not everyone who has PCOS will have all these problems. However, you and your health care provider may want to monitor your health for signs of them, so they can be treated early.

How is polycystic ovary syndrome (PCOS) diagnosed?

There is no specific test for PCOS. To find out if you have PCOS, your provider:

• Will do a physical exam, which will include looking for the physical signs of PCOS.
• Will ask about your medical history and family health history.
• May do a pelvic exam to check for signs of extra male hormones and to see if your ovaries are enlarged or swollen.
• May order a pelvic ultrasound to look for cysts on your ovaries and check the thickness of your endometrium (the lining of your uterus, or womb).
• May order blood tests, including tests to check your hormone levels.

What are the treatments for polycystic ovary syndrome (PCOS)?

There is no cure for PCOS, but treatments can help you manage your symptoms. The treatments may include:

• Lifestyle changes, which can help reduce many symptoms. They can also lower your risk for or help manage related health problems. These changes include:
  • Maintaining a healthy weight
  • Getting regular physical activity
  • Eating healthy foods
• Medicines:
  • Hormonal birth control, such as pills, shots, and IUDs, can make your period more regular. They may also help remove acne and extra facial and body hair. But you would only use them if you don't want to get pregnant.
  • Anti-androgen medicines, which block the effect of androgens. This can help reduce hair loss on your head, the growth of facial and body hair, and acne. Providers do use them to help with these symptoms, but anti-androgen medicines are not approved by the U.S. Food and Drug Administration (FDA) to treat PCOS. These medicines can cause problems during pregnancy. Your provider may have you take them with birth control (to prevent pregnancy).
  • Insulin-sensitizing medicines, which are medicines that are used to treat type 2 diabetes. They improve insulin resistance and keep your blood glucose levels steady. They may also lower your androgen levels. They are not approved by the FDA to treat PCOS. But they may help with your symptoms.
  • Medicines for acne. These medicines come in pills, creams, or gels.
• Treatments for hair removal, such as facial hair removal creams, laser hair removal, and electrolysis.
• Fertility treatments if you are having trouble getting pregnant. They include medicines and procedures such as in vitro fertilization (IVF).

Potassium

Potassium is a mineral that your body needs to work properly. It is a type of electrolyte. It helps your nerves to function and muscles to contract. It helps your heartbeat stay regular. It also helps move nutrients into cells and waste products out of cells. A diet rich in potassium helps to offset some of sodium's harmful effects on blood pressure.

Many people get all the potassium they need from what they eat and drink. Sources of potassium in the diet include:

• Leafy greens, such as spinach and collards
• Fruit from vines, such as grapes and blackberries
• Root vegetables, such as carrots and potatoes
• Citrus fruits, such as oranges and grapefruit

Your kidneys help to keep the right amount of potassium in your body. If you have chronic kidney disease, your kidneys may not remove extra potassium from the blood. Some medicines also can raise your potassium level. You may need a special diet to lower the amount of potassium that you eat.

Preconception Care

If you are trying to have a baby or are just thinking about it, it is not too early to prepare for a safe pregnancy and a healthy baby. You should see your health care provider for preconception care.

Preconception care is care you receive before you get pregnant. Your health care provider can help you figure out which steps you need to take now, such as:

• Finding and taking care of any problems that might affect you and your baby later, like diabetes or high blood pressure
• Increasing the amount of folic acid you get to prevent neural tube defects
• Getting up to date on vaccines
• Avoiding smoking, drinking alcohol, or taking drugs
• Trying to reach a healthy weight

By taking action on health issues before pregnancy, you can prevent many future problems for yourself and your baby. Once you're pregnant, you'll get prenatal care until your baby is born.

NIH: National Institute of Child Health and Human Development

Prediabetes

What is prediabetes?

Prediabetes means that your blood glucose, or blood sugar, levels are higher than normal but not high enough to be called diabetes. Glucose comes from the foods you eat. Too much glucose in your blood can damage your body over time.

If you have prediabetes, you are more likely to develop type 2 diabetes, heart disease, and stroke. But if you make some lifestyle changes now, you may be able to delay or prevent type 2 diabetes.

What causes prediabetes?

Prediabetes usually happens when your body has a problem with insulin. Insulin is a hormone that helps the glucose get into your cells to give them energy. A problem with insulin could be:

• Insulin resistance, a condition in which the body can't use its insulin properly. It makes it hard for your cells to get glucose from your blood. This can cause your blood sugar levels to rise.
• Your body can't make enough insulin to keep your blood sugar levels at a healthy level

Researchers think that being overweight and not getting regular physical activity are major factors in causing prediabetes.

Who is at risk for prediabetes?

About 1 out of every 3 adults has prediabetes. It is more common in people who:

• Are overweight or have obesity
• Are age 45 or older
• Have a parent, brother, or sister with diabetes
• Are African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander American
• Are not physically active
• Have health conditions such as high blood pressure and high cholesterol
• Have had gestational diabetes (diabetes in pregnancy)
• Have a history of heart disease or stroke
• Have metabolic syndrome
• Have polycystic ovary syndrome (PCOS)

What are the symptoms of prediabetes?

Most people don't know they have prediabetes because usually there are no symptoms.

Some people with prediabetes may have darkened skin in the armpit or on the back and sides of the neck. They may also have many small skin growths in those same areas.

How is prediabetes diagnosed?

There are a few different blood tests that can diagnose prediabetes. The most common ones are:

• Fasting plasma glucose (FPG) test, which measures your blood sugar at a single point in time. You need to fast (not eat or drink) for at least 8 hours before the test. The results of the test are given in mg/dL (milligrams per deciliter):
  • A normal level is 99 or below
  • Prediabetes is 100 to 125
  • Type 2 diabetes is 126 and above
• A1C test, which measures your average blood sugar over the past 3 months. The results of an A1C test are given as a percentage. The higher the percentage, the higher your blood sugar levels have been.
  • A normal level is below 5.7%
  • Prediabetes is between 5.7 to 6.4%
  • Type 2 diabetes is above 6.5%

If I have prediabetes, will I get diabetes?

If you have prediabetes, you may be able to delay or prevent type 2 diabetes through lifestyle changes:

• Losing weight, if you are overweight
• Getting regular physical activity
• Following a healthy, reduced-calorie eating plan

In some cases, your health care provider may also recommend taking diabetes medicines.

Can prediabetes be prevented?

If you are at risk for prediabetes, those same lifestyle changes (losing weight, regular physical activity, and a healthy eating plan) may prevent you from getting it.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Prenatal Care

What is prenatal care?

Prenatal care is the health care you get while you are pregnant. It includes your checkups and prenatal testing. Typically, a health care provider specializing in the delivery of babies and the care of pregnant women, such as an obstetrician or a midwife, provides prenatal care.

Why do I need prenatal care?

Prenatal care can help keep you and your fetus healthy until you're ready to deliver your baby. It lets your provider spot health problems early. Early treatment can cure many problems and prevent others from developing.

Every prenatal visit offers you the chance to ask questions about having a healthy pregnancy and preparing for delivery. Talk to your provider about childbirth education classes for you and your partner to help you prepare for the birth of your baby.

How often do I need prenatal visits?

Your provider will give you a schedule for your prenatal visits. Usually, visits during your pregnancy occur:

• Once a month for weeks 4 through 28
• Twice a month for weeks 28 through 36
• Weekly for week 36 until your baby is born

If you are over 35 years old or your pregnancy is high risk because of health problems like diabetes or high blood pressure, your provider will probably want to see you more often. You can also expect to see your provider more often as your due date gets closer.

What happens during prenatal visits?

During prenatal visits, your provider will check your health and carefully monitor your pregnancy until you deliver your baby.

Your first prenatal visit may take a little longer. Your provider will most likely:

• Ask about your health history, including prior pregnancies
• Ask about your family's health history
• Discuss any health conditions and risk factors that could affect you or your fetus
• Do a complete physical exam, including a pelvic exam and Pap test
• Review blood, urine, or other routine prenatal lab tests
• Check your blood pressure, height, and weight
• Discuss a healthy amount of weight gain, healthy eating, and prenatal vitamins
• Figure out your due date (when you are 40 weeks pregnant)

During most visits, your provider will most likely:

• Check your blood pressure and weight gain
• Measure your abdomen (belly) to check fetal growth once you begin to show
• Check the fetal heart rate
• Check your hands and feet for swelling
• Do routine prenatal tests

Depending on the stage of your pregnancy, you may have additional tests.

Always talk to your provider before you start or stop any medicine. Some medicines can harm your fetus. To help keep yourself and your fetus healthy, avoid substances that could be harmful, such as tobacco, alcohol, and drugs.

Dept. of Health and Human Services Office on Women's Health