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Case Study: Polycystic Ovarian Syndrome (PCOS)

Learn what you need to know about PCOS, the most common cause of irregular periods, abnormal hair growth, and problems with infertility in young women.

By
Sanaz Majd, MD

What Are the Signs of PCOS?

Now, just by examining Bella in my office, I did notice a few important potential signs of PCOS:

  1. Being overweight: She is about five feet tall and 20 pounds overweight, and she carries most of her weight in the mid section. She admits that she has a tough time losing weight, no matter how hard she tries.

  2. Acne: She suffers from a mild case of acne on her face and upper back.

  3. Hirsutism: She has a little bit of hair growth on her upper lip, chin, stomach, and feet.

  4. Acanthosis Nigracans: The back of her neck has a thickened, dark brown, leather-like quality to it. That is referred to as Acanthosis Nigracans, and is often a sign of pre-diabetes or diabetes. Bella had never noticed this herself until I pointed it out. 

How is PCOS Diagnosed?

Being that Bella suffers from irregular periods, I did test her for a few other health conditions that can cause that, like thyroid disorder. But I made sure to test her for PCOS by ordering the following blood tests:

  1. Testosterone Level: Women with PCOS tend to have higher testosterone levels than what is considered normal. This is likely partly genetic, so Bella can thank her parents for their wonderful genes. High testosterone causes women with PCOS to exhibit male-like qualities--such as acne, excess hair growth in awkward places (like the face, hands, feet, etc.), and possibly even some diffuse thinning of the hair on the scalp. 

  2. Elevated Fasting Sugars: One of the defining features of PCOS is a phenomenon called “insulin resistance,” meaning there’s an elevated amount of insulin in the body. Well, this elevated insulin attacks the ovaries and causes the ovaries to produce more testosterone. This insulin resistance is quite common in those with prediabetes and diabetes, and women with PCOS have a greater tendency to develop diabetes later in life if they are not careful. 

Bella’s testosterone level was slightly above normal and her fasting blood sugar was normal. 

So, her test results were pretty normal—but that’s what makes diagnosing PCOS tricky. There is a subset of PCOS women whose labs are normal. Bella's seemed to fall into that category. Despite her test results, I diagnosed her with PCOS because of her irregular periods, acne, excess hair growth, extra pounds, and Acanthosis Nigracans.

What Are the Effects of PCOS?

So, what does it mean to have PCOS? Women with PCOS have a greater propensity towards diabetes. It’s really important for them to exercise, eat right, and be at a normal healthy weight in order to prevent diabetes.

PCOS can also make it a little more difficult to get pregnant, but pregnancy is usually very achievable with the right treatments. 

Lastly, women with PCOS may have a higher risk of endometrial cancer if they don’t have regular periods. It’s important to have a period (but only if you are not on hormones) at least once every two to three months in order to allow the lining of your uterus to shed. If it doesn’t shed, cells can build up and place you at risk for cancer of the uterus later in life.

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About the Author

Sanaz Majd, MD

Dr. Sanaz Majd is a board-certified Family Medicine physician who graduated from Drexel University College of Medicine in Philadelphia. Her special interests are women's health and patient education. 

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