Too Old for Acne? Difficult-to-Diagnose PCOS May Be the Cause

Polycystic Ovarian Syndrome, or PCOS, is a health condition resulting from a hormonal imbalance that affects approximately one in every 10 to 15 women in the United States. More than half of women with PCOS will have diabetes or prediabetes by age 40. Learn more about the link and how to treat these often-related conditions.

PCOS and DiabetesAcne and unwanted facial hair can be two of the undesirable symptoms of polycyctic ovarian symptom or PCOS which is often related to insulin sensitivity.

Though the exact cause of PCOS is unknown, many scientists believe that a combination of environmental and genetic factors are involved. Your risk may be higher if you are overweight or if your mother, aunt, or sister has PCOS.

As Andrea Dunaif, MD, Chief of the Division of Endocrinology, Diabetes, and Bone Disease at the Icahn School of Medicine at Mount Sinai points out, “The name can be confusing and misleading, because not all women with PCOS have cysts on their ovaries.” In fact, many experts and patient advocates are joining an international effort to change the name to something that is more reflective of what PCOS actually is – a metabolic issue. The hope is that having a more accurate name will help further research and improve treatment.

Signs and Symptoms

Most women are diagnosed in their twenties and thirties, but PCOS often starts in adolescents and can affect girls before they begin menstruating. The hormonal imbalance can interrupt the development and release of eggs from the ovaries. It often goes undiagnosed because many of the symptoms can be attributed to other causes. Common symptoms of PCOS include:

  • Irregular or missed periods
  • Weight gain
  • Fatigue
  • Unwanted hair growth on the face, arms, chest, back, abdomen, and extremities
  • Thinning hair on the head
  • Infertility
  • Acne
  • Mood changes, depression, and anxiety
  • Pelvic pain
  • Headaches
  • Sleep problems such as insomnia, sleep apnea, or poor sleep

These symptoms are caused by hormonal imbalances including lower-than-average levels of the progesterone, higher-than-average levels of androgens, and decreased insulin sensitivity. This helps explain the PCOS-diabetes connection—in both conditions, the body isn’t as sensitive to insulin as it should be. This leads to high blood sugar levels, which in turn cause the body to produce more insulin. High levels of insulin in the body triggers the production of more androgens, contributing to additional symptoms.

When talking to patients, Dr. Dunaif tries to stress that although these symptoms can sound overwhelming and scary, with the right treatment plan, both PCOS and diabetes can be managed and women can live normal, healthy lives. Everyone is different, so it’s important to work with your healthcare team to come up with a treatment plan that works for you.

Diagnosis and Treatment

Getting diagnosed and properly treated is important because women with PCOS are often at risk for having co-occurring health problems such as diabetes, high blood pressure, and high cholesterol. Because there isn’t one specific test that is used to diagnose PCOS, your healthcare provider(s) might use a combination of the following to help rule out other causes for your symptoms and diagnose you:

  • Your medical history of any symptoms listed above
  • Your family’s medical history
  • A complete physical exam, including your weight and vitals
  • Lab tests to look at blood sugar levels and hormone levels–your doctor may refer you to an endocrinologist (hormone specialist) to help order and interpret tests like these.

Although there isn’t a cure for PCOS yet, there are a number of very effective treatments available to help decrease or completely eliminate your symptoms. Many of the treatment options are also used to treat type 2 diabetes. Unfortunately, due to a lack of funding for research, many haven’t been officially approved by the FDA for the treatment of PCOS. 

Some Good Options Not Approved for PCOS Treatment

birth control pillsBirth-control pills can be a treatment option for women diagnosed with PCOS.

Talk to your doctor about which options might benefit you. Here, some options that may be recommended:

  • The first line of defense against PCOS symptoms and related health complications (such as type 2 diabetes) is a healthier lifestyle. Increasing physical activity, eating a well-balanced diet, and losing weight if needed can significantly impact your health and quality of life with both PCOS and diabetes. Feeling overwhelmed? It’s okay to start small. “Even a 5-10% reduction in body weight can improve insulin sensitivity and help regulate ovulation and hormone levels,” says Dr. Dunaif. “In my experience, diets that favor more protein and less carbs, such as the Mediterranean Diet, make people feel better and help them reach weight loss goals.”
  • Metformin, a drug approved to treat diabetes, is often prescribed for patients with PCOS to help improve insulin sensitivity and therefore lower blood sugar and androgen levels. Metformin can also help you lose weight and regulate your period. Metformin has not yet been approved by the FDA for treatment of PCOS, so talk to your doctor about the benefits and risks associated with including metformin in your treatment plan.
  • Birth control pills or other hormonal birth control methods can be used to balance androgens, helping to regulate periods, acne, and unwanted hair growth. This treatment is for women who are not trying to get pregnant.
  • For those struggling with infertility, an oral medication called clomiphene (brand name Clomid) is a common treatment used to induce ovulation. Other fertility treatments include gonadotropin injections, in vitro fertilization (IVF) and in vitro maturation (IVM). The important thing to remember is that there are options!
  • The anti-androgen drug spironolactone is also prescribed to treat acne and unwanted hair growth, although this medication has not been FDA approved for PCOS. Spironolactone is dangerous during pregnancy, so your doctor will talk about birth control options (like the pill or condoms) if you are taking this medication. 
  • Last but not least, other acne medications and hair treatments like creams and laser therapy can be prescribed to manage symptoms.

How to Build the Best PCOS Treatment Team

Due to the less-than-accurate name, the lack of published research on PCOS, and the symptoms that mimic other conditions, a diagnosis is easy to miss. “Women usually have to go to a number of providers to get the right kind of tests and treatments underway,” says Dr. Dunaif.

If you think you may have PCOS, Dr. Dunaif recommends asking your doctor for a referral to an endocrinologist who specializes in reproductive disorders. These specialists can order and interpret the appropriate hormonal and glucose tests, and are well-versed in PCOS symptoms and treatments. Your care team might include a combination of the following providers: a primary care doctor, a gynecologist, an endocrinologist, a fertility specialist, a dermatologist, a certified diabetes educator, a registered dietitian, and a mental health provider.

Updated on: January 31, 2019
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