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Polycystic Ovarian Syndrome (PCOS)

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by Dr. Genevieve Lowell, RN, MSN, PNP, NP, DNP, CRNA

Polycystic ovarian syndrome (PCOS) can be hard to recognize and easily mistaken for other health problems, but early detection of PCOS can save teens and young women a lifetime of problems. About 1 in 10 and 1 in 20 women of childbearing age have PCOS and PCOS can occur in girls as young as 11yrs/old. The exact cause of this syndrome isn't known, but more likely to show in girls and young women who have a family member that was diagnosed with PCOS, aren't active, and overweight. The main underlying problem of PCOS is a hormonal imbalance. In girls and young women with PCOS, your ovaries make more androgens than normal. Androgens are male hormone that females also make, but not as much as males do. High levels of androgen affect the development and release of eggs during ovulation. Researchers also think insulin may be linked to PCOS. Insulin is a hormone that controls the change of sugar, starches, and other food into energy for the body to use or store. Many girls and young women with PCOS have too much insulin in their bodies because they have problems using insulin. Too much insulin can increase the levels of androgen. High levels of androgen can cause acne, excessive hair growth, weight gain, and problems with ovulation. Symptoms of PCOS can differ from women to women, but the most common symptoms of PCOS are:
  • Infertility (not able to get pregnant) because of not ovulating.
  • Absent or irregular menstrual periods.
  • Hirsutism - increased hair growth on the face, chest, stomach, back, thumbs, or toes.
  • Cysts on the ovaries.
  • Acne, oily skin, or dandruff.
  • Weight gain or obesity - usually more weight around the waist.
  • Male-pattern baldness or thinning hair.
  • Patches of skin on the neck, arms, breasts, thighs that are thick and dark brown or black.
  • Skin tags.
  • Anxiety or depression.
  • Sleep apnea - when breathing stops for short periods of time while asleep.
Treatment for PCOS differs from women to women, but is generally treated with birth control pills to control menstrual cycles, reduce male hormone levels and to help clear acne. Many women with PCOS are overweight and need lifestyle changes, such as limiting processed foods and foods with added sugar and adding more fruits, vegetables, lean meats, and more whole-grain products. Diabetic medications are used too to treat type 2 diabetes and pre-diabetes that most women have with PCOS. Medications like metformin are used to control the way insulin controls blood glucose (sugar) and lower testosterone production. It also slows growth of abnormal hair and after a few months of taking the medication it may help ovulation return. Fertility medications are used for when the patient is ready to get pregnant and needs help. PCOS can be mistaken for hypothyroidism and appendicitis. Hypothyroidism and PCOS have very similar symptoms and many doctors misdiagnose hypothyroidism, when it really is PCOS the whole time. Working as an emergency room NP and operating room NP many young women have had their appendixes taken out due to ovarian cysts being mistaken for appendicitis. Most parents of young women show up in the emergency room with pain in the lower right corner that is commonly a symptom of appendicitis and with excruciating pain. As blood tests were run, we didn't see high white blood cell counts and a cat scan (CT) was needed, but parents didn't want their daughter to be exposed to that radiation, so the only thing to do was to operate in the case that is really was appendicitis, but once the surgeon made the incision and saw that the appendix wasn't inflamed or infected, it was too late to go back they had to remove the appendix anyway. The patient then had an unnecessary surgery and was put at a risk for infection. Once the patient woke up, they still had a similar pain and an ultrasound was done, only to show several ovarian cysts causing the pain. Most time surgeons don't think about doing an ultrasound at the time nor did the emergency room physician. That is why, it is very important for surgeons and emergency room physicians to check for ovarian cysts and PCOS in young women, who show up to the emergency room with pain similar to appendicitis. Yes, it may be appendicitis, but it is very important to rule out ovarian cysts and PCOS so patients don't have an unnecessary surgery. Early detection of PCOS is very important in young women and especially teens. PCOS doesn't just effect young women and teens physically; it affects young women and teens emotionally too. PCOS can change your physical appearance and cause anxiety and depression. Teens with PCOS are generally depressed and have anxiety, which leads to not wanting to attend school, sports, wear certain clothes, and become more and more of a recluse in life. Young women and adults with PCOS also struggle with depression and anxiety mostly because of infertility and weight gain. Early detection of PCOS can help teens, adults and young women greatly. Untreated PCOS can cause anxiety, depression, infertility, type 2 diabetes, obesity, insulin resistance, unwanted hair growth, pain, cardiovascular complications, and other reproductive complications. What you don't know can hurt you. Even though, there is no cure for PCOS it is highly treatable and manageable. Source: www.mayoclinic.org & www.kidshealth.org   Dr. Genevieve Lowell, RN, MSN, PNP, NP, DNP, CRNA

Dr. Genevieve Lowell, RN, MSN, PNP, NP, DNP, CRNA

I was a U.S. Army FNP for thirty-four years and I worked at Army hospitals, bases and clinics. I went to the University of Pennsylvania for undergraduate studies, then went to Johns Hopkins University School of Nursing to get my RN, BSN and MSN. I then went on to Duke University School of Nursing DNP and CRNA. I am also a PNP and worked in a children's hospital for nineteen years. I love working in the operating room and in the emergency room. I have six children and nine grandchildren, I also have four sisters and one brother along with tons of nieces and nephews and great nephews, great nieces and tons of other family members. I currently work in a urgent care clinic in Villanova, PA as an NP.
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