If you have been diagnosed with polycystic ovary syndrome (PCOS), we don’t need to tell you how difficult it can be to keep up with and treat the diverse array of symptoms. For example, the hormonal imbalances associated with PCOS can lead to skin and hair concerns ranging from breakouts and pigmentation or unwanted hair growth and loss.
We know that the lack of information out there on the topic is, at best, frustrating, which is why we tapped our expert network to break down the complexities of PCOS diagnosis and treatment. From what PCOS is (and what kind of provider you should go to if you think you are experiencing symptoms) to how to manage it, here’s what you need to know about polycystic ovary syndrome.
An Intro to Polycystic Ovary Syndrome (PCOS)
So, what is PCOS exactly? Polycystic ovary syndrome, better known as PCOS, is a hormonal disorder in which the ovaries produce an abnormal amount of androgens (read: male sex hormones). The name describes the small cysts that form in the ovaries, though not everyone with PCOS experiences cysts. It should also be noted that not all females with ovarian cysts have polycystic ovary syndrome.
While PCOS is increasingly common among females of childbearing age, it is not a straightforward diagnosis. “[It] can be a difficult condition to diagnose due to its varied presentation,” says Iyanna Liles, MD, Connecticut-based OB/GYN and women’s health specialist. “In general, most patients who are evaluated for PCOS by an OB/GYN present with symptoms of irregular periods.”
But that’s not all. “They can report other symptoms such as increased acne, abnormal body hair growth (requiring extensive hair removal techniques), infertility, or metabolic syndromes including diabetes or high cholesterol,” Dr. Liles explains. Weight gain, anxiety and depression, hair loss, and sleep apnea are also possible side effects.
When it comes to diagnosing PCOS, providers often start with a discussion of medical history — including, skin, hair, and weight changes — and a physical exam. From there, a pelvic exam, blood tests, and an ultrasound may be in order.
Causes of PCOS
The symptoms are well-documented, yet there is less known about what causes PCOS. “While we do not completely understand PCOS, we do know that this condition involves increased available circulating androgens due to multiple possible causes,” Dr. Liles says. Factors that are thought to play a role include insulin resistance and genetics. Generally speaking, PCOS signs and symptoms tend to be more severe in patients who are obese.
Just as there is no singular presentation of PCOS, there is no one-size-fits-all treatment plan. There are, however, a number of ways the condition can be managed depending on a patient’s symptoms. “In general, we start treatment for PCOS with lifestyle changes such as diet and exercise,” Dr. Liles says. “These interventions decrease the amount of circulating androgens and their effect on the body.” It’s also important for your provider(s) to know if and when you hope to become pregnant, as “some medications will either prevent pregnancy or should not be used in pregnancy,” she cautions.
Many PCOS diagnoses begin at the gynecologist because patients are concerned about irregular periods or difficulty conceiving. But long-term care plans often include additional specialties and experts. “If a patient primarily has skin and/or hair issues without menstrual issues, a dermatologist or skincare specialist may take on treatment,” Dr. Liles explains. “It can be confusing to know who to go to first, but both types of providers can refer to the appropriate specialist based on the patient's concerns.”
Elizabeth Trattner, AP, DOM, a board certified acupuncturist and doctor of Chinese and integrative medicine in North Miami Beach, FL, works with clients with PCOS and advocates for a comprehensive approach. “I believe it takes a team of professionals to create a cohesive treatment plan,” she shares. “I always triage patients to gynecologists and dermatologists [because they] like a teamwork approach.” This is especially important when prescription medications are involved. “There are many times that patients are under other physician’s care and are on medication,” she adds. “It is important to work in tandem with other doctors to monitor blood levels, track progress, and lower medication as the patient improves.”
At Dr. Trattner’s practice, PCOS is treated using a combination of Traditional Chinese Medicine (TCM) and integrative medicine techniques. “Chinese Medicine, including acupuncture and herbal medicine, are a comprehensive and effective system for treating PCOS,” she explains. “It alleviates symptoms along with regulating the endocrine and reproductive system.” In fact, there is a good deal of research into the many benefits of acupuncture for patients with PCOS. “[It] can regulate ovarian and adrenal sex hormone levels,” she notes.
As it relates to integrative medicine, she says dietary changes are an important component of treatment. “This multi-pronged approach helps address both root issues and symptoms,” Dr. Trattner says.
The Impact of PCOS on Skin & Hair
As we mentioned, skin and hair concerns are common among patients with PCOS. Acne is a common side effect, as is both excessive hair growth and hair loss. Below, we break down what you need to know about treating and managing skin- and hair-related PCOS symptoms.
How PCOS Can Affect the Skin
There are a number of ways PCOS can affect the skin. Many patients experience face and body acne. Some also develop melasma and (in rarer cases) skin tags. Not everyone deals with any or all of these symptoms, but, for those that do, they are often treated with a combination of professional and at-home remedies.
For starters, it’s important to consider what your plans are for the months ahead. “If a patient is actively pursuing pregnancy in the next year, I would recommend lifestyle changes and discuss various skincare techniques,” Dr. Liles says of treating patients with PCOS-associated skin concerns. “If a patient is not pursuing pregnancy, I recommend lifestyle changes, improved skincare, and combined oral contraceptives (birth control pills) for about three to six months.”
As she explains, birth control pills “decrease ovarian androgen secretion and increase a protein that binds circulating androgens with the intent to decrease circulating androgen levels.” She specifically prescribes pills with a progestin component that has low androgen potential. If patients do not see their desired effect during the trial period with oral contraceptives alone, Dr. Liles usually refers them to a dermatologist for further evaluation.
Additionally, Dr. Trattner says that Chinese Medicine and acupuncture can be employed to “regulate the endocrine system and lower the number of androgens in the body.” To complement acupuncture sessions, she also integrates Western supplements and Chinese herbs and recommends blue light therapy for skin concerns. “Using these modalities lower testosterone and insulin levels,” she explains. “It takes at least three months to rebalance hormones, but, within that time, excessive hair growth and skin issues — including acne and melasma — begin to wane.”
How PCOS Can Affect Hair
Like the skin, the hair is also affected by PCOS in many ways. Because PCOS increases the amount of male sex hormones in the body, a female with PCOS could find unwanted hair growth on the thighs, chest, stomach, and around the nipples. The hormonal imbalance can also lead to male pattern hair loss. “The increased circulating androgens act on the pilosebaceous units (hair follicles) in the skin leading to hair disorders such as hirsutism (abnormal sexual hair growth in male pattern) or hair loss,” Dr. Liles explains.
As with the skin, treatment protocols will depend on whether or not a patient is looking to get pregnant. “In the treatment of PCOS associated with unwanted hair growth, if a patient is actively pursuing pregnancy in the next year, I would recommend lifestyle changes and mechanical hair removal techniques,” Dr. Liles says. That can include shaving, waxing, sugaring, and the like (learn more in our comprehensive guide to hair removal).
For patients not pursuing pregnancy, she recommends birth control pills for about three to six months. If combined oral contraceptives do not yield an adequate result, Dr. Liles says she may suggest adding anti-androgen medications such as spironolactone, finasteride, or flutamide. “You should always make sure patients have reliable contraception with anti-androgen medications, as they can negatively affect a developing fetus with male organs during pregnancy,” she cautions. If unwanted facial hair growth is a concern, eflornithine cream (a.k.a. Vaniqa) may be an option. At the end of the day, “the choice of medication is individualized to the patient,” Dr. Liles says.
When beginning treatment for PCOS, it’s important to remember that patience will be needed. “When I begin with a new patient for PCOS, I create a comprehensive treatment plan,” Dr. Trattner says. “Once symptoms subside — after approximately three months — I will reevaluate the patient’s case on a regular basis and then transfer them to maintenance.” That maintenance will look different for everyone, but consistency is key. “It can vary from every week to twice a month,” she notes. “Hormones always need to be regulated with PCOS.”
Additionally, regular care will allow your healthcare team to keep an eye out for more serious complications. “Other possible conditions to consider in patients with PCOS include diabetes, high cholesterol, infertility, and endometrial cancer,” Dr. Liles says. “If someone thinks they have PCOS or has been diagnosed with PCOS, they should make sure they have a clinician closely monitoring them for these conditions and assisting them in preventing the negative side effects seen with PCOS.”
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