Understanding and Managing Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders among women and a frequent cause of infertility. Yet, despite its prevalence, this condition in which women produce too many androgens (aka male hormones) and too much insulin, is often misunderstood and underdiagnosed. 

Between 6% to 12% of American women of reproductive age (that’s up to 5 million) have PCOS. Polycystic ovary syndrome can begin as early as adolescence, but most women don’t discover they have PCOS until they seek medical help for difficulty trying to conceive.

Board-certified OB-GYN Shamsah Amersi, MD is extremely familiar with this scenario. At her private practice in Santa Monica, CA, Dr. Amersi and her team are known for their holistic and individualized treatment approach that helps women with PCOS reclaim their health and fertility. 

Here’s what Dr. Amersi wants you to know about PCOS.

Understanding how PCOS affects your body

When you have PCOS, imbalanced hormones cause your ovaries to form multiple cysts. The cysts contain eggs, but your imbalanced hormone levels mean they won’t mature, so they don’t get released. 

In short, your body doesn’t ovulate, and your periods are irregular. Irregular periods exacerbate the issue because when you don’t ovulate, your hormones become even more out of balance.

Just what causes some women to develop PCOS isn’t known. However, genetics are believed to play a role. If your mother, sister, or aunt have PCOS, you may be at increased risk.

Obesity is considered a factor, too. Although overweight people seem to be at higher risk, obesity is also a symptom of PCOS. 

Common PCOS Symptoms

Some women have few or no symptoms, while others have many. These can include:

• Excessive body and facial hair,
• Thinning scalp hair
• Acne and skin problems
• Weight gain
• Irregular periods 
• Infertility

Serious health issues linked to PCOS

In addition to its troublesome symptoms, PCOS is linked to serious health issues, including:  

• Infertility
• Mental health and emotional concerns
• Type 2 diabetes
• Metabolic syndrome
• High blood pressure
• High cholesterol
• Heart disease and stroke
• Endometrial hyperplasia

PCOS is also associated with an increased risk of sleep apnea and certain cancers. 

How is PCOS diagnosed?

Unlike many diseases, no one test can confirm you have PCOS. Diagnosis requires an experienced clinician like Dr. Amersi to compile clues from physical observations and medical tests. These include:

• Assessing a history of your menstrual cycles 
• A  physical exam for signs of common symptoms like excessive body and facial hair,
• A sonogram to examine your ovaries for cysts; 12 or more cysts is an indicator
• Measuring your body mass index (BMI)

Blood tests are also used to evaluate a number of markers, including:

• Aandrogen hormone levels
• Cholesterol
• Blood sugar levels and insulin resistance 

Additionally, blood tests are used to rule out other issues with similar symptoms, such as thyroid disease.

Holistic approaches for managing PCOS 

Dr Amersi treats PCOS holistically, using a combination of supplements, lifestyle changes, and prescriptions. PCOS cannot be cured, but Dr. Amersi enables patients to manage its symptoms and resume a fulfilling quality of life and wellness with her multi-prong approach.

Treatment may include a combination of the following:

Weight-loss plans

Being overweight can play a role in PCOS. Research shows exercise positively affects PCOS, helping patients manage their weight and lower body fat.

This helps reduce the concentration of male hormones in the blood. Fitness strategies include cardiovascular fitness, resistance training, and strength-building activities like yoga.

In addition, because many patients with PCOS have insulin resistance, improving your diet can help you manage this symptom and lose excess weight. Try dietary changes like eating a fiber- and plant-based diet and avoiding gluten, saturated fats, full-fat dairy, and processed foods.  

For patients needing additional help managing their weight, our practice provides a comprehensive plan, including diet supplements, dietary consultation, and, in some cases, medications like semaglutide.  

Medications or supplements

Other medications and holistic supplements may help improve your PCOS symptoms. Here’s a look at some of the most common and what they’re used to treat:

Metformin

Metformin is a medication that helps lower insulin levels and decreases male hormones. Researchers have found that for women with PCOS struggling with infertility, the medication also helps encourage ovulation and promotes more regular periods—even in patients who don’t have diabetes. 

Progesterone 

Women who ovulate produce this hormone during the later part of their menstrual cycle. Studies show women with PCOS with irregular periods show signs of progesterone resistance, causing hormonal imbalance. Supplementing progesterone can help restore this balance and ease symptoms.

Spironolactone

The high androgen hormones that come with PCOS can trigger excessive body hair. Dr. Amersi may recommend spironolactone, which blocks androgen receptors, including those in hair follicles. This stops testosterone from binding and triggering hair growth. 

Berberine

Berberine is a supplement extracted from an herb, and recent research has found it helpful in managing some of the symptoms of PCOS. It helps with weight loss, increasing insulin sensitivity, and improving fertility. 

Inositol

Inositol, or vitamin B8, is a type of sugar in your body. When used as a supplement, it’s often referred to as myo-inositol. 

Researchers have found that this chemical may affect insulin by helping improve blood sugar levels. For women with PCOS, it can also help promote ovulation, improving infertility and irregular periods.  

N-acetyl cysteine (NAC)

Recent research shows this essential amino acid has been shown to help improve insulin response and increase fertility in women with PCOS. It may also help reduce androgens in women, further improving PCOS symptoms. 

Vitamin D

Low levels of vitamin D have been linked to PCOS and infertility issues. At the same time, research shows improving vitamin D levels is related to better insulin sensitivity and lower levels of male hormones in women. 

Hormone replacement therapy

For women with PCOS who aren’t seeking to become pregnant, Dr. Amersi may recommend safe and effective bioidentical hormone replacement (BHRT). This can be especially helpful for women with PCOS who are also going through perimenopause. 

FDA-approved BHRT uses hormones made from natural plant compounds, such as wild yams, that have the same chemical structure as natural female hormones, making them easier to tolerate and very effective. 

Visit Dr. Amersi, the country's leading expert in PCOS

For help with PCOS, schedule an appointment online or over the phone with Dr. Shamsah Amersi in Santa Monica, California.