Do You Have PCOS?

Polycystic Ovarian Syndrome (PCOS) affects millions of women in the United States and causes a variety of fertility, hormone, skin, and ovarian problems.  In January 2013, a panel based on the Evidence Based Methodology Workshop at the National Institutes of Health suggested renaming and redefining the diagnostic criteria as they reported that PCOS should be determine by having 2 out of 3 criteria: excess androgens, ovulatory issues and multiple cysts in the ovaries.  This eliminates the requirement for ovarian cysts in absolute diagnosis as many people currently believe.

Typical symptoms of PCOS include: acne, excessive hair growth in places women typically do not want it, missed periods or irregular periods, not ovulating, weight gain especially around the middle, blood sugar and insulin problems, fertility problems, and ovarian cysts.  Androgens are a group of hormones such as DHEA, testosterone, androstenedione, and dihydrotestosterone that cause the skin and hair complaints.  Testing for PCOS can be difficult and as it is very multi-factorial .  First, evaluating for symptoms is important. Next, testing for androgens and looking for elevated levels.  Evaluating the menstrual cycle history looking to see if it is regular (roughly every 26 to 32 days) and if she ovulations. Testing for fasting blood sugar and insulin levels may indicate further consequences.  An ultrasound will visualize cysts on the ovary and discussing fertility challenges are important.

One of the issues the panel discussed was the difficulty in diagnosis as women will see different doctors or specialists for different issues.  A woman having trouble conceiving may see a fertility specialist while the woman with no menstrual cycle visits her gynecologist.  Acne and hair growth around the upper lip, chin, neck, nipples and abdomen may be evaluated by a dermatologist or aesthetician. If all symptoms are not accounted for, PCOS may be missed.  Also, women and their doctors may rule PCOS out if the ultrasound does not show multiple cysts on the ovaries yet she still has all the other symptoms.

Treatment for PCOS is important as long term sequelae can include diabetes mellitus, high blood pressure, high cholesterol, obesity, and a higher risk for cancer.  Seeking a healthcare provider who can evaluate all the symptoms, blood work and imaging then come up with a short and long term plan addressing all aspects is critical for health.  If the symptoms of PCOS sounds like you, do not hesitate to seek help as your health is important.

References:

1.       PCOS Diagnostic Criteria Clarified; Name Must Change.  Web.  27 January, 2013.
http://www.medscape.com/viewarticle/778066
2.       Increased Risk of Type 2 Diabetes with Polycystic Ovary Syndrome.  Web.  27 January, 2013.
http://www.medscape.com/viewarticle/767811

What Is Gestational Diabetes?

The saying goes that a woman is ‘eating for two’ when she is pregnant however what she chooses to eat has a drastic impact on her risk of gestational diabetes.  There are the common cravings such as ice cream and pickles but many find themselves also reaching more for bread, crackers or comfort food and avoiding their normally healthy choices out of convenience, nausea or sudden aversion to foods they once loved.  These high carbohydrates, high sugar foods cause a considerable amount of weight gain and fill the system with glucose leading to hyperglycemia and insulin resistance.

It is well known that everything changes with pregnancy.  Anatomically, the body shifts completely to accommodate a growing fetus.  Hormones sky rocket and the brain seems to turn to mush (commonly called, mommy brain).  A pregnant woman’s endocrine system also changes as the body has to adapt to all of the shifts however if the output of insulin by the pancreas cannot keep up with the increase in carbohydrate/sugar heavy foods, she becomes diabetic.  Having gestational diabetes also increases a women’s risk for type 2 diabetes later in life and therefore should be monitored carefully both from a screening glucose/insulin  test and a lifestyle stand point.  It is also important to note that given the current increasing trend in overweight and obesity in the United States, research shows that 50-60% of women go into their pregnancy already carrying too many extra pounds on their frame further increasing the risk.

There is not one set standard for diagnosing gestational diabetes however a woman is more at risk if she has a body mass index (BMI) of 30 or more going into the pregnancy, has had gestational diabetes in a prior pregnancy, or has a strong family history of diabetes.  The most common test is the Oral Glucose Tolerance Test (OGTT) where a pregnant woman drinks a very sweet drink then waits an hour and has her glucose tested.  A normal result (depending on the lab) is under 130-140 mg/dL.  The drink is very syrupy and often can cause vomiting, in which case the test must be repeated at a later date.  Follow up testing can include the 3 hour Oral Glucose Tolerance Test where the same test is repeated however glucose levels are drawn every hour for 3 hours.  If 2 out of the 3 hours have abnormally high levels of glucose, gestational diabetes is diagnosed.

As there are considerable risks for the growing baby (heavy birth weight babies, early delivery, and shoulder dystocia) it is important that gestational diabetes be taken seriously.  Pregnancy is not the time to lose weight or go on a diet however routine glucose monitoring, changes in diet and proper exercise can make a huge difference and possibly avert the use of insulin in order to control glucose levels.  Make sure to eat a variety of vegetables, lean protein, good fats and fiber rich foods for the health of everyone involved!

To learn more, read about the women's health website, Empowher, here!

References:

11) Mild Gestational Diabetes.  Web.  20 January, 2013.

http://www.medscape.com/viewarticle/775396

22)  Gestational Diabetes. Web.  20 January, 2013.

http://www.mayoclinic.com/health/gestational-diabetes/DS00316

33) The Relative Contribution of Prepregnancy Overweight and Obesity, Gestational Weight Gain, and IADPSG-Defined Gestational Diabetes Mellitus to Fetal Overgrowth.  Web.  20 January, 2013.

http://www.medscape.com/viewarticle/777162

5 Important Exams for the New Year!

Welcome to the New Year! Making and keeping a resolution can be daunting as unfortunately, many fail within the first few weeks of January because old habits are hard to break.  This year, choose a resolution that is easily attainable and also important for your health by reviewing important examinations.  In fact, some of these suggestions you may have already done and can easily check off your ‘to-do’ list.

1.       Are you due for a physical exam?  Do you need a pap smear?  Do you need a breast exam? Thankfully this can often be achieved in the same visit as your health care provider can check you out from head-to-toe, and collect cells to screen you for cervical cancer.  Insurance companies are changing and often allow a full well-woman exam without having to meet the deductible.  Depending on your health status, you may not need a pap every year but a physical is a good idea to touch base with your provider.

2.       Are you due for your mammogram?  Current guidelines suggest women start with a screening mammogram every other year starting at 40 years old, then yearly at 50 years old.  This may change depending on personal or family history. 

3.       Are you due for your colonoscopy?  This important test evaluates the health of your colon and screens for colon cancer.  Typically, men and women should have their initial screening at 50 years old however certain gastrointestinal symptoms such as abdominal pain, blood or mucus in the stool, black stools, inflammatory bowel disease  or ongoing irritable bowel type symptoms may require a screening at an earlier age.  Those with a family history of colon cancer often start at an earlier age as well.

4.       Have you seen your dentist in the last 6 months?  Routine dental examinations are important not only for teeth and gum health, but also the health of the entire body such as reducing the risk of heart disease and stroke.  The dentist can be a scary place for a lot of adults however it is important to remember that you probably look better and feel healthier with your teeth than without.

5.       Have you had an eye exam?  Not only can an eye doctor assess for vision changes, put they can also evaluate the blood vessels, glaucoma, cataracts, cholesterol deposits, diabetes damage, and for potential tumors.

Some of these exams may have you quickly making an appointment while others may be too early for you depending on your age and symptoms.  If you are unsure, talk with your health care provider about which ones would be most appropriate for your health.  Start out the 2013 on the right foot and focus on staying healthy.

 

Read more on the women's health website, www.Empowher.com

References:

1.        National Cancer Institute: Mammograms. Web. 6 January, 2013.

http://www.cancer.gov/cancertopics/factsheet/Detection/mammograms

2.       National Cancer Institute:  Test to Detect Colorectal Cancer and Polyps.  Web.  6 January 2013.

http://www.cancer.gov/cancertopics/factsheet/Detection/colorectal-screening

3.       Dental Screenings Linked to Lower Heart Disease, Stroke Risk.  Web.  6 January, 2013.

http://abcnews.go.com/Health/dental-screenings-linked-lower-heart-disease-stroke-risk/story?id=14936485