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Polycystic Ovary Syndrome

Polycystic Ovary Syndrome (PCOS) Skin Manifestation and Therapy

What is Polycystic Ovary Syndrome (PCOS)?

Polycystic Ovary Syndrome (PCOS) is a health problem that can affect 7-15% of woman, and affects:

  • Menstrual cycle
  • Ability to have children
  • Hormones-Diabetes, increased Androgens
  • Heart
  • Blood vessels

Appearance with a redistribution increased central weight gain, acne, increased alopecia or loss of scalp hair and increased facial hair, severe scaling of the scalp, cyst in the axillae, groin and under the breast, increased thickening and pigment in axillae, neck and other skin folds.
With PCOS, women typically have:

  • High levels of androgens. These are sometimes called male hormones, though females also make them.
  • Missed or irregular periods (monthly bleeding)
  • Many small cysts in their ovaries

What causes PCOS?

The cause of PCOS including genetics, and environmental. Women with PCOS are more likely to have a mother or sister with PCOS.

A main underlying problem with PCOS is a hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. Androgens are male hormones that females also make. High levels of these hormones 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 women with PCOS have too much insulin in their bodies because they have problems using it. Excess insulin appears to increase production of androgen. High androgen levels can lead to:

  • Acne-that may be cystic with scarring in a hormonal pattern
  • Increased hair loss on scale in a pattern distribution
  • Excessive hair growth in classically male areas
  • Cysts and sinuses in axillae, groin, under breast
  • Increase scalp oiliness and dandruff
  • Increased skin pigmentation in the axillae and neck with skin thickening
  • Weight gain-central
  • Problems with ovulation

What are the symptoms of PCOS?

The symptoms of PCOS can vary from woman to woman. Some of the symptoms of PCOS include:

  • Infertility (not able to get pregnant) because of not ovulating. In fact, PCOS is the most common cause of female infertility.
  • Infrequent, absent, and/or irregular menstrual periods
  • Cysts on the ovaries
  • Weight gain or obesity, usually with extra weight around the waist
  • Pelvic pain
  • Anxiety or depression
  • Sleep apnea — when breathing stops for short periods of time while asleep
  • Cutaneous manifestation
  • Acne, oily skin, or dandruff
  • Male-pattern baldness or thinning hair
  • Hirsutism — increased hair growth on the face, chest, stomach, back, thumbs, or toes
  • Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black
  • Skin tags — excess flaps of skin in the armpits or neck area

Does PCOS put women at risk for other health problems?

Women with PCOS have greater chances of developing several serious health conditions, including life-threatening diseases. Recent studies found that:

  • More than 50 percent of women with PCOS will have diabetes or pre-diabetes (impaired glucose tolerance) before the age of 40.
  • The risk of heart attack is 4 to 7 times higher in women with PCOS than women of the same age without PCOS.
  • Women with PCOS are at greater risk of having high blood pressure.
  • Women with PCOS have high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol.
  • Women with PCOS can develop sleep apnea. This is when breathing stops for short periods of time during sleep.

Women with PCOS may also develop anxiety and depression. It is important to talk to your doctor about treatment for these mental health conditions.

Women with PCOS are also at risk for endometrial cancer. Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Progesterone causes the endometrium (lining of the womb) to shed each month as a menstrual period. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia, when the lining grows too much, and cancer.

I have PCOS. What can I do to prevent complications?

If you have PCOS, get your symptoms under control at an earlier age to help reduce your chances of having complications like diabetes and heart disease. Talk to your doctor about treating all your symptoms, rather than focusing on just one aspect of your PCOS, such as problems getting pregnant. Also, talk to your doctor about getting tested for diabetes regularly. Other steps you can take to lower your chances of health problems include:

  • Eating right

Lifestyle modification. Many women with PCOS are overweight or obese, which can cause health problems. You can help manage your PCOS by eating healthy and exercising to keep your weight at a healthy level. Healthy eating tips include:

  • Limiting processed foods and foods with added sugars
  • Adding more whole-grain products, fruits, vegetables, and lean meats to your diet

This helps to lower blood glucose (sugar) levels, improve the body’s use of insulin, and normalize hormone levels in your body. Even a 10 percent loss in body weight can restore a normal period and make your cycle more regular.

  • Exercising
  • Not smoking

How is PCOS treated?

Because there is no cure for PCOS, it needs to be managed to prevent problems. Treatment goals are based on your signs and symptoms, whether or not you want to become pregnant, and lowering your chances of getting heart disease and diabetes. Many women will need a combination of treatments to meet these goals. Some treatments for PCOS include:

Birth control pills. For women who don’t want to get pregnant, birth control pills can (some BCPs may be more helpful than others, but may also have increased risk for thrombosis that needs to be evaluated for):

    • Control menstrual cycles
    • Reduce male hormone levels
    • Help to clear acne

Taking a pill that only has progesterone, like Provera, to control the menstrual cycle and reduce the risk of endometrial cancer will not help acne or increased facial hair.

Diabetes medications. The medicine metformin (Glucophage) is used to treat type 2 diabetes. It has also been found to help with PCOS symptoms. Metformin affects the way insulin controls blood glucose (sugar) and lowers testosterone production. It slows the growth of abnormal hair and, after a few months of use, may help ovulation to return. Recent research has shown metformin to have other positive effects, such as decreased body mass and improved cholesterol levels. Metformin will not cause a person to become diabetic.

Medicine for increased decreased scalp hair and increased facila hair growth due to extra male hormones. Medicines called anti-androgens may reduce hair growth and clear acne. Spironolactone, first used to treat high blood pressure, has been shown to reduce the impact of male hormones on hair growth in women and may be used topically as well as systemically.

Some other shampoos, topical prescription and over the counter medications, vitamins and supplements and forms of electromagnetic radiation therapy may also be helpful and may be recommended by your Dermatologist.

Other options for increased facial hair include:

      • Vaniqa (van-ik-uh) cream to reduce facial hair
      • Laser hair removal or electrolysis

Your Dermatologist may also suggest specific topical and systemic therapies for other cutaneous manifestation of PCOS, and some systemic therapies that control other manifestations of metabolic syndrome may be helpful in lessening the clinical manifestations including skin manifestation in patients with PCOS.

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