Nathan Bertoldo, MD, a local obstetrician-gynecologist, treats hundreds of women every year who deal with polycystic ovary syndrome (PCOS), a hormonal disorder common in women of childbearing age. In this Q&A, Dr. Bertoldo answers some questions about the common effects of PCOS and the treatments he has found effective in helping his patients reduce the severity of the disease.

QUESTION: WHAT IS PCOS?

PCOS occurs when an ovary is overactive in producing follicles. The more follicles that are produced or are active, the more hormones are secreted, and reproductive hormones get out of balance. This can lead to irregular periods, infertility, and weight gain/pre-diabetes, among other symptoms. 

QUESTION: HOW COMMON IS PCOS?

It is quoted at 10% of the population, but is likely more common than that. About 30% of the patients I see have some degree of PCOS.

PCOS is not the same for everyone. Some patients may have abnormal hair growth, some may have insulin resistance, and others may have irregular periods. It can be different for every patient. Women with PCOS may be at higher risk for diabetes, heart disease, sleep apnea, and uterine cancer.

QUESTION: IS PCOS TREATABLE?

Yes. Most OB/GYNs will treat PCOS by balancing the hormones with a birth control pill. Estrogen and progesterone hormones can reduce the symptoms of PCOS. Other medications are also sometimes used to block the testosterone side of the hormones to manage symptoms like acne, male pattern hair growth, or even hair loss. 

Many patients tolerate birth control pills fine, but some experience symptoms that are undesirable. In those cases, we come back and talk to patients about underlying factors increasing their symptoms. They may have a genetic predisposition to diabetes that adds to it and aren’t ovulating because their blood glucose or insulin growth factors are too high, or they may have had a pregnancy and not lost the excess weight after delivery. These things can add to the severity of the symptoms of PCOS.

In my practice, I take a multifaceted approach to treating the symptoms of PCOS in order to help patients achieve their health goals. It is important to me to not only help my patients recognize what they need to do for their overall well-being, but also help learn how to achieve those goals. 

QUESTION: WHAT LIFESTYLE CHANGES CAN BE MADE TO TREAT PCOS?

I have patients who are dealing with PCOS infertility, whether it is initial infertility or subsequent infertility after a pregnancy, and their weight gain is the big issue. When they can lower their overall weight, their symptoms of PCOS and fertility often improve. I frequently see patients lose 5% of their overall bodyweight, whatever that is, and their cycles start to regulate again. 

Because everyone’s genetics are different, excess weight can affect women’s hormones differently. Often the underlying problem surrounding of the symptoms of PCOS are not so much that a patient’s hormones need to be controlled with a pill, but that the weight side of things needs to be controlled.

Diets can be very frustrating and very hard to sustain for the long term. The program I encourage patients to use is macro-based and requires them to monitor their intake and exercise. This program will increase their energy levels and mental clarity. It is important for patients to understand that their excess weight gain didn’t happen overnight and that it will take time to get back to where they want to be.

After patients establish a pattern of healthy eating and exercise for about a month, we meet again. I do some testing to look at vitamins, minerals, and lipids that have an impact on weight loss to make a plan for supplementation that will help them improve the results of their efforts. 

I encourage my patients to put the scale away and not make weighing themselves part of their daily routine. The scale may not move right away, but as they implement the regimen, they will find success. It is important for patients to find and remember what their motivation is throughout the process. 

For more information about PCOS, weight loss, infertility, and how it may be affecting your overall well-being, contact Dr. Bertoldo at his new office by calling 435-557-0608.