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Hidden fertility disorder can lead to diabetes

Women with facial hair, unexplained weight gain and irregular periods may have more than cosmetic or fertility problems but a serious disorder that can eventually lead to diabetes and even heart attacks.
/ Source: The Associated Press

Women with facial hair, unexplained weight gain and irregular periods may have more than cosmetic or fertility problems but a serious disorder that can eventually lead to diabetes and even heart attacks.

Too few doctors connect the disparate symptoms — or even know about the heart link — say specialists issuing a new call for aggressive diagnosis and care of the more than 6 million young women thought to have “polycystic ovary syndrome,” or PCOS.

Even the name is somewhat misleading. You don’t have to have cysts on your ovaries to have PCOS. And although best characterized by leaving women with too many of the male sex hormones, called androgens, it affects far more than reproduction.

While women usually don’t get heart disease until after menopause, some striking studies show PCOS patients’ arteries already are significantly hardening in their 30s, more so even than obese women’s. Not to mention a risk of Type 2 diabetes that’s three to seven times higher than average.

“All of the evidence was piling up that these women were at risk and we were not doing enough,” says Dr. Robin Cobin, past president of the American Association of Clinical Endocrinologists. “I’ve had so many patients say to me, 'I was sent to you because I have hair on my face,' and they already had diabetes.”

New recommendations
So last week, the endocrinology group issued new recommendations on how to spot the disorder early and prevent its dire consequences.

The AACE campaign is aimed at educating dermatologists, gynecologists and other doctors who frequently just treat a symptom at a time — and patients, too, so they’ll know to ask if symptoms are related.

“I never connected the dots,” says Christine DeZarn, 40, of Castle Rock, Colo.

She saw a fertility specialist to try to get pregnant, a dermatologist to zap away chin hair and treat severe acne — and puzzled over why she gained 70 pounds one year without a diet or exercise change. After six years of symptoms, she stumbled across PCOS on the Internet and sought diagnosis.

PCOS has long been recognized as a leading cause of infertility and a risk factor for uterine cancer, because of the hormone imbalance. But only fairly recently have the links to diabetes and heart disease emerged.

Watch for key symptoms
Ask a doctor about PCOS if you have two or more of the following symptoms, the AACE campaign advises: infertility, severe acne, excess face or body hair, male-like balding, irregular periods, ovarian cysts, high blood pressure, weight problems, or elevated insulin levels — a condition called insulin resistance or pre-diabetes.

Don’t expect to have all the symptoms. Skinny women can get PCOS. So can women who’ve had children. The variety and unpredictability complicate diagnosis.

“Myths are rampant,” says DeZarn, who founded the Polycystic Ovarian Syndrome Association and recalls patients told they couldn’t have PCOS because they lacked classic symptoms.

Diagnosis requires blood tests to check numerous hormone levels.

If you have PCOS, AACE recommends:

  • Get checked for diabetes by age 30, and regularly thereafter. Most PCOS patients have insulin resistance, and early treatment can prevent worsening that causes full-blown diabetes and kidney, eye, nerve and heart damage, Cobin says.
  • Get regular checks for, and aggressive treatment of, high blood pressure and bad cholesterol.
  • Diet and exercise are crucial. Patients also should be considered for treatment with a diabetes medicine called metformin, especially if they’re overweight. It seems to reduce excess androgens and improve menstrual regularity and ovulation.

However, metformin comes with side effects, some serious, that limit its use. So newer diabetes drugs, such as Avandia and Actos, are being studied as alternatives.

  • Certain birth-control pills and androgen blockers such as the drug spironolactone are options for skin and hair symptoms.