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Nearly every episode of "This Is Us" has fans reaching for tissues, but last night's season premiere was particularly sad for Kate Pearson (Chrissy Metz).
After suffering a miscarriage at the end of last season, Kate and her now husband Toby (Chris Sullivan) visited a fertility specialist who delivered heartbreaking news: Kate has polycystic ovarian syndrome, or PCOS, which combined with her weight, could be contributing to her fertility issues.
Like many women, Kate had no idea she had PCOS. Though the condition is relatively common, many women can go years before receiving a correct diagnosis. For that reason, estimates of the number of women who suffer from PCOS aren’t exact, Dr. Anuja Dokras, director of the Penn PCOS Center at the University of Pennsylvania in Philadephia and president of the Androgen Excess and PCOS Society told TODAY in a previous interview. It may be anywhere from 1 in 10 to 2 in 10.
The condition can disrupt a woman’s hormones, menstrual cycles and weight. There isn’t a single test to screen for PCOS, like the fasting glucose test for diabetes.
PCOS Symptoms and PCOS diagnosis
PCOS is a sort of “umbrella term,” explained Dr. Meredith Snook an endocrine and fertility specialist the Magee-Womens Hospital at the University of Pittsburgh Medical Center. Women are said to have PCOS if they have two out of the following three symptoms:
Irregular periods or no menses at all.
Clinical evidence of high levels of male hormones, which can lead to increased acne and hair growth in places such as the chin, the upper lip and the sideburns. Blood tests can reveal high testosterone levels even when hair growth appears to be normal and acne isn’t present.
A large number of bumps on the ovaries seen on ultrasound. The little bumps are actually follicles that contain eggs, Snook says, adding that the name of the syndrome is a bit misleading since there aren’t any cysts involved. Women normally produce a large number of follicles at the beginning of their menstrual cycles As the cycle progresses, one or two keep growing, while the others die down. That doesn’t happen in women with PCOS. The follicles don’t sort themselves out. They all remain about half an inch tall.
According to The American College of Obstetricians and Gynecologists (ACOG), up to 80 percent of women with PCOS are obese, and the condition is one of the most common causes of female infertility.
These issues can lead to a host of other health problems.
Irregular menstrual cycles and follicles that don’t grow, mature and spew out an egg, can lead to infertility.
When periods are missed and the lining of the uterus doesn’t have a chance to shed, the lining can get thicker and thicker which can lead to an increased risk of abnormal cells in the uterus.
The syndrome also puts women at a greater risk for metabolic syndrome, which leads to increases in belly fat, cholesterol levels and blood pressure.
Currently no one knows exactly what is at the root of PCOS, but it’s suspected that some women inherit a predisposition to developing it, Dokras said. She suspects that there are multiple genes involved, including ones in the brain that send chemical messages to the ovaries to produce more testosterone than is normal and ones in the ovaries that make them more sensitive to the messages from the brain.
There’s also a suspicion that weight plays a role in exacerbating the syndrome, Dokras said, with the caveat that there are women with PCOS who are not overweight.
Therapies for PCOS focus on symptom control.
The most simple treatment is birth control pills, which can fix many of the issues related to PCOS. Oral contraceptives can help regulate irregular periods and clear up acne by knocking back testosterone levels. While the pill may also help with hair growth in unwanted areas, sometimes electrolysis is recommended if the problem is severe.
Women who want to get pregnant may be prescribed a medication that helps follicles to mature.
“Clomid helps one or two of the follicles to become dominant and once that happens, most will ovulate on their own,” Snook explained. The good news: The abundance of follicles shows that the woman has a lot of eggs, Dokras said.
If the woman is overweight or obese, weight loss can sometimes ease symptoms.
If you think you may have PCOS, talk to your doctor. Getting diagnosed is the first step.