August 16, 2010 • 27 mins
Polycystic ovary syndrome is a metabolic disorder that creates hormone imbalances in women's bodies. Molly and Cristen discuss PCOS research, definitions, symptoms and treatment -- and why it's so hard to get a correct diagnosis -- in this episode.
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Speaker 1 (00:00):
Brought to you by the reinvented two thousand twelve Camray.
It's ready. Are you welcome to stop? Mom never told you?
From how Stuff Works dot Com, Hey, welcome the podcast.
This is Molly and I'm Kristen Christon's day. We're going
(00:20):
to discuss polycystic ovary syndrome. And this has been a
red class sort of almost from the beginning of the
time we started the podcast. But I'm kind of glad
you waited, if only because all of the elements that
go in to polycystic overary syndrome or p COST as
we'll be calling it, reflect on things we've already talked about,
for example, women and their insecurity or security over hair
(00:45):
embody hair, uh security and insecurity about menstruation, how difficult
that is to talk about acne, in fertility, like everything
that we've ever mentioned about things that are hard to
accept or to get just right in this society about
being a woman, they come into play in this condition.
(01:07):
So I'm kind of gladuated because we when we talked
then about how hard it is to like have you know,
certain you know conditions, it will reflect back on the
difficulty we've discussed before. I think You're exactly right, and uh,
picos has actually been around for a while, even though
it sounds like from the research, Molly that you and
I've done, it's really only come into the forefront of
(01:31):
women's medicine in the past uh ten or so years UM.
It was initially discovered or identified, if you will, around
seventy years ago UM, and it used to be called
stein Levinthal syndrome after the two doctors who discovered it
in ninety five. And it affects as many as ten
(01:52):
percent of women, but it goes largely unrecognized for reasons
that we'll get into later in this podcast. Because rather
than having one single symptom, one identifiable symptom like an
irregular period or trouble getting pregnant, it is a host
of symptoms and researchers aren't even sure exactly why picos
(02:16):
happens in the first place. They have some ideas, but
they're not really sure, and it can be pretty challenging
to identify what The good thing is that more doctors
are starting to pay attention to it, look for these
symptoms and get women the treatment that they need because picos,
as Molly, you and I've have, really discovered through our research.
(02:36):
Is not a pleasant syndrome. I would say it's downright
awful because it sounds pretty awful. Let's go over the symptoms,
because I think that will demonstrate to listeners just what
we're dealing with here in terms of stigma and in
terms of difficulty just living your life. UM. As the
name implies, something's going on with your ovaries. You have
(02:57):
these tiny bubble cysts on your ovary and they're the
result of eggs that didn't quite descend to become a
menstrual period and they just kind of sit there on
your ovaries. And as that implies, you have a regular
menstruation and UM, this is classified as a metabolic disorder
(03:19):
UM due to abnormal hormone levels UM and it's the
hormones are f s H and l H, which are
created by your pituitary gland that really control your menstrual cycle,
and this imbalance can lead to a host of symptoms
including infertility, obesity, acne, excessive facial hair and body hair, diabetes,
(03:43):
heart disease, and uterine cancer. Yes, so these hormones that
Kristen mentioned, follicle stimulating hormone f s H and LH
lutenizing hormone. If everything's working correctly, they're the ones that
are gonna say, hey, ovaries, you need to release an
egg and if that expertilize and you can have a baby.
And if it's not, then there'll be a menstrual period.
(04:03):
So when these hormones are out of whack, then you
don't have the period and that will affect UH fertility
down the line. Right, and LH and FSH also regulate
the ovaries production of estrogen, progesterone, and testosterone, and so
all of the it starts this ripple effect where all
(04:23):
of these different hormones are out of balance and produce
this wide range can produces wide range of really uncomfortable symptoms. Right,
because the blood levels of testosterone are what can cause
dark corse facial hair UH baldness. There might be a
patches of dark skin around the neck and the chest.
(04:46):
And then complicating all of this, we've got a problem
with insulin because insulince primary task is to maintain your
blood level glucose, and it moves the sugar, helps you
digest carbohydrates UH the best ways that it makes it
into energy. But insulin also deals with storage of fats
so if you've got really high levels of insulin, then
(05:08):
you might gain weight even if you're eating healthfully, and
you might have a lot of trouble losing weights. So
one of the big symptoms of peacos is obesity. Half
of women with peacos at least have OBEs. And it's
not like a gradual thing, you know, reading some of
these accounts, it's like over six weeks when WU put
on fifty pounds. It's it's a really sudden change in
(05:30):
your insulin production and levels that can uh, you know,
just take you on a weight roller coaster, right, And
when the pancreas starts to overproduce insulin to such extremes
like this, it can also lead to type two diabetes.
So as you can see, there's like this chain reaction
of of symptoms all relating back to these hormone imbalances.
(05:56):
And we should point out that not every woman with
pecos will it at the same types of symptoms were
kind of painting the worst case scenario. But nevertheless, it's
not a fun thing to happen. I mean, if you
think about just one of them, it's one of those
symptoms is enough to cripple your life. You know, you
wouldn't want to go outside if you've got facial hair
(06:17):
thanks to the testosterone. Acne is already a big struggle
even without the stress of having a regular periods. You know,
as I said, all these things we've talked about in
the past being difficult for women, and for adolescent women
in particular, they're all compounded and put into this one syndrome.
And I think that that is why it's really hard
to get a diagnosis, because who wants to go to
(06:39):
their doctor and say, hey, what's the deal with the
facial hair, what's the deal with the fact that I'm
not having regular periods? Because I think that some of
these symptoms you have the tendency to dismiss, especially when
you're young girl. People tell you it'll take a while
to get your periods on a regular track. They tell
you that acne is due to stress and it's a
normal part of growing up. So there are some of
(07:01):
these symptoms are thought to be so, you know, part
of a rite of passage, whereas the other ones are
so scary and out of the norm that when you
put them all together, it's very uh, very difficult for
a woman to a come to their doctor and then
be for the doctor to figure out what's going on, right,
because also some of these symptoms can also apply to
(07:22):
other serious disorders like tumors or you know, the doctor
might spot the sudden spike and weight and also dark
overgrown skin at the base of your neck which is
a sign of an insulin problem and say that you
might have diabetes and completely bypass the picos issue. And
Molly and I found an article from Science Stanley that
(07:46):
was really highlighting the work of um one kinnecologist who's
trying to get Pico's research out into the forefront more.
And she said that a lot of times women will
have to go to an average of four doctors before
they're correctly diagnosed. And this is happening to about five
million women in the US who are affected by pekos. Yes,
(08:08):
so these women go to doctors and are told, oh,
this is just a weight problem, or that this is
just an acne problem. And then to add fuel to fire,
this researcher Andrew D. Knife who's at Northwestern says that
because the condition has ovary in the name, you know,
it's sort of relegated to this back burner of you know,
female troubles women's issues. You know, it's hard to confront
(08:31):
problems with menstrual cycles straight on, just because you know,
one's talking about it, as we discussed in the Menstruation
Taboo episode. So she wants to get peakos renamed. She
likes the name syndrome x X. I don't love that name,
but split hairs, Yeah, yeah, said, it's gravity er, you know,
than pekos, and you know, pecos is kind of a mouthful.
(08:52):
But one of the main problems too with this diagnosis
is that physicians aren't sure whether or not it's caused
by environmental or genetic factors, because there's there's sort of
two different camps on this uh, one camp thinking that
it might have to do with the defect within the
ovary or if it's due to the abnormal insulin activity.
(09:16):
And there's even um a split between American and European
definitions of picos and the different um symptomatic criteria they
have for diagnosing this, which I was kind of fascinated
by because not only is there just sort of this
kind of knowledge based divide, but also just a straight
(09:37):
up geographical divide and what actually is and is not
considered picos, I know, and you know, this goes back
to the name polycystic ovary syndrome. You know, not all
women who have other symptoms even have the cysts on
their ovaries, and that kind of leads us well into
this discussion of you know, the very definition is is
(09:58):
skewed depending on where you are. Basically what happened is
in ninety there's this big being in the United States
and the National Institute Tutes of Health established the criteria
of what they thought peak host was. Then, uh, you know,
in two thousand three, these positions in Europe got together
and they were like these you know that that criteria
is really doing it for us. We're gonna issue our
(10:19):
own criteria. And so now there's the two thousand three
Rotter Damn criteria is how you'll here referred to, and
the and I AH criteria. And because you know one
was sort of a European thing, a wast a u
S thing, you know, the the definition that might be
used will really depend on where you are. And uh,
let's go over the criteria to be uh nine and
(10:41):
I aged criteria to be a diagnosed with peak hosts,
then you would have hyper hyper androgenism, which refers to
the levels of hormones. They're gonna find your bloodstream a regular,
a regular ovulation and menstruation and exclusion of related disorders.
So if they can rule out, you know, the diabetes
or um just other problems with your menstrual cycle. So
(11:03):
that's that's one thing. But the Rotterdam people came in
and said, Okay, yeah, we're gonna go with that irregular
ovulation or no ovulation at all. We're gonna go with
the biochemical clinical signs of the hyperandrogenism. So the things
like the facial hair, the acne, the dark the dark
patches of skin, and we're gonna include the polycystic ovaries.
But you only have to have two of those three, right,
(11:25):
So the Rotterdam essentially Rotterdamn criteria essentially opened up the
criteria for peaks because they thought that the NIH definition
would just be a little too a little too narrow,
and so under Rotterdamn criteria, a lot more women have
peak hosts, but they might have more minor cases of
it because you don't have to meet as many of
(11:45):
the clinical criteria. But you know, there's also this problem
of polycystic overies is one of the elements of Rotterdamn criteria.
And if you're going to let's say an indo chronologists,
they may not do the ultrasound that finds that. So
it kind of gets thin into which doctor are you seeing.
You know, Kristen mentioned you have to see four doctors
(12:07):
and they may not all be within the same field
of gynecology or you know, if you have the acting,
you might have started with a dermatologist. Um, not all
of them are going to be equipped to find the
polycystic ovaries right away, and if they're not causing you pain. Uh,
And if you just start thinking that, oh, I have
a regular period because people say that's normal, you may
not have figured out that that's one of your symptoms yet.
(12:29):
So it's it really does come down to which doctor
you see and which criteria they're using, and whether they're
equipped to figure out something like polycystic overies with an
ultrasound or a with the exam. So let's say that
a woman is experiencing these types of symptoms and she
is diagnosed with picos um. Even though there isn't necessarily
(12:52):
a cure if you will for picos there are treatments
that have been proven to reduce these symptoms and a
lot of times a doctor and this is coming from
a really good overview article from the New York Times. UM,
a lot of times women will be tested for blood
levels of prolactin, for LH and F s H, progesterone, testosterone,
(13:14):
all of those different hormones, insulin, her ability to process blood,
glue close glucose excuse me, UM, all of those different
chemicals that are regulating these different types of symptoms. And
while treatments are going to be very just like the
types of symptoms that women are experiencing. So let's say
(13:34):
that you are a woman experiencing some are all of
these symptoms, You go to your doctor, your doctor diagnoses
you with pekos. What happens next, Um, there is a
pretty common treatment for it, which I was surprised UH
is birth control. A lot of times they will put
you on UH oral contraceptive in particular that contain quote
(13:59):
low and genic progestins like ortho tricycline or ortho cycling
excuse me, an ovulan, and these are gonna regulate your
menstrual cycle, suppress your follicle, stimulating hormone and lutinizing hormone release.
Which were those two hormones that we we mentioned right
at the beginning of the podcast that really seemed to
(14:20):
regulate all of these UH that chain reaction of negative
symptoms throughout your body. They're also going to lower the
testosterone level, which is going to help with symptoms like
your acne, excessive hair growth and all of that. And
then it's also going to raise level of protective cholesterol
and protect the uterine lining. And the uterine lining is
important because that's what builds up during your menstrual cycle
(14:43):
UH to receive a fertilized egg, and if the egg
doesn't drop down, then you shed it during menstruation. And
so oral contraceptives have been shown to be helpful. And
I should note that this information is coming from a
great overview article that we found from the New York Times, right,
And so let's really quick talk about for women who
(15:04):
are trying to get pregnant. Lee peaks is a really
big issue, and like Christen said, it protects that uterine
lining and makes it easier for a woman to get pregnant.
And um, so if a woman is trying to become pregnant,
they will have women take the pill and then try
to get pregnant immediately after she stops the pill, because
if if if it goes on too long, then those
(15:24):
hormone levels get back out of whack. And UH. They
also use the ovulation simulian drug Clomad when the woman
is trying to get pregnant, and it's uh it's sometimes
called the gold standard in terms of infertility because of
the way it does stimulate simulate the follical growth and
the ovulation. But I think it's important to note that
even though, but I think it's important to note that
(15:47):
even beyond the infertility problems, you can have problems with pregnancy.
If you've had peaks, you might have early pregnancy loss,
just gestational diabetes, pregnancy induced hype blood pressure, pre acclaim
and sees. So it's a huge problem for women who
are trying to have children. UM, So that's sort of
the side side road into fertility. But I also wanted
(16:09):
to say that because of all these problems with insulin
that are related to PEAK hosts, sometimes they might prescribe
you with insulin sensitizing medications or they might just you know,
put you on regular exercise and low carb diet. You know, obviously,
if you are risker diabeteses are things that a doctor
would put you on anyway. But you know, it seems
like when it was birth control plus this insulin thing.
(16:32):
It's very a symptomatic approach to this. There is no
sort of, as Kristen said, overall cure. You're going to
be sort of treating symptom by symptom because you know,
they don't really know what's causing this. They don't know
um what exactly they're trying to go after to stop
it from happening or to stop it from progressing. It's
very much like, Okay, now we're gonna deal with the
regular menstrual cycle cycles. Now we'll deal with the weight.
(16:55):
Now we'll deal with the act anything. But the good
news is in terms of peak hoast is, in recent
years it really has started to get a lot more
attention within the medical field. For instance, uh in two
thousand and six there was a huge medical seminar in
which a couple of doctors estimated that it affects one
(17:15):
in fifteen women worldwide, and they really called attention to
um this issue, not just in terms of it affecting
the health of women, especially like in westernized nations. I
think that when we think about, um, women's health care,
we can tend to have a very Western view of that. Okay,
I've got I'm having all these symptoms. I'm going to
go to my guy no and get on meds and
(17:37):
it's going to be totally kosher. That's not really the
case worldwide. UM. If you think about happening to one
in fifteen women, it's a major economic health burden as well, UM,
just because of the wide range of symptoms that it
can have, especially in places where this kind of medical
assistance is not going to be as available for these women.
(18:00):
So doctors have really tried to dig into finding the
root cause of pcos and there have been some studies
that Molly and I've found that are starting to get
a clearer understanding of where picos come from comes from,
its linked to obesity in particular, and genetics involved. Right,
(18:23):
Let's start with one study from two thousand nine. It
found that there was this gene that's implicated in obesity
that might be associated with susceptibility to polycystic overa syndrome
and carriers of one gene, the ft O gene. Uh,
It's not only influenced whether the person became obese, but
also whether they developed the other symptoms related to PICOS.
(18:44):
And one thing we should say is that it is
possible it's not as common for men to get PICOS
because if there is this genetic component, then uh, if
you know, if your mother or sister has it, then
you are at risk for also having this gene. So
they're trying to find out more about that. But in
two thousand ten there was another study that sort of
(19:05):
looked at how fat tissue was handled in someone who
had PICOS and it acts differently, so there's something there's
some gene. They're still trying to figure out what it
is that affects how your fat is stored, how it's
acting within the body, and how it could possibly then
trigger these problems with the pituitary gland and the hormones
related to reproduction. Researchers from the London Women's Clinic analyzed
(19:29):
six eighteen women who attended the clinic for fertility treatment
over two years okay, and they found that eighty percent
of the lesbian women who were involved in the study
had polycystic ovaries, compared to only thirty in heterosexual women.
(19:51):
Lesbian women also had higher rates of PICOS with thirty
eight percent having the syndrome compared to fourteen percent of
hetero sexual women. That suggests some kind of biological, hormonal
underlying link to sexuality, which could then possibly be linked
to genetics. So that was the study was significant just
(20:14):
because it linked for the first time so concretely that
hormonal makeup, that genetic makeup with sexual orientation. So for
those people who still argue that it's a choice that
these you know that everyone can be straight if they
want to, it's another brick in the wall that there's
a genetic reason for for sexual orientation, right, and perhaps
(20:35):
a higher incidents rated picos Not the most pleasant link
in the world, um, but a link all the same. Yeah,
and we felt like it was definitely worth highlighting. Now, finally,
we've been talking a lot about genes, but there is also,
as I mentioned a little bit earlier in the podcasts,
the idea that there could be an environmental influence to
(20:55):
picos and specifically, UM, this chemical that is containing a
lot of plastics, although it is being gradually phased out. UH,
this chemical bisphenol A or b p A. If you
don't want to give it the Grand the Grand pronouncement
that Kristen did and uh b p A amazingly. It
(21:15):
just it creates this really vicious cycle in women who
are susceptible to peak host because once you have peaks,
then you are more uh then uh b p A
has an easier time kind of steeping into your bloodstream
and causing reproductive damage. But then again, you're already having
reproductive problems. Your hormones are already out of whack, so
then b p A can kind of heighten that as well.
(21:38):
And so not only are you more susceptible to it,
you're going to have greater problems from It's just cycle
after cycle because BP has been b p A has
been shown to be an endocrine disruptor. So yeah, it's
just like throwing um, yes fuel chemical fuel on the fire.
It's true, that's my phrase today, I fuel on the fire.
(22:00):
So that is an overview of picos. Obviously, for the
women out there who are listening to this, who are
dealing with picos, it probably seems like an incredibly oversimplified
version of it because living with it day to day,
from what we've read, seems like quite a task. Um
and even getting it diagnosed in the first place can
(22:21):
behalf the battle, right, And like we said at the beginning,
I think that this podcast really encapsulates a lot of
things we've talked about. So if you've ever heard a
podcast about, you know, women's attachment to hair or why
women don't want facial hair, then just sort of magnify
it by you know, a million in terms of what
you'd be dealing with with this um condition. But I
(22:42):
would hope that what Chris and I always try and
do is just open up conversations and try and less
than stigma around some of these symptoms. So if you
are living with a lot of shame, depression, pain just
because you don't know how to approach a doctor about
any one of these problems issues within fertility, and there's
so many, so many factors associated with us, just try
(23:03):
and take the confidence to uh, just try and build
it up. It's hard to try and get medical help.
And when you have to see those four doctors in
a row, be persistent and know that you know you
know when something's wrong with your body and and you
need to fight for your diagnosis of that absolutely. So
in the meantime, if you would like to share your
(23:27):
story of Pico's story with Molly me our email addresses
mom stuff at house stuff works dot com, or share
it with all of our listeners on our Facebook page.
In the meantime, let's read a couple of those listener emails. Actually,
this one was a listener snail mail, and you can
find our snail mail address on the website how stuff
works dot com. And this is from Helena, who also
(23:50):
sent us brownies. They were delicious and muffins her but
you were the one who requested brownies in a recent
podcast Christen and Molly and I Love Baked Goods. She
took us up on it um and but she included
this email that was response to the podcast about men
and women cooking differently, and she writes, You're entirely right
in your observation that there's an underlying gendering of cooking.
(24:12):
This gendering, however evident in the public workplace, is equally
as evident in the domestic one. Let me use myself
as an example. For me, cooking is a creative process,
a stress reliever, and something I've loved since I was
a little kid. Growing up, I thought I would either
be one of two things, a writer or a cook.
But as I grew older, I realized quickly that working
in the service industry might would not offer me the
same satisfying experiences as cooking at home for family and
(24:35):
friends might. If I cooked for a profession, then I
would never really lose all passion for it, and I
never wanted to jeopardize my enthusiasm for being in the kitchen.
So she writes about how she made that decision to
you know, not not going to cooking professionally, send to
another field. But in two thousand nine, she writes, I
started a food cooking and recipe blog, and the address
(24:56):
of that is clearly delicious food blog dot com. And
Helena goes on to write, as an academic, I find
food blogging to be a wonderful source of creative writing
while also indulging in one of my favorite hobbies. And uh,
she writes about how food blogging is it a credible
community for women, which is pretty interesting and probably its
own podcast topic, and then she writes to summarize, perhaps
(25:18):
then the question is not do you men or women
cook differently? But where do you men or women cook?
And how is that different? And that very possibly the
answer to your two questions cooking at Homer as a
creative outlet allows many women to strengthen the divide between
work and home. For me and many other food bloggers,
we can have our cake and eat it too. Thank
you so much, Helena, and yeah again, many things for
(25:40):
those brownies and mohn. All right, well the closings out.
I've got an email here from Paul and this was
in relation to our podcast about pain of size. Uh,
he says, Uh. It reminded me of a saying a
girl I once knew who said men care about the
penis attached to the guy. Women care about the guy
attached to the penis. I don't know why, but I've
(26:01):
always remembered that he said. He mentioned women in their
weight several times towards the end of the podcast, so
I throught so I thought i'd throw this in. Speaking
as a guy, I can tell you that guys honestly
don't care about a girl's weight. In general, guys each
have their own types weight wise, and they generally don't
even bother dating women who aren't in the category. So
if a guys into a girl, he's into the girl
(26:23):
as she is. He doesn't care about weight at all,
And it's a totally non issue and my way, we
have gotten so many interesting responses about this penis episode
from our male listeners, and um, very few of you
guys believe that size doesn't matter. So Molly, we might
just have to have a follow up and let the
men speak in response to their anatomy that when I
(26:44):
don't share. Um, And they were the exact emails that
I was hoping to get, because I was really hoping
to uh to provoke some some thoughts and responses and
keep them coming men and women. Of course, our email
mom stuff at how stuff works dot com. Find us
on Facebook where it Stuff Monever told You, follow us
(27:05):
on Twitter. I can really just engage us in every
aspect of your life. That's what Molly and I want, uh,
And during the week read what we have to say
with words on a page. It's the Stuff Monever Told
You blog and it's at how stuff works dot com.
(27:29):
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It's ready. Are you welcome to stop? Mom never told you?
From how Stuff Works dot Com, Hey, welcome the podcast.
This is Molly and I'm Kristen Christon's day. We're going
(00:20):
to discuss polycystic ovary syndrome. And this has been a
red class sort of almost from the beginning of the
time we started the podcast. But I'm kind of glad
you waited, if only because all of the elements that
go in to polycystic overary syndrome or p COST as
we'll be calling it, reflect on things we've already talked about,
for example, women and their insecurity or security over hair
(00:45):
embody hair, uh security and insecurity about menstruation, how difficult
that is to talk about acne, in fertility, like everything
that we've ever mentioned about things that are hard to
accept or to get just right in this society about
being a woman, they come into play in this condition.
(01:07):
So I'm kind of gladuated because we when we talked
then about how hard it is to like have you know,
certain you know conditions, it will reflect back on the
difficulty we've discussed before. I think You're exactly right, and uh,
picos has actually been around for a while, even though
it sounds like from the research, Molly that you and
I've done, it's really only come into the forefront of
(01:31):
women's medicine in the past uh ten or so years UM.
It was initially discovered or identified, if you will, around
seventy years ago UM, and it used to be called
stein Levinthal syndrome after the two doctors who discovered it
in ninety five. And it affects as many as ten
(01:52):
percent of women, but it goes largely unrecognized for reasons
that we'll get into later in this podcast. Because rather
than having one single symptom, one identifiable symptom like an
irregular period or trouble getting pregnant, it is a host
of symptoms and researchers aren't even sure exactly why picos
(02:16):
happens in the first place. They have some ideas, but
they're not really sure, and it can be pretty challenging
to identify what The good thing is that more doctors
are starting to pay attention to it, look for these
symptoms and get women the treatment that they need because picos,
as Molly, you and I've have, really discovered through our research.
(02:36):
Is not a pleasant syndrome. I would say it's downright
awful because it sounds pretty awful. Let's go over the symptoms,
because I think that will demonstrate to listeners just what
we're dealing with here in terms of stigma and in
terms of difficulty just living your life. UM. As the
name implies, something's going on with your ovaries. You have
(02:57):
these tiny bubble cysts on your ovary and they're the
result of eggs that didn't quite descend to become a
menstrual period and they just kind of sit there on
your ovaries. And as that implies, you have a regular
menstruation and UM, this is classified as a metabolic disorder
(03:19):
UM due to abnormal hormone levels UM and it's the
hormones are f s H and l H, which are
created by your pituitary gland that really control your menstrual cycle,
and this imbalance can lead to a host of symptoms
including infertility, obesity, acne, excessive facial hair and body hair, diabetes,
(03:43):
heart disease, and uterine cancer. Yes, so these hormones that
Kristen mentioned, follicle stimulating hormone f s H and LH
lutenizing hormone. If everything's working correctly, they're the ones that
are gonna say, hey, ovaries, you need to release an
egg and if that expertilize and you can have a baby.
And if it's not, then there'll be a menstrual period.
(04:03):
So when these hormones are out of whack, then you
don't have the period and that will affect UH fertility
down the line. Right, and LH and FSH also regulate
the ovaries production of estrogen, progesterone, and testosterone, and so
all of the it starts this ripple effect where all
(04:23):
of these different hormones are out of balance and produce
this wide range can produces wide range of really uncomfortable symptoms. Right,
because the blood levels of testosterone are what can cause
dark corse facial hair UH baldness. There might be a
patches of dark skin around the neck and the chest.
(04:46):
And then complicating all of this, we've got a problem
with insulin because insulince primary task is to maintain your
blood level glucose, and it moves the sugar, helps you
digest carbohydrates UH the best ways that it makes it
into energy. But insulin also deals with storage of fats
so if you've got really high levels of insulin, then
(05:08):
you might gain weight even if you're eating healthfully, and
you might have a lot of trouble losing weights. So
one of the big symptoms of peacos is obesity. Half
of women with peacos at least have OBEs. And it's
not like a gradual thing, you know, reading some of
these accounts, it's like over six weeks when WU put
on fifty pounds. It's it's a really sudden change in
(05:30):
your insulin production and levels that can uh, you know,
just take you on a weight roller coaster, right, And
when the pancreas starts to overproduce insulin to such extremes
like this, it can also lead to type two diabetes.
So as you can see, there's like this chain reaction
of of symptoms all relating back to these hormone imbalances.
(05:56):
And we should point out that not every woman with
pecos will it at the same types of symptoms were
kind of painting the worst case scenario. But nevertheless, it's
not a fun thing to happen. I mean, if you
think about just one of them, it's one of those
symptoms is enough to cripple your life. You know, you
wouldn't want to go outside if you've got facial hair
(06:17):
thanks to the testosterone. Acne is already a big struggle
even without the stress of having a regular periods. You know,
as I said, all these things we've talked about in
the past being difficult for women, and for adolescent women
in particular, they're all compounded and put into this one syndrome.
And I think that that is why it's really hard
to get a diagnosis, because who wants to go to
(06:39):
their doctor and say, hey, what's the deal with the
facial hair, what's the deal with the fact that I'm
not having regular periods? Because I think that some of
these symptoms you have the tendency to dismiss, especially when
you're young girl. People tell you it'll take a while
to get your periods on a regular track. They tell
you that acne is due to stress and it's a
normal part of growing up. So there are some of
(07:01):
these symptoms are thought to be so, you know, part
of a rite of passage, whereas the other ones are
so scary and out of the norm that when you
put them all together, it's very uh, very difficult for
a woman to a come to their doctor and then
be for the doctor to figure out what's going on, right,
because also some of these symptoms can also apply to
(07:22):
other serious disorders like tumors or you know, the doctor
might spot the sudden spike and weight and also dark
overgrown skin at the base of your neck which is
a sign of an insulin problem and say that you
might have diabetes and completely bypass the picos issue. And
Molly and I found an article from Science Stanley that
(07:46):
was really highlighting the work of um one kinnecologist who's
trying to get Pico's research out into the forefront more.
And she said that a lot of times women will
have to go to an average of four doctors before
they're correctly diagnosed. And this is happening to about five
million women in the US who are affected by pekos. Yes,
(08:08):
so these women go to doctors and are told, oh,
this is just a weight problem, or that this is
just an acne problem. And then to add fuel to fire,
this researcher Andrew D. Knife who's at Northwestern says that
because the condition has ovary in the name, you know,
it's sort of relegated to this back burner of you know,
female troubles women's issues. You know, it's hard to confront
(08:31):
problems with menstrual cycles straight on, just because you know,
one's talking about it, as we discussed in the Menstruation
Taboo episode. So she wants to get peakos renamed. She
likes the name syndrome x X. I don't love that name,
but split hairs, Yeah, yeah, said, it's gravity er, you know,
than pekos, and you know, pecos is kind of a mouthful.
(08:52):
But one of the main problems too with this diagnosis
is that physicians aren't sure whether or not it's caused
by environmental or genetic factors, because there's there's sort of
two different camps on this uh, one camp thinking that
it might have to do with the defect within the
ovary or if it's due to the abnormal insulin activity.
(09:16):
And there's even um a split between American and European
definitions of picos and the different um symptomatic criteria they
have for diagnosing this, which I was kind of fascinated
by because not only is there just sort of this
kind of knowledge based divide, but also just a straight
(09:37):
up geographical divide and what actually is and is not
considered picos, I know, and you know, this goes back
to the name polycystic ovary syndrome. You know, not all
women who have other symptoms even have the cysts on
their ovaries, and that kind of leads us well into
this discussion of you know, the very definition is is
(09:58):
skewed depending on where you are. Basically what happened is
in ninety there's this big being in the United States
and the National Institute Tutes of Health established the criteria
of what they thought peak host was. Then, uh, you know,
in two thousand three, these positions in Europe got together
and they were like these you know that that criteria
is really doing it for us. We're gonna issue our
(10:19):
own criteria. And so now there's the two thousand three
Rotter Damn criteria is how you'll here referred to, and
the and I AH criteria. And because you know one
was sort of a European thing, a wast a u
S thing, you know, the the definition that might be
used will really depend on where you are. And uh,
let's go over the criteria to be uh nine and
(10:41):
I aged criteria to be a diagnosed with peak hosts,
then you would have hyper hyper androgenism, which refers to
the levels of hormones. They're gonna find your bloodstream a regular,
a regular ovulation and menstruation and exclusion of related disorders.
So if they can rule out, you know, the diabetes
or um just other problems with your menstrual cycle. So
(11:03):
that's that's one thing. But the Rotterdam people came in
and said, Okay, yeah, we're gonna go with that irregular
ovulation or no ovulation at all. We're gonna go with
the biochemical clinical signs of the hyperandrogenism. So the things
like the facial hair, the acne, the dark the dark
patches of skin, and we're gonna include the polycystic ovaries.
But you only have to have two of those three, right,
(11:25):
So the Rotterdam essentially Rotterdamn criteria essentially opened up the
criteria for peaks because they thought that the NIH definition
would just be a little too a little too narrow,
and so under Rotterdamn criteria, a lot more women have
peak hosts, but they might have more minor cases of
it because you don't have to meet as many of
(11:45):
the clinical criteria. But you know, there's also this problem
of polycystic overies is one of the elements of Rotterdamn criteria.
And if you're going to let's say an indo chronologists,
they may not do the ultrasound that finds that. So
it kind of gets thin into which doctor are you seeing.
You know, Kristen mentioned you have to see four doctors
(12:07):
and they may not all be within the same field
of gynecology or you know, if you have the acting,
you might have started with a dermatologist. Um, not all
of them are going to be equipped to find the
polycystic ovaries right away, and if they're not causing you pain. Uh,
And if you just start thinking that, oh, I have
a regular period because people say that's normal, you may
not have figured out that that's one of your symptoms yet.
(12:29):
So it's it really does come down to which doctor
you see and which criteria they're using, and whether they're
equipped to figure out something like polycystic overies with an
ultrasound or a with the exam. So let's say that
a woman is experiencing these types of symptoms and she
is diagnosed with picos um. Even though there isn't necessarily
(12:52):
a cure if you will for picos there are treatments
that have been proven to reduce these symptoms and a
lot of times a doctor and this is coming from
a really good overview article from the New York Times. UM,
a lot of times women will be tested for blood
levels of prolactin, for LH and F s H, progesterone, testosterone,
(13:14):
all of those different hormones, insulin, her ability to process blood,
glue close glucose excuse me, UM, all of those different
chemicals that are regulating these different types of symptoms. And
while treatments are going to be very just like the
types of symptoms that women are experiencing. So let's say
(13:34):
that you are a woman experiencing some are all of
these symptoms, You go to your doctor, your doctor diagnoses
you with pekos. What happens next, Um, there is a
pretty common treatment for it, which I was surprised UH
is birth control. A lot of times they will put
you on UH oral contraceptive in particular that contain quote
(13:59):
low and genic progestins like ortho tricycline or ortho cycling
excuse me, an ovulan, and these are gonna regulate your
menstrual cycle, suppress your follicle, stimulating hormone and lutinizing hormone release.
Which were those two hormones that we we mentioned right
at the beginning of the podcast that really seemed to
(14:20):
regulate all of these UH that chain reaction of negative
symptoms throughout your body. They're also going to lower the
testosterone level, which is going to help with symptoms like
your acne, excessive hair growth and all of that. And
then it's also going to raise level of protective cholesterol
and protect the uterine lining. And the uterine lining is
important because that's what builds up during your menstrual cycle
(14:43):
UH to receive a fertilized egg, and if the egg
doesn't drop down, then you shed it during menstruation. And
so oral contraceptives have been shown to be helpful. And
I should note that this information is coming from a
great overview article that we found from the New York Times, right,
And so let's really quick talk about for women who
(15:04):
are trying to get pregnant. Lee peaks is a really
big issue, and like Christen said, it protects that uterine
lining and makes it easier for a woman to get pregnant.
And um, so if a woman is trying to become pregnant,
they will have women take the pill and then try
to get pregnant immediately after she stops the pill, because
if if if it goes on too long, then those
(15:24):
hormone levels get back out of whack. And UH. They
also use the ovulation simulian drug Clomad when the woman
is trying to get pregnant, and it's uh it's sometimes
called the gold standard in terms of infertility because of
the way it does stimulate simulate the follical growth and
the ovulation. But I think it's important to note that
even though, but I think it's important to note that
(15:47):
even beyond the infertility problems, you can have problems with pregnancy.
If you've had peaks, you might have early pregnancy loss,
just gestational diabetes, pregnancy induced hype blood pressure, pre acclaim
and sees. So it's a huge problem for women who
are trying to have children. UM, So that's sort of
the side side road into fertility. But I also wanted
(16:09):
to say that because of all these problems with insulin
that are related to PEAK hosts, sometimes they might prescribe
you with insulin sensitizing medications or they might just you know,
put you on regular exercise and low carb diet. You know, obviously,
if you are risker diabeteses are things that a doctor
would put you on anyway. But you know, it seems
like when it was birth control plus this insulin thing.
(16:32):
It's very a symptomatic approach to this. There is no
sort of, as Kristen said, overall cure. You're going to
be sort of treating symptom by symptom because you know,
they don't really know what's causing this. They don't know
um what exactly they're trying to go after to stop
it from happening or to stop it from progressing. It's
very much like, Okay, now we're gonna deal with the
regular menstrual cycle cycles. Now we'll deal with the weight.
(16:55):
Now we'll deal with the act anything. But the good
news is in terms of peak hoast is, in recent
years it really has started to get a lot more
attention within the medical field. For instance, uh in two
thousand and six there was a huge medical seminar in
which a couple of doctors estimated that it affects one
(17:15):
in fifteen women worldwide, and they really called attention to
um this issue, not just in terms of it affecting
the health of women, especially like in westernized nations. I
think that when we think about, um, women's health care,
we can tend to have a very Western view of that. Okay,
I've got I'm having all these symptoms. I'm going to
go to my guy no and get on meds and
(17:37):
it's going to be totally kosher. That's not really the
case worldwide. UM. If you think about happening to one
in fifteen women, it's a major economic health burden as well, UM,
just because of the wide range of symptoms that it
can have, especially in places where this kind of medical
assistance is not going to be as available for these women.
(18:00):
So doctors have really tried to dig into finding the
root cause of pcos and there have been some studies
that Molly and I've found that are starting to get
a clearer understanding of where picos come from comes from,
its linked to obesity in particular, and genetics involved. Right,
(18:23):
Let's start with one study from two thousand nine. It
found that there was this gene that's implicated in obesity
that might be associated with susceptibility to polycystic overa syndrome
and carriers of one gene, the ft O gene. Uh,
It's not only influenced whether the person became obese, but
also whether they developed the other symptoms related to PICOS.
(18:44):
And one thing we should say is that it is
possible it's not as common for men to get PICOS
because if there is this genetic component, then uh, if
you know, if your mother or sister has it, then
you are at risk for also having this gene. So
they're trying to find out more about that. But in
two thousand ten there was another study that sort of
(19:05):
looked at how fat tissue was handled in someone who
had PICOS and it acts differently, so there's something there's
some gene. They're still trying to figure out what it
is that affects how your fat is stored, how it's
acting within the body, and how it could possibly then
trigger these problems with the pituitary gland and the hormones
related to reproduction. Researchers from the London Women's Clinic analyzed
(19:29):
six eighteen women who attended the clinic for fertility treatment
over two years okay, and they found that eighty percent
of the lesbian women who were involved in the study
had polycystic ovaries, compared to only thirty in heterosexual women.
(19:51):
Lesbian women also had higher rates of PICOS with thirty
eight percent having the syndrome compared to fourteen percent of
hetero sexual women. That suggests some kind of biological, hormonal
underlying link to sexuality, which could then possibly be linked
to genetics. So that was the study was significant just
(20:14):
because it linked for the first time so concretely that
hormonal makeup, that genetic makeup with sexual orientation. So for
those people who still argue that it's a choice that
these you know that everyone can be straight if they
want to, it's another brick in the wall that there's
a genetic reason for for sexual orientation, right, and perhaps
(20:35):
a higher incidents rated picos Not the most pleasant link
in the world, um, but a link all the same. Yeah,
and we felt like it was definitely worth highlighting. Now, finally,
we've been talking a lot about genes, but there is also,
as I mentioned a little bit earlier in the podcasts,
the idea that there could be an environmental influence to
(20:55):
picos and specifically, UM, this chemical that is containing a
lot of plastics, although it is being gradually phased out. UH,
this chemical bisphenol A or b p A. If you
don't want to give it the Grand the Grand pronouncement
that Kristen did and uh b p A amazingly. It
(21:15):
just it creates this really vicious cycle in women who
are susceptible to peak host because once you have peaks,
then you are more uh then uh b p A
has an easier time kind of steeping into your bloodstream
and causing reproductive damage. But then again, you're already having
reproductive problems. Your hormones are already out of whack, so
then b p A can kind of heighten that as well.
(21:38):
And so not only are you more susceptible to it,
you're going to have greater problems from It's just cycle
after cycle because BP has been b p A has
been shown to be an endocrine disruptor. So yeah, it's
just like throwing um, yes fuel chemical fuel on the fire.
It's true, that's my phrase today, I fuel on the fire.
(22:00):
So that is an overview of picos. Obviously, for the
women out there who are listening to this, who are
dealing with picos, it probably seems like an incredibly oversimplified
version of it because living with it day to day,
from what we've read, seems like quite a task. Um
and even getting it diagnosed in the first place can
(22:21):
behalf the battle, right, And like we said at the beginning,
I think that this podcast really encapsulates a lot of
things we've talked about. So if you've ever heard a
podcast about, you know, women's attachment to hair or why
women don't want facial hair, then just sort of magnify
it by you know, a million in terms of what
you'd be dealing with with this um condition. But I
(22:42):
would hope that what Chris and I always try and
do is just open up conversations and try and less
than stigma around some of these symptoms. So if you
are living with a lot of shame, depression, pain just
because you don't know how to approach a doctor about
any one of these problems issues within fertility, and there's
so many, so many factors associated with us, just try
(23:03):
and take the confidence to uh, just try and build
it up. It's hard to try and get medical help.
And when you have to see those four doctors in
a row, be persistent and know that you know you
know when something's wrong with your body and and you
need to fight for your diagnosis of that absolutely. So
in the meantime, if you would like to share your
(23:27):
story of Pico's story with Molly me our email addresses
mom stuff at house stuff works dot com, or share
it with all of our listeners on our Facebook page.
In the meantime, let's read a couple of those listener emails. Actually,
this one was a listener snail mail, and you can
find our snail mail address on the website how stuff
works dot com. And this is from Helena, who also
(23:50):
sent us brownies. They were delicious and muffins her but
you were the one who requested brownies in a recent
podcast Christen and Molly and I Love Baked Goods. She
took us up on it um and but she included
this email that was response to the podcast about men
and women cooking differently, and she writes, You're entirely right
in your observation that there's an underlying gendering of cooking.
(24:12):
This gendering, however evident in the public workplace, is equally
as evident in the domestic one. Let me use myself
as an example. For me, cooking is a creative process,
a stress reliever, and something I've loved since I was
a little kid. Growing up, I thought I would either
be one of two things, a writer or a cook.
But as I grew older, I realized quickly that working
in the service industry might would not offer me the
same satisfying experiences as cooking at home for family and
(24:35):
friends might. If I cooked for a profession, then I
would never really lose all passion for it, and I
never wanted to jeopardize my enthusiasm for being in the kitchen.
So she writes about how she made that decision to
you know, not not going to cooking professionally, send to
another field. But in two thousand nine, she writes, I
started a food cooking and recipe blog, and the address
(24:56):
of that is clearly delicious food blog dot com. And
Helena goes on to write, as an academic, I find
food blogging to be a wonderful source of creative writing
while also indulging in one of my favorite hobbies. And uh,
she writes about how food blogging is it a credible
community for women, which is pretty interesting and probably its
own podcast topic, and then she writes to summarize, perhaps
(25:18):
then the question is not do you men or women
cook differently? But where do you men or women cook?
And how is that different? And that very possibly the
answer to your two questions cooking at Homer as a
creative outlet allows many women to strengthen the divide between
work and home. For me and many other food bloggers,
we can have our cake and eat it too. Thank
you so much, Helena, and yeah again, many things for
(25:40):
those brownies and mohn. All right, well the closings out.
I've got an email here from Paul and this was
in relation to our podcast about pain of size. Uh,
he says, Uh. It reminded me of a saying a
girl I once knew who said men care about the
penis attached to the guy. Women care about the guy
attached to the penis. I don't know why, but I've
(26:01):
always remembered that he said. He mentioned women in their
weight several times towards the end of the podcast, so
I throught so I thought i'd throw this in. Speaking
as a guy, I can tell you that guys honestly
don't care about a girl's weight. In general, guys each
have their own types weight wise, and they generally don't
even bother dating women who aren't in the category. So
if a guys into a girl, he's into the girl
(26:23):
as she is. He doesn't care about weight at all,
And it's a totally non issue and my way, we
have gotten so many interesting responses about this penis episode
from our male listeners, and um, very few of you
guys believe that size doesn't matter. So Molly, we might
just have to have a follow up and let the
men speak in response to their anatomy that when I
(26:44):
don't share. Um, And they were the exact emails that
I was hoping to get, because I was really hoping
to uh to provoke some some thoughts and responses and
keep them coming men and women. Of course, our email
mom stuff at how stuff works dot com. Find us
on Facebook where it Stuff Monever told You, follow us
(27:05):
on Twitter. I can really just engage us in every
aspect of your life. That's what Molly and I want, uh,
And during the week read what we have to say
with words on a page. It's the Stuff Monever Told
You blog and it's at how stuff works dot com.
(27:29):
Want more how stuff works, check out our blogs on
the house stuff works dot com home page. Brought to
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