Posted on Tue, Jul. 27, 2004
Ed Suba Jr., Akron Beacon Journal
Kellie Watson and husband, Edgar, at home in Cuyahoga Falls: "My prime goal is to get healthy and if a baby comes along as a result, that's great."
At last, she knows
Symptoms of disorder are common among women, but few are diagnosed, and not anywhere near early enough
By Tracy Wheeler
Beacon Journal medical writer
If only she had known sooner, maybe Kellie Watson's life would be different now.
Maybe she would have been able to avoid diabetes, high cholesterol and high blood pressure. Maybe she would have been able to shed a few more pounds. Maybe she would have avoided the most difficult moment in her life -- a miscarriage in 1999 -- and maybe she'd be a mother by now.
Instead -- like millions of other women -- her life has been ruled by polycystic ovary syndrome (PCOS), unbeknownst to her for most of her adult life.
About one in three premenopausal women have symptoms of PCOS, but few are diagnosed. In Watson's case, the disorder went undiagnosed for nearly 20 years, even though she had been seeing doctors for several of the syndrome's tell-tale signs -- irregular menstrual cycles, insulin resistance, facial hair, dark patches of skin on the back of her neck and obesity.
It wasn't until she went for an ultrasound in her 13th week of pregnancy that she was diagnosed.
``When they did that ultrasound, they discovered that I'd miscarried,'' the 36-year-old Cuyahoga Falls woman said.''
They also discovered that her ovaries were about eight times their normal size, covered in cysts.
``So I'm dealing, first of all, with losing my baby and then dealing with this diagnosis, which answered a lot of questions from a lot of years, but also opened up a whole new can of worms.''
Unfortunately, Watson's path is a common one for women with polycystic ovary syndrome. They go years without being diagnosed, often not finding out until they have fertility problems and after years of building up risks for diabetes, cardiovascular disease and uterine cancer.
``Too often, when I see women who have it, they're already in their early 30s,'' said Dr. Jennifer Wojtowicz, an endocrinologist at the Cleveland Clinic's Women's Health Center. ``The problem is that a lot of times the symptoms are cosmetic -- facial hair, acne. And people are treated symptomatically and not looked at as a whole disorder.''
The key is earlier diagnosis, preferably during the teen years, which would help take care of both the cosmetic concerns, as well as the serious long-term health risks -- diabetes, uterine cancer and cardiovascular disease.
``I might see a 16- or 17-year-old girl who comes in because of a mustache and pimples and she wants to get rid of them for the prom,'' said Dr. Toni King of Endocrine Associates in Akron. ``That's my opportunity to help the underlying causes. I can help her cosmetically and make sure she's old before she gets her first heart attack.''
The causes of PCOS are a complex combination of insulin resistance, obesity and the presence of too many male hormones, like testosterone.
Insulin's job is to carry glucose (blood sugar) to the cells, where it's used as energy. But in someone with insulin resistance the cells don't respond, causing the body to overproduce insulin.
Too much insulin causes the ovaries to make too much testosterone, which in turn causes irregular menstrual cycles, facial hair, acne, ovarian cysts, male-pattern hair thinning and an excess of fat around the abdomen.
And the extra inches around the waistline aggravate insulin resistance, keeping the whole cycle rolling.
There's still no firm answer, though, whether obesity causes PCOS or whether PCOS causes obesity.
Watson believes the high insulin load she's been carrying has contributed to her weight problem, by making her body think it needs food for fuel when it doesn't. She's tried numerous diets, even a 600-calorie-a-day diet, with exercise, that barely skimmed off 10 pounds.
Linked
Though the U.S. Centers for Disease Control and Prevention lists PCOS as a possible reason for the country's obesity problem, not everyone is convinced.
``The only thing that causes obesity is eating too many calories,'' Watson said.
Either way, obesity and PCOS are linked.
``The fatter we are, the more likely we are to have PCOS,'' King said. ``The more muscle you have, the less insulin resistant you'll be. Even if you're overweight, if you're walking and lifting weights, you'll slow down the process.''
It's clear that losing weight -- if you can do it -- helps markedly. By losing weight, the body's sensitivity to insulin improves, so less insulin is produced. Less insulin means less testosterone. And less testosterone means improvement of some of the symptoms.
Wojtowicz said that an improved diet is part of the weight-loss equation, with a focus on low-fat proteins and complex carbohydrates, like whole grains.
Exercise, though, is the most important factor.
``It doesn't have to be anything fancy,'' she said. ``Just plain walking is enough -- a half hour a day, five days a week.''
Specialists in endocrinology, like King and Wojtowicz, quickly recognize the symptoms of PCOS. They may be less obvious to family doctors.
Just ask Watson. As a teen-ager, she saw a family doctor who knew something was wrong, but couldn't figure out what. Even after she was diagnosed with PCOS and then Type 2 diabetes, a doctor put her on insulin -- when her body was already overproducing insulin.
She's finally found a doctor who seems to be making a difference. She was prescribed Avandamet, a combination of the diabetes drug Avandia and metformin for insulin resistance. And she's walking two miles, though she admits not often enough.
She's not losing weight yet, but her clothes are fitting differently. And she ``kind of, sort of'' had a monthly cycle for the first time in recent memory.
``If I cycle on my own, that's a good sign,'' Watson said. ``That means, `Hey, I must have ovulated.' For someone who wants to have a baby, ovulation is key.''
She's not allowing herself to be optimistic yet, though.
``I keep thinking, `All I want is to have a baby. It shouldn't be this hard,' '' she said. ``I don't know if we'll ever succeed. At this point, my prime goal is to get healthy and if a baby comes along as a result, that's great.
``But I keep thinking, `When's it going to be my turn?' ''
It's an understandable sentiment, one that many women facing PCOS ask themselves. But the real goal of early diagnosis and treatment is prevention of diabetes, uterine cancer and heart disease -- in other words, a long, healthy life.
``When they have their babies in their 30s, we want to make sure they'll be around to raise them,'' King said.
http://www.ohio.com/mld/ohio/living/health/9251870.htm
Article: At Last, She Knows 
